A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study

Background and purpose: To evaluate (a) whether an active weight reduction strategy based on the cognitive-behavioral approach and an initial very-low-calorie diet might lead to short- and long-term weight loss and alleviation of OSAS; and (b) whether the results of this intervention could be enhanced by combining it with nasal continuous positive airway pressure (CPAP) treatment during the first 6 months. Patients and methods: Thirty-one obese male symptomatic sleep apnea patients underwent a 2-year weight reduction program with total follow-up of 36 months from baseline. The mean age (+/- SD) was 49.1 +/- 7.9 years, body mass index 43.8 +/- 5.4, and oxygen desaturation index (ODI4) 51.3 +/- 31.1. The patients were randomized to CPAP (17 patients) and non-CPAP groups (14 patients). Results: The mean weight loss was 19.1 +/- 10.2 kg (14% of the original weight) for the whole group at 6 months, 18.3 +/- 13.2 (13%) at 12 months and 12.6 +/- 14.7 kg (9%) at 24 months. Excellent or good treatment results, as defined in terms of an ODI4 (average number of oxygen desaturation events p/h > 4% from baseline) reduction of at least 50% from the baseline, were seen in 61% of patients at 6 months and were still observable in 42% of patients at 24 months. The correlations between changes in weight and in ODI4 were 0.59 (P < 0.01) at 6 months, 0.68 (P < 0.01) and 0.75 (P < 0.01) at 24 months. Adding CPAP treatment to the weight reduction therapy for the first 6 months did not result in greater weight loss or diminution of desaturation indices (without CPAP) at any time point. One year after the termination of the program the mean weight loss was 6.6 +/- 12.9 kg, and 42% of patients still showed at least 5% weight loss as compared with their original weight. Conclusion: Satisfactory weight loss associated with improvement of OSAS could be achieved by means of a cognitive-behavioral weight loss program. Adding CPAP in the initial phase of the weight reduction program did not result in significantly greater weight loss. (C) 2003 Elsevier B.V. All rights reserved.