Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes
Open accessAbstract
STUDY OBJECTIVES: To examine whether the initial benefit of weight loss on obstructive sleep apnea (OSA) severity at 1 year is maintained at 4 years. DESIGN: Randomized controlled trial with follow-up at 1, 2, and 4 years. SETTING: 4 Look AHEAD clinical centers. PARTICIPANTS: Two hundred sixty-four obese adults with type 2 diabetes and OSA. INTERVENTIONS: Intensive lifestyle intervention with a behavioral weight loss program or diabetes support and education. MEASUREMENTS: Change in apnea-hypopnea index on polysomnogram. RESULTS: The intensive lifestyle intervention group's mean weight loss was 10.7 ± 0.7 (standard error), 7.4 ± 0.7, and 5.2 ± 0.7 kg at 1, 2, and 4 years respectively, compared to a less than 1-kg weight loss for the control group at each time (P < 0.001). Apnea-hypopnea index difference between groups was 9.7 ± 2.0, 8.0 ± 2.0, and 7.7 ± 2.3 events/h at 1, 2 and 4 years respectively (P < 0.001). Change in apnea-hypopnea index over time was related to the amount of weight loss (P < 0.0001) and intervention, independent of weight loss (P = 0.001). Remission of OSA at 4 years was 5 times more common with intensive lifestyle intervention (20.7%) than diabetes support and education (3.6%). CONCLUSIONS: Among obese adults with type 2 diabetes and OSA, intensive lifestyle intervention produced greater reductions in weight and apnea-hypopnea index over a 4 year period than did diabetes support and education. Beneficial effects of intensive lifestyle intervention on apneahypopnea index at 1 year persisted at 4 years, despite an almost 50% weight regain. Effect of intensive lifestyle intervention on apnea-hypopnea index was largely, but not entirely, due to weight loss.
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Longer maintenance of weight loss might further reduce the risk of type 2 diabetes in at-risk people and preserve gains in sleep apnea, physical mobility, and other conditions improved by weight loss.
“Sustaining weight loss for longer periods may further improve the prevention of type 2 diabetes in at-risk individuals,34 as well as maintain improvements in sleep apnea,5 physical mobility,6 and other health conditions ameliorated by weight loss.7–9”
From Eight-year weight losses with an intensive lifestyle intervention: The look AHEAD study (2014) · cites this paper as [5]
In South Asian, Southeast Asian, and East Asian adults, waist circumference ≥85 cm in men and ≥74 cm in women indicate excess abdominal fat.
“In South Asian, Southeast Asian, and East Asian adults, WC ≥85 cm in men and ≥74 cm in women indicate excess abdominal fat.676,677”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [677]
Table 1 reports participants’ mean waist circumference, and the Discussion considers changes in waist circumference as a measure of central adiposity. Neither gives thresholds for excess abdominal fat in South Asian, Southeast Asian, or East Asian adults. Searches for the 85 cm and 74 cm cutoffs and Asian-specific waist criteria found no supporting passage in our copy. (LLM, conf=0.77)
Experimental — accuracy not yet measuredWaist circumference cutoff points for increased cardiometabolic disease risk are ≥102 cm for men and ≥88 cm for women in the United States and Canada, and ≥94 cm for men and ≥80 cm for women in many other populations.
“Distribution of fat to the abdominal/visceral compartment can be assessed by WC, using cutoff points of ≥102 cm for men and ≥88 cm for women in the United States and Canada and ≥94 cm in men and ≥80 cm in women in many other populations.”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [677]
Table 1 reports participants’ waist circumferences, and the Discussion considers waist circumference as a measure of central adiposity; neither gives risk cutoffs. Searches for the 102/88 cm and 94/80 cm thresholds and their geographic applicability found no passage in our copy stating them. (LLM, conf=0.76)
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- Authors
- Kuna, S. T., Reboussin, D. M., Borradaile, K. E., Sanders, M. H., Millman, R. P., Zammit, G., Newman, A. B., Wadden, T. A., Jakicic, J. M., Wing, R. R., Pi-Sunyer, F. X., Foster, G. D., & Sleep AHEAD Research Group of the Look AHEAD Research Group
- Affiliations
- Philadelphia VA Medical Center (US)
- Wake Forest University (US)
- Temple University (US)
- University of Pittsburgh (US)
- Brown University (US)
- Clinilabs (United States) (US)
- University of Pennsylvania (US)
- Columbia University, New York, NY
- Corresponding author
- Kuna, Samuel T.
- ORCID
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-05-01
- Volume
- 36
- Issue
- 5
- Pages
- 641-649
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC3624818
- OpenAlex
- W1968884608
- Cited by
- 231
- References
- 42
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 10 · 2023: 11 · 2022: 18 · 2021: 16 · 2020: 18 · 2019: 11 · 2018: 16 · 2017: 24 · 2016: 19 · 2015: 23 · 2014: 31 · 2013: 9 · 2012: 1
- FWCI
- 19.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (P30AG024827)
- National Heart, Lung, and Blood Institute (HL070301, R01HL070301)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK60426, U01DK057135, U01DK057131, U01DK057136, DK-56992, U01DK056992, DK057135)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pharmacology › Apelin-related biomedical research
- Keywords
- obstructive sleep apnea, weight loss, type 2 diabetes, obesity, intensive lifestyle intervention, behavioral weight loss program, diabetes support and education, apnea-hypopnea index, weight regain, long-term follow-up
- MeSH terms
- Adult, Aged, Diabetes Mellitus, Type 2, Feeding Behavior, Female, Follow-Up Studies, Humans, Life Style, Male, Middle Aged, Obesity, Patient Education as Topic, Severity of Illness Index, Time Factors, Weight Loss, Body Mass Index, Treatment Outcome, Polysomnography, Sleep Apnea, Obstructive
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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