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- Sleep Study Details – Sleep Apnea
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Our findings are therefore consistent with those of Redenius et al. In a randomized controlled trial of sibutramine in comparison to CPAP for weight loss, CPAP treatment for one year in 18 patients was not associated with a change in weight. In a much larger, although non-blinded randomized study, CPAP treatment for a median of four years failed to result in weight loss. However, there was no significant weight change for the group overall. We observed that aside from adherence to treatment assignment, no other factors modified the association between CPAP or sham CPAP and change in weight.
In contrast, Redenius et al. Thus, participant characteristics may account for this different observation. In our study, participants treated with CPAP not only failed to lose weight, but actually appeared to gain a small amount of weight.
Moreover, we found that those who were adherent to CPAP gained weight over six months of therapy in contrast to no significant weight increase observed in the sham or non-adherent CPAP participants. Furthermore, there was a dose response relationship between hours of adherence and amount of weight gained.
These findings are consistent with Redenius et al. Thus, our findings and those of previous studies suggest that CPAP is inducing a state of positive energy balance resulting in weight gain. There are several mechanisms related to energy expenditure EE that could explain why persons treated with CPAP gain weight. Weight gain occurs when energy intake EI exceeds EE.
Although patients with OSA often indicate that sleepiness and lack of energy are barriers to increased physical activity, a recent study observed that intervention with CPAP for three months improved sleepiness but did not alter activity levels. This results in an energy balance that favors weight gain. Fluid retention related to elevations in intrathoracic pressure from CPAP could explain some of the weight gain.
In both clinical and experimental studies, positive airway pressure results in fluid retention related to a reduction in venous return and decreased secretion of antidiuretic hormone and atrial natriuretic peptide.
Our study is not without limitations. First, overall adherence to both treatment arms was suboptimal.
How Can You Be Sure It’s Sleep Apnea, And Not Just Harmless Snoring?
However, the levels of adherence in this study are similar to those in other long-term randomized controlled trials. Second, in comparison to the CPAP group, more participants in the Sham group failed to complete the study.
Differential dropout of Sham participants who were more likely to gain weight might explain the difference between the two groups, although there is no evidence that this occurred. Third, because the primary focus of this study was on neurocognitive outcomes, we did not collect data such as direct energy expenditure measurements, which might validate proposed mechanisms underlying the increase in weight observed in CPAP participants. Lastly, most of our participants were recruited from the community and not a sleep clinic. Thus, our findings may not be representative of the patient population seen in a clinical setting.
Despite these limitations, our study had a number of strengths, including the large number of participants, a long 6-month follow-up period, use of sham CPAP as a control, and objective documentation of adherence to therapy. Thus, if overweight, OSA patients should be encouraged to lose weight by other modalities and not rely on any direct physiologic effect of CPAP.
This was not an industry supported study.
Sleep Study Details – Sleep Apnea
The other authors have indicated no financial conflicts of interest. Sylvan Green who died before the results of this trial were analyzed, but was instrumental in its design and conduct. Administrative Core: Clete A. Nichols, MS; Eileen B.
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Hyde, MA; Tyson H. Holmes, PhD; Daniel A. Bloch, PhD; William C. Dement, MD, PhD. Data Coordinating Center: Daniel A. Bloch, PhD; Tyson H. Holmes, PhD; Deborah A. Clinical Coordinating Center: Clete A. Hyde, MA, Rhonda M. University of Arizona: Stuart F. Quan, MD; James L.
Mary Medical Center: Richard D. Simon Jr. Luke's Hospital: James K. Walsh, PhD, Paula K. Brigham and Women's Hospital: Daniel J. The authors also acknowledge Sleep HealthCenters for the use of their clinical facilities to conduct this research. Methodology Team : Daniel A. Holmes, PhD, Maurice M. Walsh, PhD. Quality of Life Assessment Team : W.
Michael J. Twery, PhD, Gail G. Weinmann, MD, Colin O.
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