Scientific Studies on OSA & Weight Loss

[JQLewis]

I've read a lot of threads here about the relationship between weight loss and OSA. The consensus of opinion of the posters here seems to be that it's far from guaranteed that weight loss alone will eliminate OSA. Reduce, yes, and there are obviously other benefits to weight loss that recommend it, but it's apparently unlikely to be a cure.

Problem is, every doctor I've spoken to has indicated the exact opposite. They're all sure that you drop a few pounds and the OSA goes bye-bye. Either they know better and are just trying to get me to lose weight (unnecessary, I've already committed to losing the weight, OSA or no OSA) or they really don't know what's what. I have severe OSA (AHI of 88). Even if my weight loss shaves 30 points off that index, I've still got severe OSA. I need to get my PCP on my side regarding getting the proper treatment for my condition. So far the 3 sleep docs I've seen have all let me down. I'm seeing my PCP on Monday and I want to be able to show him research which clearly states that weight loss alone probably won't do it.

So far I've found this study which concludes:

Dietary weight loss programs are effective in reducing the severity of OSA but not adequate in relieving all respiratory events. Weight reduction programs should be considered as adjunct rather than curative therapy.

Kinda depressing, cause if weight loss isn't curative therapy then there isn't any curative therapy. If so, I could be on the tube for the rest of my life, and so far the tube aint working for me. I want to show my PCP as much research as possible to convince him that he's got to help me get the equipment most likely to make my x-pap therapy a success.

So does anyone know of any other studies which discusses weight loss and curing OSA? Thanks.

[sleepy1235]

My doctor told me that losing weight will not necessarily result in a reduction or end of your apnea. I lost 50 pounds weight and it had no impact. From 230 to 200.

Of course with some people it might have a significant impact. I am just saying that not all doctors agree that weight loss will eliminate apnea.

[palerider]

I lost 50 pounds weight and it had no impact. From 230 to 200.

that must be that new math I kept hearing about, 230-50=200...

[Albacore]

General practitioners know little to nothing about sleep apnea. If your PCP won't work for you to get the assistance you need, get a new PCP, or get them to refer you to a better sleep doctor. Your condition is at the high end of severe. My sleep study showed an AHI of 97. Our condition is life threatening. Again, if your doctor needs convincing, then they are incompetent, and need to be replaced!

[Janknitz]

As an obese woman (but now not so obese as I've lost 73 lbs), I can tell you that doctors for the most part have a bias against obesity. They believe that it is the root cause of most acquired illnesses, that it causes OSA, diabetes, PCOS, cardiovascular disease and more. They give out advice on eating less and moving more, and when that advice doesn't work (because they have virtually NO training in nutrition and metabolism and don't know how to advise patients about what does work) they blame their patients for being lazy and non-compliant. They never doubt their own advice.

Here's the reality:
Sleep Apnea, for one, may be the CAUSE of obesity. Sleep impairments cause disruption in the very hormones that regulate blood sugar, hunger, satiety, and metabolism. So telling one to lose weight to "cure" apnea is a little crazy. Until the apnea is treated, it's very difficult to lose weight, an uphill battle against the hormones. And how about those people who have apnea but who are NOT overweight???

Likewise, PCOS (polycystic ovary syndrome) which turns out to be a problem with insulin metabolism is thought to be the result of obesity. But, I had PCOS when I was an underweight 13 year old, my currently 13 year old daughter has severe PCOS and she's now in the 5th percentile for height and weight. Obesity came after, as a result of the severe hyperinsulinemia, not the other way around.

Not all people with diabetes or cardiovascular disease are overweight, either. How many runners have you heard about who just dropped dead one day?

So when a doctor tells you that apnea will be "cured" by weight loss, ask him to show you the studies. He can't because they don't exist. It's a product of his own personal bias, nothing more.

SOME people are "cured" or need significantly less pressure when they lose weight, but just as many are not. We've even seen people need MORE pressure when they lost weight.

It's never a bad idea to carefully change your diet and activity level to healthfully lose weight. But it's no guarantee you won't need CPAP.

[Woody]

Here is a little off the wall paper about child hood stuttering and sleep apnia. It seems in this
small study about 40% of the men rembered stutering as children where as in the general population
only about 5 % of children stutter as. Which lead them to the conclusion that there may be a
little underlying brain dysfunction predisposing us to sleap apnia not just the obesity.





http://articles.latimes.com/2002/nov/19 ... na-apnea19

[rosacer]

Hi JGLewis,

Sadly I don't have a study to give to you. But I can tell you my story. Two years ago I was morbidly obese (BMI=39.5, almost 100 lbs in excess).

