Effect of a Weight Loss and Lifestyle Intervention on Dietary Behavior in Men with Obstructive Sleep Apnea: The INTERAPNEA Trial

Almudena Carneiro-Barrera, Francisco J Amaro-Gahete, Lucas Jurado-Fasoli, Germán Sáez-Roca, Carlos Martín-Carrasco, Francisco J Tinahones, Jonatan R Ruiz, Almudena Carneiro-Barrera, Francisco J Amaro-Gahete, Lucas Jurado-Fasoli, Germán Sáez-Roca, Carlos Martín-Carrasco, Francisco J Tinahones, Jonatan R Ruiz

Abstract

This study investigated the effects of an eight-week interdisciplinary weight loss and lifestyle intervention on dietary behavior in men who were overweight/had obesity and moderate-to-severe obstructive sleep apnea (OSA). It was based on data from INTERAPNEA (ClinicalTrials.gov ID: NCT03851653); a randomized clinical trial conducted from April 2019 to April 2020. Men aged 18-65 years with moderate-to-severe OSA and a body mass index ≥25 kg/m2 were randomly assigned to a usual-care group or an eight-week interdisciplinary weight loss and lifestyle intervention combined with usual-care. Dietary behavior was assessed through the Food Behavior Checklist (FBC) and the Mediterranean Diet Adherence Screener (MEDAS). Of the 89 participants who underwent randomization, 75 completed the intervention endpoint assessment, 89 participants being therefore included in the intention-to-treat analyses, and 75 in the per-protocol approach. As compared with usual-care, the intervention group had greater improvements at intervention endpoint in dietary behavior, as measured by the FBC total score (20% increase in FBC total score, mean between-group difference, 8.7; 95% confidence interval, 5.7 to 11.7), and MEDAS total score (33% increase in MEDAS total score, mean between-group difference, 2.1; 95% CI 1.3 to 2.9). At 6 months after intervention, the intervention group also had greater improvements in both the FBC total score (15% increase) and MEDAS total score (25% increase), with mean between-group differences of 7.7 (CI 95%, 4.4 to 10.9) and 1.7 (CI 95%, 0.9 to 2.6), respectively. An eight-week interdisciplinary weight loss and lifestyle intervention resulted in meaningful and sustainable improvements in dietary behavior, including adherence to the Mediterranean diet in men who were overweight/ had obesity and CPAP-treated moderate-to-severe OSA.

Keywords: Mediterranean diet; dietary behavior; lifestyle intervention; obesity; obstructive sleep apnea; weight loss.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow-chart diagram of the INTERAPNEA randomized clinical trial.
Figure 2
Figure 2
Dietary behavior outcomes. The ends of the boxes in the boxplots are located at the first and third quartiles, with the black line in the middle illustrating the median. Whiskers extend to the upper and lower adjacent values, the location of the furthest point within a distance of 1.5 interquartile ranges from the first and third quartiles. The parallel line plot contains 1 vertical line for each patient, which extends from their baseline value to their 8-week value (A,B) or 6-month value (C,D). Ascending lines indicate an improvement in the outcome. Baseline values are placed in ascending order for the control group and descending order for the intervention group. (A,C), The Food Behavior Checklist assesses dietary behavior (range, 23–85; higher scores indicate healthier dietary behavior) [45]. (B,D), The Mediterranean Diet Adherence Screener assesses adherence to the Mediterranean diet (range, 0–14; higher scores indicate greater adherence; scores ≥ 10 indicate high adherence to the Mediterranean diet) [46].
Figure 3
Figure 3
Association of changes in dietary behavior over time with changes in sleep outcomes. Each dot represents one of three separate observations (baseline, 8 weeks and 6 months after intervention) of dietary behavior—as measured by the Food Behavior Checklist (A–C) and Mediterranean Diet Adherence Screener (D–F)—and sleep outcomes for a participant. Observations from the same participant are given the same color, with corresponding lines to show the repeated measures correlation fit for each participant. (A–C) The Food Behavior Checklist assesses dietary behavior (range, 23–85; higher scores indicate healthier dietary behavior) [45]. (D–F) The Mediterranean Diet Adherence Screener assesses adherence to the Mediterranean diet (range, 0–14; higher scores indicate greater adherence; scores ≥ 10 indicate high adherence to the Mediterranean diet) [46].
Figure 4
Figure 4
Association of changes in dietary behavior over time with changes in body weight and composition outcomes. Each dot represents one of three separate observations (baseline, 8 weeks and 6 months after intervention) of dietary behavior—as measured by the Food Behavior Checklist (A–C) and Mediterranean Diet Adherence Screener (D–F)—and body weight and composition outcomes for a participant. Observations from the same participant are given the same color, with corresponding lines to show the repeated measures correlation fit for each participant. (A–C) The Food Behavior Checklist assesses dietary behavior (range, 23–85; higher scores indicate healthier dietary behavior) [45]. (D–F) The Mediterranean Diet Adherence Screener assesses adherence to the Mediterranean diet (range, 0–14; higher scores indicate greater adherence; scores ≥ 10 indicate high adherence to the Mediterranean diet) [46].
Figure 5
Figure 5
Association of changes in dietary behavior over time with changes in body circumferences outcomes Each dot represents one of three separate observations (baseline, 8 weeks and 6 months after intervention) of dietary behavior—as measured by the Food Behavior Checklist (A–C) and Mediterranean Diet Adherence Screener (D–F)—and body circumferences outcomes for a participant. Observations from the same participant are given the same color, with corresponding lines to show the repeated measures correlation fit for each participant. (A–C) The Food Behavior Checklist assesses dietary behavior (range, 23–85; higher scores indicate healthier dietary behavior) [45]. (D–F) The Mediterranean Diet Adherence Screener assesses adherence to the Mediterranean diet (range, 0–14; higher scores indicate greater adherence; scores ≥ 10 indicate high adherence to the Mediterranean diet) [46].

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