Weight loss is a frequently recommended treatment for obese patients with obstructive sleep apnea (OSA). The empirical support for this recommendation is lacking. Based on descriptive studies, weight loss appears to improve but not abolish sleep disordered breathing. Moreover, the degree of improvement in OSA is quite variable and not directly proportional to weight loss. The lack of randomized trials, the study of predominantly male samples, and the absence of follow-up evaluations leave physicians and patients unsure about the utility of weight loss treatment in obese OSA patients. The research proposed in this application will assess the effects of weight loss on sleep disordered breathing in 120 obese, Type 2 diabetics with OSA (RDI greater than or equal to 15) who are randomly assigned to either weight loss (n=60) or usual care (n=60) treatments within the context of the Look AHEAD study. Home polysomnography studies will be performed before treatment and at 1 and 2 years. Among the 60 weight loss subjects, we will assess the relative importance of changes in neck and abdominal fat in explaining the variability of changes in sleep disordered breathing after weight loss. Finally, we will examine the relationship between changes in sleep-disordered breathing and changes in blood pressure after weight loss in the 60 weight loss participants. Specifically, this research will: 1) determine the efficacy of a weight loss program in reducing sleep disordered breathing in obese Type 2 diabetics; 2) identify sources of variability in sleep disordered breathing associated with weight loss; and 3) examine the role of sleep disordered breathing in mediating changes in blood pressure associated with weight loss. The results of this study will provide an empirical basis for making recommendations about the effectiveness of weight loss in Type 2 diabetics with OSA.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
3R01HL070301-01S1
Application #
6591997
Study Section
Special Emphasis Panel (ZDK1 (M1))
Program Officer
Twery, Michael
Project Start
2001-09-30
Project End
2006-07-31
Budget Start
2001-09-30
Budget End
2002-07-31
Support Year
1
Fiscal Year
2002
Total Cost
$13,916
Indirect Cost
Name
University of Pennsylvania
Department
Psychiatry
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Shechter, Ari; Foster, Gary D; Lang, Wei et al. (2017) Effects of a lifestyle intervention on REM sleep-related OSA severity in obese individuals with type 2 diabetes. J Sleep Res 26:747-755
Kline, Christopher E; Reboussin, David M; Foster, Gary D et al. (2016) The Effect of Changes in Cardiorespiratory Fitness and Weight on Obstructive Sleep Apnea Severity in Overweight Adults with Type 2 Diabetes. Sleep 39:317-25
Shechter, Ari; St-Onge, Marie-Pierre; Kuna, Samuel T et al. (2014) Sleep architecture following a weight loss intervention in overweight and obese patients with obstructive sleep apnea and type 2 diabetes: relationship to apnea-hypopnea index. J Clin Sleep Med 10:1205-11
Kuna, Samuel T; Reboussin, David M; Borradaile, Kelley E et al. (2013) Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep 36:641-649A
St-Onge, Marie-Pierre; Zammit, Gary; Reboussin, David M et al. (2012) Associations of sleep disturbance and duration with metabolic risk factors in obese persons with type 2 diabetes: data from the Sleep AHEAD Study. Nat Sci Sleep 4:143-50
Rice, Thomas B; Foster, Gary D; Sanders, Mark H et al. (2012) The relationship between obstructive sleep apnea and self-reported stroke or coronary heart disease in overweight and obese adults with type 2 diabetes mellitus. Sleep 35:1293-8
Foster, Gary D; Borradaile, Kelley E; Sanders, Mark H et al. (2009) 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 169:1619-26
Foster, Gary D; Sanders, Mark H; Millman, Richard et al. (2009) Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care 32:1017-9
Rodway, George W; Hoffman, Leslie A; Tasota, Frederick J et al. (2008) Inducing hypoxemia in healthy humans: a method for intermittently lowering arterial blood oxygenation during physiological studies. Wilderness Environ Med 19:218-20
Sanders, Mark H; Montserrat, Josep M; Farre, Ramon et al. (2008) Positive pressure therapy: a perspective on evidence-based outcomes and methods of application. Proc Am Thorac Soc 5:161-72

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