A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study

Background and purpose: To evaluate (a) whether an active weight reduction strategy based on the cognitive-behavioral approach and an initial very-low-calorie diet might lead to short- and long-term weight loss and alleviation of OSAS; and (b) whether the results of this intervention could be enhanced by combining it with nasal continuous positive airway pressure (CPAP) treatment during the first 6 months. Patients and methods: Thirty-one obese male symptomatic sleep apnea patients underwent a 2-year weight reduction program with total follow-up of 36 months from baseline. The mean age (±SD) was 49.1±7.9 years, body mass index 43.8±5.4, and oxygen desaturation index (ODI 4) 51.3±31.1. The patients were randomized to CPAP (17 patients) and non-CPAP groups (14 patients). Results: The mean weight loss was 19.1±10.2 kg (14% of the original weight) for the whole group at 6 months, 18.3±13.2 (13%) at 12 months and 12.6±14.7 kg (9%) at 24 months. Excellent or good treatment results, as defined in terms of an ODI 4 (average number of oxygen desaturation events p/ h>4% from baseline) reduction of at least 50% from the baseline, were seen in 61% of patients at 6 months and were still observable in 42% of patients at 24 months. The correlations between changes in weight and in ODI 4 were 0.59 ( P