Effects of a lifestyle intervention on REM sleep‐related OSA severity in obese individuals with type 2 diabetes. (31st May 2017)

• Record Type: Journal Article
• Authors: Shechter, Ari; Foster, Gary D.; Lang, Wei; Reboussin, David M.; St‐Onge, Marie‐Pierre; Zammit, Gary; Newman, Anne B.; Millman, Richard P.; Wadden, Thomas A.; Jakicic, John M.; Strotmeyer, Elsa S.; Wing, Rena R.; Pi‐Sunyer, F. Xavier; Kuna, Samuel T.
• Is Part Of: Journal of sleep research. Volume 26:Number 6(2017)
• Page Start: 747
• Page End: 755
• Publication Date: 2017-05-31
• Subjects: HbA1c -- obesity -- obstructive sleep apnea -- REM sleep -- type 2 diabetes; Sleep -- Periodicals; Sleep disorders -- Periodicals; 612.821
• DOI: 10.1111/jsr.12559
• Languages: English
• ISSNs: 0962-1105

Abstract

Summary: The aim of this study was to determine if an intensive lifestyle intervention (ILI) reduces the severity of obstructive sleep apnea (OSA) in rapid‐eye movement (REM) sleep, and to determine if longitudinal changes in glycaemic control are related to changes in OSA severity during REM sleep over a 4‐year follow‐up. This was a randomized controlled trial including 264 overweight/obese adults with type 2 diabetes (T2D) and OSA. Participants were randomized to an ILI targeted to weight loss or a diabetes support and education (DSE) control group. Measures included anthropometry, apnea–hypopnea index (AHI) during REM sleep (REM‐AHI) and non‐REM sleep (NREM‐AHI) and glycated haemoglobin (HbA1c) at baseline and year 1, year 2 and year 4 follow‐ups. Mean baseline values of REM‐AHI were significantly higher than NREM‐AHI in both groups. Both REM‐AHI and NREM‐AHI were reduced significantly more in ILI versus DSE, but these differences were attenuated slightly after adjustment for weight changes. Repeated‐measure mixed‐model analyses including data to year 4 demonstrated that changes in HbA1c were related significantly to changes in weight, but not to changes in REM‐AHI and NREM‐AHI. Compared to control, the ILI reduced REM‐AHI and NREM‐AHI during the 4‐year follow‐up. Weight, as opposed to REM‐AHI and NREM‐AHI, was related to changes in HbA1c. The findings imply that weight loss from a lifestyle intervention is more important than reductions in AHI for improving glycaemic control in T2D patients with OSA.