Skip to main content
Log in

The impact of diet and lifestyle management strategies for obstructive sleep apnoea in adults: a systematic review and meta-analysis of randomised controlled trials

  • Review
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

To systematically evaluate the impact of diet, exercise and lifestyle modification programmes on indices of obesity, Obstructive Sleep Apnoea (OSA) parameters and quality of life (QoL) in adults with OSA.

Methods

Electronic databases were searched to identify randomised controlled trials published in English with an intervention based on dietary weight loss, exercise and/or lifestyle programme in adults with OSA. Meta-analyses were conducted using random-effects models.

Results

Twelve studies met the inclusion criteria with nine comparing similar interventions. Diet and diet plus continuous positive airway pressure (CPAP) therapy were compared in three studies (n = 261), and intensive lifestyle programmes and routine care were compared in six studies (n = 483). Diet with CPAP therapy reduced weight by −2.64 kg (95 % Confidence Interval (CI) −3.98, −1.30, I 2 = 0 %) compared with diet alone. No differences were observed for QoL or Epworth Sleepiness Scale. A significant reduction in weight was seen in participants receiving an intensive lifestyle intervention of −5.65 kg (95 % CI −10.91, −0.40, I 2 = 95.7 %) compared with controls. Reductions were also observed for waist circumference (−5.80 cm, 95 % CI −8.64, −2.96, I2 = 77.7 %), body mass index (BMI) (−2.33 kg/m2, 95 % CI −3.41, −1.24, I2 = 78.8 %) and the Apnoea Hypopnoea Index (AHI) (−4.55 events/h, 95 % CI −7.12, −1.98, I 2 = 54.4 %) but with high levels of heterogeneity.

Conclusions

Intensive lifestyle management can significantly reduce obesity indices and improve AHI. Future research is required to investigate this effect due to a limited number of studies identified.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Punjabi NM (2008) The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 5:136–143

    Article  PubMed  Google Scholar 

  2. Vgontzas AN, Tan TL, Bixler EO, Martin LF, Shubert D, Kales A (1994) Sleep apnea and sleep disruption in obese patients. Arch Intern Med 154:1705–1711

    Article  CAS  PubMed  Google Scholar 

  3. Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP (2010) Pathophysiology of sleep apnea. Physiol Rev 90:47–112

    Article  CAS  PubMed  Google Scholar 

  4. Berger G, Berger R, Oksenberg A (2009) Progression of snoring and obstructive sleep apnoea: the role of increasing weight and time. Eur Respir J 33:338–345

    Article  CAS  PubMed  Google Scholar 

  5. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. J Am Med Assoc 2:3015–3021

    Article  Google Scholar 

  6. West SD, Nicoll DJ, Stradling JR (2006) Prevalence of obstructive sleep apnoea in men with type 2 diabetes. Thorax 61:945–950

    Article  CAS  PubMed  Google Scholar 

  7. Coughlin SR, Mawdsley L, Mugarza JA, Calverley PMA, Wilding JPH (2004) Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 25:735–741

    Article  PubMed  Google Scholar 

  8. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep disordered breathing and hypertension. N Engl J Med 342:1378–1384

    Article  CAS  PubMed  Google Scholar 

  9. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ, The National High Blood Pressure Education Program Coordinating Committee (2003) JNC:7 complete report: seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42:1206–1252

    Article  CAS  PubMed  Google Scholar 

  10. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, O’ Connor GT, Boland LL, Schwartz JE, Samet JM (2001) Sleep disordered breathing and cardiovascular disease:cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163:19–25

    Article  CAS  PubMed  Google Scholar 

  11. Shamsuzzaman AS, Gersh BJ, Somers VK (2003) Obstructive sleep apnoea: implications for cardiac and vascular disease. J Ame Med Assoc 290:1906–14

    Article  CAS  Google Scholar 

  12. Iqbal M, Shah S, Fernandez S, Karam J, Jean-Louis G, McFarlane SI (2008) Obesity, obstructive sleep apnea and cardiovascular risk. Curr Cardiovasc Risk Rep 2:101–106

    Article  Google Scholar 

  13. Wolk R, Somers VK (2006) Obesity-related cardiovascular disease: implications of obstructive sleep apnea. Diabetes Obes Metab 8:250–260

    Article  CAS  PubMed  Google Scholar 

  14. Meslier N, Gagnadoux F, Giraud P, Person C, Ouksel H, Urban T, Racineux JL (2003) Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J 22:156–160

    Article  CAS  PubMed  Google Scholar 

  15. Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, Wadden TA, Kelley D, Wing RR, Xavier Pi Sunyer F, Darcey V, Kuna ST, for the Sleep AHEAD Research Group (2009) Obstructive sleep apnoea among obese patients with type 2 diabetes. Diabetes Care 32:1017–1019

    Article  PubMed  Google Scholar 

  16. Leger D, Bayon V, Laaban JP, Philip P (2012) Impact of sleep apnea on economics. Sleep Med Rev 5:455–462

    Article  Google Scholar 

  17. Sjösten N, Vahtera J, Salo P, Oksanen T, Saaresranta T, Virtanen M, Pentti J, Kivimäki M (2009) Increased risk of lost workdays prior to the diagnosis of sleep apnea. Chest 136:130–136

