The Association of Intentional Weight Reduction with Symptom Burden and PRO Measures in Patients with Obstructive Sleep Apnea: A Systematic Literature Review

OBJECTIVES: A systematic literature review was conducted to assess the relationship between intentional weight reduction (WR) and symptom burden (SB) (e.g., dry mouth, morning headaches, difficulty remembering, extensive daytime sleepiness) and patient-reported outcomes (PRO) in adults with obstructive sleep apnea (OSA).

METHODS: Embase, MEDLINE, and CENTRAL were searched for English peer-reviewed articles (1998 – 2023). Clinical trials and observational studies in adults with OSA reporting changes in PRO measures or SB following WR treatment were included.

RESULTS: 62 studies (35 clinical trials, 27 observational studies) were included. Interventions for WR included: bariatric surgery (n=25), lifestyle interventions (n=35) or pharmacological (n=4). Heterogeneity was observed for WR interventions, study designs, patient characteristics, duration of intervention and severity of OSA. WR ranged from 0% (standard care) to 27.7% (bariatric surgery). Change in Epworth sleepiness scale (ESS) was reported in 22 studies and ranged from 0.1 to -4.8 and -0.2 to -9.7 for patients achieving <5% and >5% WR, respectively. Changes in ESS were influenced by WR but also by patient characteristics, type and intensity of interventions. Three studies reported excessive daytime sleepiness, both of which reported improvements with WR (bariatric surgery and Mediterranean diet/lifestyle). No other data for SB were reported. Improvements in Pittsburgh Sleep Quality Index (n=2 studies), Functional Outcomes of Sleep Questionnaire (n=6), Sleep Apnea quality of life (n=1), Quebec Sleep Questionnaire (n=1) and Hamilton Depression Scale (n=1) were observed with WR. Across four studies, quality of life was generally improved with WR using the SF-36 scale.

CONCLUSIONS: Limitations of data available in the literature and heterogeneity of study design make it difficult to draw firm conclusions. The data suggest WR is an effective approach for improving PROs in adults with OSA. This may, however, be influenced by the type and intensity of the support received.