34 overweight Spanish dudes from a JAMA study

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GrumpyHere
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34 overweight Spanish dudes from a JAMA study

Post by GrumpyHere » Wed Dec 07, 2022 1:50 am

For some people, healthier lifestyle choices can led to lowered treated AHI.

https://jamanetwork.com/journals/jamane ... le/2791455
Findings In this randomized clinical trial involving 89 Spanish men with moderate to severe OSA who had overweight or obesity and were receiving CPAP therapy, an 8-week interdisciplinary weight loss and lifestyle intervention significantly improved OSA severity and other outcomes compared with usual care alone.
the intervention was conducted for 8 weeks and comprised 5 components or modules: nutritional behavior change, moderate aerobic exercise, smoking cessation, alcohol intake avoidance, and sleep hygiene. Each component included group-based weekly sessions of 60 to 90 minutes that were led and supervised by trained professionals (A.C.-B., F.J.A.-G., and L.J.-F.) in each field. Participants in the intervention group also continued to receive usual care with CPAP therapy. A detailed intervention description, including assessment of intervention adherence and integrity, has previously been published and is also provided in eMethods 3 and eMethods 4 in Supplement 2.
A main limitation is the sole inclusion of men in the study sample; the generalization of our findings is therefore limited to this population. The sample also included only Spanish participants; thus, our results are restricted to this ethnic population. Although this study included a 6-month follow-up assessment, the study’s duration may not have been sufficient to determine long-term intervention effects and maintenance of benefits. Due to ethical considerations, we did not include any group for whom no therapy was provided; CPAP therapy is the standard of care for moderate to severe OSA, and the inclusion of a group not receiving CPAP therapy may not be feasible.
The claim that 10 of 34 participants at 6 months follow-up had complete OSA remission is wild.
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Julie
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Re: 34 overweight Spanish dudes from a JAMA study

Post by Julie » Wed Dec 07, 2022 6:12 am

And so is the fact that no controls were included - for some reason making that sound like a good thing.

Weird.

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lazarus
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Re: 34 overweight Spanish dudes from a JAMA study

Post by lazarus » Wed Dec 07, 2022 9:07 am

ALL humans benefit from dietary, activity, and lifestyle improvements, whether overweight or diagnosed with OSA or neither.

Much of the documented benefit in that study may relate to the cessation of all smoking and all alcohol intake and related individualized attention in the intervention group.

The "complete remission" category included those still in the so-called "mild OSA" category of AHI as tested. There is no proof that those participants would gain zero benefits from continuing PAP now and especially in their future.

Small. Dishonest definitions, IMO. Weighted to find what they were looking for. No one anywhere believes that good diet, good activity, and good medical attention is damaging to anyone with any medical condition. So the cynical side of me, despite respecting the intentions, fails to see any seeming ground-breaking data in the study as framed.

Hey, just me.

[edited to correct one of the typos]
Last edited by lazarus on Wed Dec 07, 2022 9:16 am, edited 1 time in total.
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Jlfinkels
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Re: 34 overweight Spanish dudes from a JAMA study

Post by Jlfinkels » Wed Dec 07, 2022 9:10 am

Sure that wasn’t printed in MAD Magazine?

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Re: 34 overweight Spanish dudes from a JAMA study

Post by chunkyfrog » Wed Dec 07, 2022 12:16 pm

A study can not be scientific if its parameters are set to ensure
a predetermined outcome.
Too many articles are paid by the word--accuracy is not an issue.

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Re: 34 overweight Spanish dudes from a JAMA study

Post by robysue1 » Wed Dec 07, 2022 3:03 pm

This study confirms what we already know: A healthier lifestyle, getting some moderate aerobic exercise, quitting smoking, avoiding (excess) alcohol intake, and shedding the excess weight and keeping it off typically makes anybody healthier. And given that these folks were still using their CPAPs, it's not a big surprise that their results were better with a lot of positive reinforcement that most folks never get:
the intervention was conducted for 8 weeks and comprised 5 components or modules: nutritional behavior change, moderate aerobic exercise, smoking cessation, alcohol intake avoidance, and sleep hygiene. Each component included group-based weekly sessions of 60 to 90 minutes that were led and supervised by trained professionals (A.C.-B., F.J.A.-G., and L.J.-F.) in each field.
If all new xPAPers got this kind of support, my guess is that far fewer folks would just abandon xPAP when they hit the inevitable difficulties during the early days. And folks would most likely see clear benefits much earlier than the several weeks to a few months that most of us take to start feeling better.

It's also good that they did a follow-up at six months. But the real question is not what's happening after six months; it's what's happening after six years. In other words, will the subjects continue with their newer, healthier lifestyle? Or will they slowly start reverting to old habits and a less healthy lifestyle? And what happens in terms of their OSA if they do start reverting to their old lifestyle habits? That's a particularly important question for the ones who were told they no longer had OSA and thus presumably were told they could just stop xPAP therapy: Should they revert back to their old habits, their apnea is likely to return, but they may be more resistant to the idea that the apnea has returned if they were declared "cured" several years earlier.
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Re: 34 overweight Spanish dudes from a JAMA study

Post by lynninnj » Thu Dec 08, 2022 10:47 am

sad that a respectable publication like jama allows “peers” to review and approve shoddy work luke this for publication.

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Re: 34 overweight Spanish dudes from a JAMA study

Post by lazarus » Thu Dec 08, 2022 11:13 am

I give them extra credit for making sleep and CPAP a focus of the research. So I probably would have signed off on publication. It's worth other researchers seeing what they did and how they did it. By "dishonest definitions," I meant misleading in others' interpreting the conclusions, not bad motives.

No study is perfect, and they did a lot right, and you gotta do what you can to move the dialogue along. But framing it as if you can scientifically imply that OSA can easily be cured with diet and exercise alone does a disservice to patients whose docs need to get them on PAP right away without wasting time repeating general instructions and then providing none of the things provided in that study.

Good intentions and good subjects for study, but with the potential for bad application in practice when overall conclusions get misapplied because of a lack of clarity.
The people who confuse "entomology" and "etymology" really bug me beyond words.
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