    Article  PubMed  Google Scholar 

  18. Gay P, Weaver T, Loube D, Iber C (2006) Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep 29:381–401

    PubMed  Google Scholar 

  19. Becker HF, Jerrentrup A, Ploch T, Grote L, Penzel T, Sullivan CE, Peter JH (2003) Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 107:68–73

    Article  PubMed  Google Scholar 

  20. Montserrat MJ, Ferrer M, Hernandez L, Farré R, Vilagut G, Navajas D, Badia RJ, Carrasco E, De Pablo J, Ballester E (2001) Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome—a randomized controlled study with an optimized placebo. Am J Respir Crit Care Med 164:608–613

    Article  CAS  PubMed  Google Scholar 

  21. Douglas NJ, Engleman HM (2000) Effects of CPAP on vigilance and related functions in patients with the sleep apnea/hypopnea syndrome. Sleep 23(Suppl 4):S147–149

    PubMed  Google Scholar 

  22. Sin DD, Mayers I, Man GC, Pawluk L (2002) Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest 121:430–435

    Article  PubMed  Google Scholar 

  23. Weaver TE, Grunstein RR (2009) Adherence to continuous positive airway pressure therapy the challenge to effective treatment. Proc Am Thorac Soc 5:173–178

    Article  Google Scholar 

  24. Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD, Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5:263–76

    PubMed  Google Scholar 

  25. Shaw JE, Punjabi NM, Wilding JP, Alberti KG, Zimmet PZ (2008) Sleep disordered breathing and type 2 diabetes: a report from the International Diabetes Federation Taskforce on Epidemiology and Prevention. Diabetes Res Clin Pract 81:2–12

    Article  PubMed  Google Scholar 

  26. Morgenthaler TI, Kapen S, Lee-Chiong T, Alessi C, Boehlecke B, Brown T, Coleman J, Friedman L, Kapur V, Owens J, Pancer J, Swick T (2006) Practice parameters for the medical therapy of obstructive sleep apnea. Sleep 29:1031–1035

    PubMed  Google Scholar 

  27. Ballester E, Badia JR, Hernandez L, Carrasco E, De Pablo J, Fornas C, Rodriguez-Roisin R, Montserrat JM (1999) Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159:495–501

    Article  CAS  PubMed  Google Scholar 

  28. Monasterio C, Vidal S, Duran J, Ferrer M, Carmona C, Barbé F, Mavos M, Gonzalez-Mangado N, Juncadella M, Navarro A, Barreira A, Capote F, Mayoralas LR, Peces-Barba G, Alonso J, Montserrat JM (2001) Effectiveness of continuous positive airway pressure in mild sleep apnea–hypopnea syndrome. Am J Respir Crit Care Med 164:939–943

    Article  CAS  PubMed  Google Scholar 

  29. Kajaste S, Brander PE, Telakivi T, Partinen M, Mustajoki P (2004) A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study. Sleep Med 5:125–131

    Article  PubMed  Google Scholar 

  30. Nerfeldt P, Nilsson BY, Uddén J, Rössner S, Friberg D (2008) Weight reduction improves nocturnal respiration in obese sleep apnoea patients—a randomized controlled pilot study. Obes Res Clin Prac 2:119–124

    Article  Google Scholar 

  31. Stradling J, Roberts D, Wilson A, Lovelock F (1998) Controlled trial of hypnotherapy for weight loss in patients with obstructive sleep apnoea. Int J Obes 28:278–281

    Article  Google Scholar 

  32. Sengul YS, Ozalevli S, Oztura I, Itil O, Baklan B (2009) The effect of exercise on obstructive sleep apnea: a randomized and controlled trial. Sleep Breath 15:49–56

    Article  PubMed  Google Scholar 

  33. Kemppainen T, Ruoppi P, Seppä J, Sahlman J, Peltonen M, Tukiainen H, Gylling H, Vanninnen E, Tuomilehto H (2008) Effect of weight reduction on rhinometric measurements in overweight patients with obstructive sleep apnea. Am J Rhin 22:410–415

    Article  Google Scholar 

  34. Foster GD, Borradaile KE, Sanders MH, Milman R, Zammit G, Newman AB, Wadden TE, Kelley D, Wing RR, Pi-Sunyer FX, Reboussin D, Kuna ST (2009) Sleep AHEAD Research Group of Look AHEA. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med 169:1619–1626

    Article  PubMed  Google Scholar 

  35. Tuomilehto HP, Seppa JM, Partinen MM, Peltonen M, Gylling H, Tuomilehto JOI, Vanninen EJ, Kokkarinen J, Sahlman JK, Martikainen T, Soini EJO, Randell J, Tukiainen H, Uusitupa M (2009) Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med 179:320–327

    Article  PubMed  Google Scholar 

  36. Johansson K, Neovius M, Lagerros YT, Harlid R, Rossner S, Granath F, Hemmingsson E (2009) Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomised controlled trial. BMJ 339:b4609

