Abstract：
OBJECTIVE: This study assessed whether the addition of continuous positive airway pressure (CPAP) during weight loss would enhance cardiometabolic health improvements in patients with obesity and Obstructive Sleep Apnoea (OSA).
RESULTS: Patients with overweight or obesity, pre-diabetes and moderatesevere OSA were randomised to receive CPAP therapy with a weight loss programme (CPAP+WL) or a weight loss programme alone (WL alone).
METHODS: 2-hour glucose assessed by an oral glucose tolerance test.
RESULTS: 24 hr blood pressure, body composition (DEXA) and fasting blood markers. 17 patients completed 3-month follow-up assessments (8 CPAP+WL and 9 WL alone). Overall, participants in both groups lost ∼12 kg which reduced polysomnography determined OSA severity by ∼45 %. In the CPAP+WL group, CPAP use (compliance 5.29 hrs/night) did not improve any outcome above WL alone. There was no improvement in 2-hour glucose in either group. However, in the pooled (n = 17) analysis there were overall improvements in most outcomes including insulin sensitivity (.000965 units, p = .008), sleep systolic BP (- 16.2 mmHg, p = .0003), sleep diastolic BP (-9.8 mmHg, p = 0.02), wake diastolic BP (- 4.3 mmHg, p = .03) and sleepiness (Epworth Sleepiness Score -3.2, p = .0003). In addition, there were reductions in glucose area under the curve (-230 units, p = .009), total (-0.86 mmol/L, p = 0.006) and LDL cholesterol (-0.58 mmol/L, p = 0.007), triglycerides (-0.75 mmol/L, p = 0.004), fat mass (-7.6 kg, p < .0001) and abdominal fat (-310 cm3, p < .0001).
CONCLUSIONS: Weight loss reduced OSA and improved sleepiness and cardiometabolic health. These improvements were not further enhanced by using CPAP. Results suggest weight loss should be the primary focus of treatment for patients with OSA and obesity.
RESULTS: Patients with overweight or obesity, pre-diabetes and moderatesevere OSA were randomised to receive CPAP therapy with a weight loss programme (CPAP+WL) or a weight loss programme alone (WL alone).
METHODS: 2-hour glucose assessed by an oral glucose tolerance test.
RESULTS: 24 hr blood pressure, body composition (DEXA) and fasting blood markers. 17 patients completed 3-month follow-up assessments (8 CPAP+WL and 9 WL alone). Overall, participants in both groups lost ∼12 kg which reduced polysomnography determined OSA severity by ∼45 %. In the CPAP+WL group, CPAP use (compliance 5.29 hrs/night) did not improve any outcome above WL alone. There was no improvement in 2-hour glucose in either group. However, in the pooled (n = 17) analysis there were overall improvements in most outcomes including insulin sensitivity (.000965 units, p = .008), sleep systolic BP (- 16.2 mmHg, p = .0003), sleep diastolic BP (-9.8 mmHg, p = 0.02), wake diastolic BP (- 4.3 mmHg, p = .03) and sleepiness (Epworth Sleepiness Score -3.2, p = .0003). In addition, there were reductions in glucose area under the curve (-230 units, p = .009), total (-0.86 mmol/L, p = 0.006) and LDL cholesterol (-0.58 mmol/L, p = 0.007), triglycerides (-0.75 mmol/L, p = 0.004), fat mass (-7.6 kg, p < .0001) and abdominal fat (-310 cm3, p < .0001).
CONCLUSIONS: Weight loss reduced OSA and improved sleepiness and cardiometabolic health. These improvements were not further enhanced by using CPAP. Results suggest weight loss should be the primary focus of treatment for patients with OSA and obesity.
摘要：
目的：本研究评估了在减肥过程中增加持续气道正压通气（CPAP）是否会增强肥胖和阻塞性睡眠呼吸暂停（OSA）患者的心脏代谢健康改善。
结果：超重或肥胖患者，糖尿病前期和中度OSA被随机分为两组,分别接受CPAP治疗和减肥方案(CPAP+WL)或单纯减肥方案(单纯WL).
方法：通过口服葡萄糖耐量试验评估2小时葡萄糖。
结果：24小时血压，身体成分（DEXA）和空腹血液标志物。17例患者完成了3个月的随访评估（8例CPAP+WL和9例WL）。总的来说,两组参与者减重~12公斤，多导睡眠图确定OSA严重程度降低~45%。在CPAP+WL组中，使用CPAP（依从性5.29小时/夜）并不能改善单独WL以上的任何结果。两组中的2小时葡萄糖均无改善。然而,在汇总(n=17)分析中,大多数结局总体改善,包括胰岛素敏感性(.000965单位,p=.008)，睡眠收缩压血压（-16.2mmHg，p=.0003),睡眠舒张压血压（-9.8mmHg，p=0.02),觉醒舒张压血压（-4.3mmHg，p=.03）和嗜睡（Epworth嗜睡评分-3.2，p=.0003）。此外,曲线下的葡萄糖面积减少（-230单位，p=.009)，总计（-0.86mmol/L，p=0.006）和LDL胆固醇（-0.58mmol/L，p=0.007),甘油三酯（-0.75mmol/L，p=0.004),脂肪质量（-7.6千克，p<.0001）和腹部脂肪（-310cm3，p<.0001）。
结论：减肥减少了OSA，改善了嗜睡和心脏代谢健康。使用CPAP并未进一步增强这些改进。结果表明，体重减轻应该是OSA和肥胖患者的主要治疗重点。
结果：超重或肥胖患者，糖尿病前期和中度OSA被随机分为两组,分别接受CPAP治疗和减肥方案(CPAP+WL)或单纯减肥方案(单纯WL).
方法：通过口服葡萄糖耐量试验评估2小时葡萄糖。
结果：24小时血压，身体成分（DEXA）和空腹血液标志物。17例患者完成了3个月的随访评估（8例CPAP+WL和9例WL）。总的来说,两组参与者减重~12公斤，多导睡眠图确定OSA严重程度降低~45%。在CPAP+WL组中，使用CPAP（依从性5.29小时/夜）并不能改善单独WL以上的任何结果。两组中的2小时葡萄糖均无改善。然而,在汇总(n=17)分析中,大多数结局总体改善,包括胰岛素敏感性(.000965单位,p=.008)，睡眠收缩压血压（-16.2mmHg，p=.0003),睡眠舒张压血压（-9.8mmHg，p=0.02),觉醒舒张压血压（-4.3mmHg，p=.03）和嗜睡（Epworth嗜睡评分-3.2，p=.0003）。此外,曲线下的葡萄糖面积减少（-230单位，p=.009)，总计（-0.86mmol/L，p=0.006）和LDL胆固醇（-0.58mmol/L，p=0.007),甘油三酯（-0.75mmol/L，p=0.004),脂肪质量（-7.6千克，p<.0001）和腹部脂肪（-310cm3，p<.0001）。
结论：减肥减少了OSA，改善了嗜睡和心脏代谢健康。使用CPAP并未进一步增强这些改进。结果表明，体重减轻应该是OSA和肥胖患者的主要治疗重点。
