Effects on obstructive sleep apnea severity following a tailored behavioral sleep medicine intervention aimed at increased physical activity and sound eating: an 18-month follow-up of a randomized controlled trial

Abstract

Study objectives: Positive effects have been reported following a behavioral sleep medicine (BSM) intervention targeting physical activity and eating behavior in addition to continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA). Long-term follow-up remains to be explored. The aim was to examine the long-term effects of a tailored BSM intervention addressing physical activity and eating behavior in addition to CPAP treatment in patients with moderate to severe OSA combined with overweight and physical inactivity. Further, the aim was to identify variables at baseline, associated with treatment success regarding OSA severity.

Methods: Sixty participants (body mass index: 34.5 ± 5.0 kg/m²; apnea-hypopnea index [AHI]: 43.7 ± 21.2 events/h) completed the randomized controlled trial with a follow-up at 18 months. The participants were randomized to either a control group treated with CPAP or an experimental group treated with CPAP and a BSM intervention targeting physical activity and eating behavior changes. OSA was categorized as mild (AHI: 5 to <14.9 events/h), moderate (AHI: 15 to <29.9 events/h), or severe (AHI ≥30 events/h).

Results: Being in the experimental group was associated with a larger improvement (B = -9.353, P = .029) in AHI at the 18-month follow-up compared with being in the control group when adjusting for baseline AHI and body mass index. Improvement in OSA category occurred more frequently in the experimental group participants (n = 11; 36.7%) compared with the control group (n = 2; 6.7%). Deterioration in OSA category was found in 1 (3.3%) participant in the experimental group and 3 (10%) in the control group.

Conclusions: The importance of a BSM intervention as an adjunct treatment in patients with OSA is emphasized due to its long-term benefits.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Lifestyle changes in obstructive sleep apnea; Identifier: NCT01102920.

Keywords: behavioural sleep medicine; eating habits; obstructive sleep apnea; physical activity.

Conflict of interest statement

All authors have seen and approved this manuscript. This study was supported by grants from the Swedish Research Council, The Swedish Heart and Lung Association, Uppsala County Council, and Swedish Sleep Research Society. The authors report no conflicts of interest.

© 2020 American Academy of Sleep Medicine.

Figures

Figure 1. Flow chart of study participation from recruitment to follow-up at 18 months.

Figure 2. AHI at baseline and the 6-month and 18-month follow-ups for the intervention and the control group.

AHI = apnea-hypopnea index.