    Article  PubMed  Google Scholar 

  37. Ackel-D’Elia C, Carlos da Silva A, Santos Silva R, Truksinas E, Saldanha Sousa B, Tufik S, Túlio de Mello M, Azeredo Bittencourt L (2012) Effects of exercise training associated with continuous positive airway pressure treatment in patients with obstructive sleep apnea syndrome. Sleep Breath 16:723–735

    Article  PubMed  Google Scholar 

  38. Papandreou C, Ssciza S, Tzatzarakis M, Kavalakis M, Hatzis C, Tsatsakis A, Kafatos A, Siafakas N, Tzanakis N (2012) Effects of Mediterranean diet on lipid peroxidation marker TBARS in obese patients with OSAHS under CPAP treatment: a randomised trial. Sleep Breath 16:873–879

    Article  PubMed  Google Scholar 

  39. Kline CE, Crowley EP, Ewing GB, Burch JB, Blair SN, Durstine JL, Davis JM, Youngstedt SD (2011) The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Sleep 12:1631–1640

    Google Scholar 

  40. Tuomilehto HP, Gylling H, Peltonen M, Martikainen T, Sahlman JK, Kokkarinen J, Randel J, Tukiainen H, Vanninen EJ, Partinen MM, Tuomilehto J, Uusitupa M, Seppá J (2010) Sustained improvement in mild obstructive sleep apnea after a diet and physical activity-based lifestyle intervention: post interventional follow-up. Am J Clin Nutr 92:688–696

    Article  CAS  PubMed  Google Scholar 

  41. Shneerson J, Wright JJ (2001) Lifestyle modification for obstructive sleep apnoea. Cochrane Database Syst. Rev Issue 1; CD002875

  42. Anandam A, Akinnusi M, Kufel T, Porhomayon J, El-Solh AA (2012) Effects of dietary weight loss on obstructive sleep apnea: a meta-analysis. Sleep Breath. doi:10.1007/s11325-012-0677-3

  43. Ashrafian H, le Roux CW, Rowland SP, Ali M, Cummin AR, Darzi A, Athanasiou A (2012) Metabolic surgery and obstructive sleep apnoea: the protective effects of bariatric procedures. Thorax 67:442–449

    Article  PubMed  Google Scholar 

  44. Liberati A, Douglas GA, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijner J, Mother D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. J Clin Epi 62:e1–e34

    Article  Google Scholar 

  45. Jadad A, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomised controlled trials is blinding necessary? Control Clin Trials 17:1–12

    Article  CAS  PubMed  Google Scholar 

  46. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  Google Scholar 

  47. Norman JF, Von Essen SG, Fuchs RH, McElligott M (2000) Exercise training effect on obstructive sleep apnea syndrome. Sleep Res Online 3:121–129

    CAS  PubMed  Google Scholar 

  48. Ueno LM, Drager LF, Rodrigues AC, Rondon MU, Braga AM, Mathias W, Krieger EM, Barretto AC, Middlekauff HR, Lorenzi-Filho G, Nagrao CE (2009) Effects of exercise training in patients with chronic heart failure and sleep apnea. Sleep 32:637–647

    PubMed  Google Scholar 

  49. Barnes M, Goldsworthy UR, Cary BA, Hill CJ (2009) A diet and exercise program to improve clinical outcomes in patients with obstructive sleep apnea—a feasibility study. J Clin Sleep Med 5:409–415

    PubMed  Google Scholar 

  50. Svendsen M, Blomhoff R, Holme I, Tonstad S (2007) The effect of an increased intake of vegetables and fruit on weight loss, blood pressure and antioxidant defense in subjects with sleep related breathing disorders. Eur J Clin Nutr 61:1301–1311

    Article  CAS  PubMed  Google Scholar 

  51. Lam B, Sam K, Mok WY, Cheung MT, Fong DY, Lam JC, Lam DC, Yam LY, Ip MS (2007) Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. Thorax 62:354–359

    Article  PubMed  Google Scholar 

  52. Kline CE, Crowley EP, Ewing GB, Burch JB, Blair SN, Durstine JL, Davis JM, Youngstedt SD (2012) Exercise training improves selected aspects of daytime functioning in adults with obstructive sleep apnea. J Clin Sleep Med 4:357–365

    Google Scholar 

  53. Dickersin K (1990) The existence of publication bias and risk factors for its occurrence. JAMA 263:1385–1389

    Article  CAS  PubMed  Google Scholar 

Download references

Financial Support

Funding was provided by the Leicester Diabetes Centre and the Hanning Sleep Laboratory.

Disclosure

The corresponding author and co-authors listed on this manuscript have no financial conflict of interest, and this research does not include off-label or investigational use of drugs or devices.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Maria-Anna Thomasouli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thomasouli, MA., Brady, E.M., Davies, M.J. et al. The impact of diet and lifestyle management strategies for obstructive sleep apnoea in adults: a systematic review and meta-analysis of randomised controlled trials. Sleep Breath 17, 925–935 (2013). https://doi.org/10.1007/s11325-013-0806-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-013-0806-7

Keywords

Navigation