When I told my sleep apnea specialist I was going to lose weight he told me he was going to give me a referral to get a new sleep test to find my new pressure (here you need to wait a good 6 months for the sleep test). He NEVER told me WOW you will be cured from sleep apnea.

Today my weight moves around 5 to 10 lbs from the normal BMI (I look slim though). The final result was my pressure reduced from 11cmH2O to 7 cmH2O (as per my cpap and my comfort at home).

I get the second sleep test last December, I passed all the night at 4cmH2O because as per the sleep test technician I didn't need to have the pressure increase although I woke up in the morning completely and terribly dizzy. I'm having today a sleep test at home using the Repironic's Alice sleep test machine.

Today I would say that loosing weight is not guarantee that you will be free from sleep apnea. Why? I have a theory, maybe your throat tissue get flaccid as the rest of your body once the fat is burned or maybe your airways are small and even if you never had gained weight you was going to have sleep apnea as a lot of slim persons have.

Change doctor, find one whom will be more comprehensive and will give you what you need.

All the best

Rosie

[SeekSleep]

I would be looking for a better doctor that is more educated in regards to sleep apnea. My sleep doctor went over my options quite well with me, to include the probabilities/best case scenario etc. and advised me that the machine was my only real option even though I had jaw structure problems, a deviated septum, and was overweight. He explained how they could affect my apnea, what the pluses and minuses of surgery to correct the correctable issues was, and he explained what I could expect as best case results. He seemed to be quite knowledgeable regarding most things that could result in obstructive apneas, although he chose not to even try and guess as to what caused my Central Apneas. He also seemed quite up front in advising me in regards to the issues involved with using the VPAP adapt.

While my Sleep doctor is great, I initially only dealt with and talked to my primary care doc for the initial sleep studies/titrations. It wasn't until I started having some issues and educated on the subject a little that I ended up cutting out the middle man and having appointments directly with the sleep doctor.

[Julie]

All the studies in the world won't guarantee that you personally will be 'lucky' even if you find some... only you can know (if and when such a time comes thåt you lose - and keep off forever (something that seems depressingly undo-able according to the latest news) however much weight does the trick for you, as tested by at least one new sleep study. I personally would spend my energy and time being the best c-papper I could and if the weight comes off, and if a new PSG says it 'worked', terrific, but if not, be at least glad that you do wake up each day and function as well as possible, not being a slave to the effects of untreated OSA.

[ChicagoGranny]

Here's the reality:
Sleep Apnea, for one, may be the CAUSE of obesity. Sleep impairments cause disruption in the very hormones that regulate blood sugar, hunger, satiety, and metabolism. So telling one to lose weight to "cure" apnea is a little crazy. Until the apnea is treated, it's very difficult to lose weight, an uphill battle against the hormones. And how about those people who have apnea but who are NOT overweight???

+1

[adolson]

My sleep doctor told me flat-out that it doesn't matter if I lose weight, I'll always have sleep apnea, and always have to use CPAP. I used to hope he was wrong, but I think he's right. My weight has fluctuated - went up really high, off the scale in fact, and then I dropped 100+lbs through better food choices, food tracking (2400-ish calories/day) and increased physical activity. I am now 30-40lbs lighter than when I originally got onto CPAP, and my pressure requirement hasn't changed since 7 years ago, according to my most recent sleep study. I had hoped for a difference, but I'm not using it as an excuse to give up on exercise and nutrition.

[JQLewis]

I'm not sure if I was clear in my original post. I'm not looking for studies to determine whether or not I should lose weight. I've lost 80 lbs. so far and I'm committed to getting to my target weight, OSA or not. My concern is that every doctor I see seems to know very little about OSA. I had undiagnosed OSA for twenty years, and I consulted with at least a dozen doctors. Not one of them ever suggested OSA as a possible cause of my insomnia. There seems to be a general lack of knowledge about this condition amongst the medical community. Now I have only seen my PCP twice, but I am due to see him again on Monday. If he thinks all it takes to "cure" OSA is weight loss he may be less concerned about making sure my therapy is successful. It's absurd that I find myself in the position of having to educate my doctor on a matter of medicine, but what choice do I have? Find a PCP with better knowledge of the condition? Easier said than done. My PCP is a really nice guy who went out of his way the last time I saw him to get me an earlier appointment with a dermatologist, which has resulted in a very effective treatment of my severe psoriasis (which doctors had always incorrectly assumed was the root cause of my insomnia). Now he's unlikely to be educated by my opinion alone, and unlikely to be impressed with what I tell him people on this forum have told me. Scientific studies may cause him to realize that he's wrong, and that making sure I have the right equipment can help me be amongst the 40% of people who make a successful adjustment to x-pap therapy, rather than the 60% who fail. This site stresses the importance of having a caring support team, and so far I have run into nothing but ignorance and extremely questionable motivations amongst the doctors I've consulted. Hopefully I can turn that around, starting with my PCP.

