Treatments for Obstructive Sleep Apnea

When OSA Patients Do Not Adhere to CPAP Treatment

With adherence rates as low as 50% [16–18], those who fail to tolerate CPAP are unlikely to be referred for additional treatment [30]. Those who do tolerate treatment dislike the side effects of CPAP and show an interest in other treatment options [14]. Other treatment options have been shown to decrease the severity of OSA.

Weight Loss and Exercise

OSA prevalence is correlated with body mass index (BMI), and the increasing rates of OSA has been attributed to the increasing rates of obesity in the United States [2]. A meta-analysis of 3 randomized controlled studies of weight loss induced by dieting or lifestyle change showed that weight loss decreased OSA severity. The effect was the greatest for OSA patients who lost more than 10 kg or had severe OSA at baseline [31]. A recent randomized controlled study involving OSA patients with type 2 diabetes investigated if either a weight loss intervention or a diabetes support and education intervention would be able to decrease OSA severity [32]. The weight loss intervention significantly decreased OSA severity, which was largely but not entirely attributed to weight loss. The participants regained 50% of their weight 4 years after the intervention and still had significantly less severe OSA compared to control intervention group. The downside to this intervention is the intensity of the regimen to which the subjects had to adapt: portion-controlled diets with liquid meals and snack bars for the first 4 months and moderate-intensity physical activity for a minimum of 3 hours a week for the first year. After that, patients were still required to follow through with the intervention for 3 years, which included one on-site visit per month and a second contact by phone, mail, or email [32]. One study looked at weight loss and sleep position (supine vs. lateral). The study showed a decrease in AHI in OSA patients that lost weight, and the biggest decrease was in AHI in the lateral sleeping position [33]. Another study looked at the more invasive procedure of bariatric surgery to decrease weight and OSA. At the 1-year follow-up, patients had significantly decreased their BMI and AHI [34]. Two more randomized controlled studies investigated if exercise or fitness level might be beneficial to OSA patients independent of weight loss. Exercise improved AHI even though there was not a significant decrease in weight between the exercise and stretching control group [35]. However, an increase in fitness level did not have any additive effect on the decrease of AHI when weight change was taken into account [36]. The difference in results might be attributed to the latter study using older type 2 diabetic patients and moderate physical activity, while the former studied incorporated moderate-intensity aerobic activity and resistance training for younger patients [35,36]. There is evidence that a sedentary lifestyle increases diurnal leg fluid volume that can shift to the neck during sleep and might play a role in pathogenesis of OSA [37]. Decreasing a sedentary lifestyle by exercising might therefore be beneficial to OSA patients. Given the increasing rates of obesity [2], implementing weight loss as a solution to OSA is viable, especially considering that OSA is not the only comorbid disease of obesity [38].