For sufferers of obstructive sleep apnea (OSA), a new study shows that losing weight is perhaps the single most effective way to reduce OSA symptoms and associated disorders, according to a new study in the American Journal of Respiratory and Critical Care Medicine, one of the American Thoracic Society's three peer-reviewed journals.

For sufferers of obstructive sleep apnea (OSA), a new study shows that losing weight is perhaps the single most effective way to reduce OSA symptoms and associated disorders, according to a new study in the American Journal of Respiratory and Critical Care Medicine, one of the American Thoracic Society's three peer-reviewed journals.

Weight loss may not be a new miracle pill or a fancy high-tech treatment, but it is an exciting therapy for sufferers of OSA both because of its short- and long-term effectiveness and for its relatively modest price tag. Surgery doesn't last, continuous positive airway pressure (CPAP) machines are only as effective as the patient's adherence, and most other devices have had disappointing outcomes, in addition to being expensive, unwieldy and having poor patient compliance. Furthermore, OSA is generally only treated when it has progressed to a moderate to severe state.

"Very low calorie diet (VLCD) combined with active lifestyle counseling resulting in marked weight reduction is a feasible and effective treatment for the majority of patients with mild OSA, and the achieved beneficial outcomes are maintained at 1-year follow-up," wrote Henri P.I. Tuomilehto, M.D., Ph.D., of the department of Otorhinolaryngology at the Kuopio University Hospital in Finland.

The prospective, randomized trial found that, in 81 patients with mild OSA, the 40 patients who were in the intervention arm underwent a diet that strictly limited caloric intake combined with lifestyle counseling lost more than 20 pounds on average in a year-and kept it off, resulting in markedly lower symptoms of OSA. The 41 patients in the control arm, who only received lifestyle counseling and lost on average less than 6 pounds, and were much less likely to see improvements in their OSA.

And not only does sustained weight loss improve OSA, it also improves the many other independently linked co-morbidities such as hypertension, high cholesterol, and diabetes.

"This is emphasized by our findings that, in conjunction with the improvement in AHI, significant improvements were also found in symptoms related to OSA, insulin resistance, lipids, and cardiorespiratory variables, such as arterial oxygen saturation, in patients belonging to the intervention group," wrote Dr. Tuomilehto.

Furthermore, Dr. Tuomilehto observed, "The greater the change in body weight or waist circumference, the greater was the improvement in OSA." In fact, mild OSA was objectively cured in 88 percent of the patients who lost more than 33 pounds, a statistic that declined with the amount of weight lost. Only in 62 percent of those who lost between 11 and 33 pounds were objectively cured of their OSA, as were 38 percent of those who lost between zero and 11 pounds, and only 11 percent of those who had not lost weight or who had gained weight.

"Witnessed apneas," i.e., those loud or disturbing enough to have wakened the bedfellows of study participants, "totally vanished" in 26 percent of those patients, but in only three percent of the control group.

"This appears to be a fairly straightforward relationship, and while we would not necessarily recommend the severe caloric restriction used in our study to every patient, one of the first treatment for OSA that should be considered in the overweight patient is clearly weight loss," said Dr. Tuomilehto.

"A more aggressive treatment of obesity in patients with OSA is well-founded. Lifestyle intervention with an early VLCD is a feasible, low-cost, and curative treatment for the vast majority of patients with mild OSA and it can be implemented in a primary care setting after diagnosis of OSA. Weight reduction also results in an improvement of obesity-related risk factors for cardiovascular diseases."

About Obstructive Sleep Apnea (OSA)

Approximately 30 million Americans are victims of a sleep disorder called obstructive sleep apnea.  People with Obstructive Sleep Apnea (OSA) experience recurrent episodes during sleep when their throat closes and they cannot suck air into their lungs (apnea). This happens because the muscles that normally hold the throat open during wakefulness relax during sleep and allow it to narrow. When the throat is partially closed and/or the muscles relax too much, trying to inhale will suck the throat completely closed and air cannot pass at all. This is an obstructive sleep apnea episode.

Obstructive apnea episodes can last as long as two minutes and are almost always associated with a reduction in the level of oxygen in the blood. When an individual is in the midst of an obstructive sleep apnea episode, as long as sleep continues, the apnea continues. It is only terminated and the victim's life is saved by waking up. This arousal instantly increases the activity of the muscles of the tongue and throat muscles that enlarge the airway. The victim will be able to breathe and to once again fill the lungs with life-giving oxygen. This cycle may be repeated hundreds of times a night while the sufferer has no idea it is happening.

Depending on the degree of severity, OSA is a potentially life-threatening condition. Someone who has undiagnosed severe obstructive sleep apnea is likely to have a heart attack, a stroke, cardiac arrest during sleep, or a harmful accident. In addition, awakening to breathe hundreds of times in a single night causes the victim to become very sleep deprived. There is a constant risk of serious accidents such as falling asleep while driving as well as impaired function in the workplace and in personal relationships. All of the negative consequences of Obstructive Sleep Apnea (OSA) increase as severity increases. Untreated Obstructive Sleep Apnea (OSA) tends to progressively worsen and sooner or later will result in partial or complete disability and death.

Risk Factors for Obstructive Sleep Apnea

• Anatomic abnormalities, such as a receding chin
• Enlarged tonsils and adenoids, the main causes of OSA in children
• Family history of OSA, although no genetic inheritance pattern has been proven
• Hypothyroidism, acromegaly, amyloidosis, vocal cord paralysis, post-polio syndrome, neuromuscular disorders, Marfan's syndrome, and Down syndrome   
• Nasal congestion 
• Use of alcohol and sedative drugs, which relax the musculature in the surrounding upper airway
• Smoking, which can cause inflammation, swelling, and narrowing of the upper airway