BTW, the study I cited in my original post is a meta-study, compiling the result of 9 different studies of OSA and weight loss. Hopefully that will, in his eyes, give it additional "weight".

[Pugsy]

Are you still fighting the battle to get a full data machine and hoping if your PCP can understand the value of data that he will help you get a full data machine?
Meaning if he can get past the "lose weight & cure apnea" mentality that he will help you get the machine you want?
Is this what you are trying to get here? Evidence to help you get the doc on board with a full data machine?

If so the argument that the data provided by a full data machine would help in the determination of whether or not losing weight impacted either the severity of the OSA ...pressure needs or even reduced things to the point a follow up PSG would be needed to be done to confirm that the OSA was gone. It would be a strong argument and not one that would/should need big major studies to convert him...I would think common sense would be enough but I know that a lot of docs seem to be on the short end of the stick when it comes to common sense.

I don't know of any studies that might help you because I have never bothered to look for any because I didn't have a need to. I am good with common sense.

[Julie]

Hi - I actually was saying that all the studies in the world won't 'give you permission' to quit Cpap if you lose weight, but didn't want to be so blunt. (we've had many on the forum come up with all kinds of tricks hoping they'll let them come off the hose, but the vast majority don't work.)

[JQLewis]

Are you still fighting the battle to get a full data machine and hoping if your PCP can understand the value of data that he will help you get a full data machine?
Meaning if he can get past the "lose weight & cure apnea" mentality that he will help you get the machine you want?
Is this what you are trying to get here? Evidence to help you get the doc on board with a full data machine?

Yup, exactly.

My main desire is that my PCP help me in getting a useful sleep doc. The insurance co. rep I've been in contact with has indicated that the chances of my getting anything approved, a new machine, a new sleep study, whatever, will be improved if a specialist is requesting it, rather than my PCP. My PCP set me up with the second sleep doc I saw, without even asking me. He just wanted me to see a doctor in his network. When that didn't work out I was told I'd need him to get me another referral, which was very difficult to get. He's a nice guy but his office is very difficult to get a hold of by phone (they use an external call center to handle their calls. I've never dealt with a doctor who does this and it doesn't work very well.). It took four calls and then he set me up with another doc without talking to me. I told the nurse who called me that I had expected a generic referral rather than a specific one, but she said no, we have to set up a specific appointment. I didn't want to waste time, and there's a limit to how many different docs I can see before they ask why I'm consulting every doctor in their directory, so I tried to do research before making an appointment with another sleep doc. I called every DME in their directory hoping one could tell me the name of a doc who prescribes autoset machines with data capability. No luck. I tried here. No luck.

So now I'm back to my PCP. I've got to find out who it was he referred me to the second time, and why he chose that doctor. I've got to ask why the first doctor he referred me to was so hostile and uncooperative. I've got to try and convince him that I'm likely to need x-pap therapy for the rest of my life, weight loss or no weight loss. I've got to get him to realize that 60% of those who try the "gold standard" for OSA therapy fail. I've got to get him to realize that, as a Resmed rep said to me, without a data capable machine it's impossible to triage why my therapy is so far not producing the results I'd hoped for. If it's my only option I'd like him to agree to try and script for the machine himself. It may not be the best option to get an approval from my insurance company, but it's better than nothing.

I've priced buying a machine on my own, and if it becomes my only hope I may go that way, but I really can't afford it, especially because I have no guarantee it will work. It's not just the machine itself, I need a humidifier, masks, tubing, filters. I'll need more sleep studies down the road. I really need to work within my insurance. The best chance I have to do that is to find a responsible, knowledgeable sleep specialist. The only suggestion the Resmed rep could make for finding one is to ask my PCP, so that's what I'm going to do on Monday.