Review Discusses Lifestyle Changes to Improve Severity of Obstructive Sleep Apnea

As a frequently undiagnosed condition, untreated obstructive sleep apnea (OSA) is associated with an increased risk of high blood pressure, diabetes, and depression. Estimated to range in prevalence from 9% to 38% in the North American general adult population, several therapies are available for the treatment of OSA, with continuous positive airway pressure (CPAP) therapy considered the gold standard.

In addition to approved therapies, lifestyle interventions such as weight loss can also markedly improve outcomes. Notably, more than 70% of patients with OSA are overweight or obese, with weight loss associated with a significant decrease in apnea frequency.

Seeking to examine the impact of lifestyle strategies in patients with OSA, authors of a review published in Cureus highlighted that, in addition to reducing weight, “quitting alcohol and smoking, eating a nutritional diet, and exercising are the modifications to benefit people.”

Speaking further on weight management, the authors noted that a panel of sleep and pulmonary specialists, weight-loss experts, and behavioral scientists had developed evidence-based recommendations to manage overweight/obesity in adults with OSA.

The committee proposed a comprehensive lifestyle intervention program characterized by a reduced-calorie diet, exercise/increased physical activity, and behavioral counseling for obese patients with OSA. Moreover, patients who may not lose sufficient weight through the program were also provided suggestions:

• patients with OSA with a body mass index (BMI) greater than or equal to 27 kg/m², who have no contraindications or active cardiovascular disease, were suggested to receive an evaluation for potential anti-obesity pharmacotherapy
• patients with OSA with a BMI greater than or equal to 35 kg/m², who have no contraindications, were suggested to undergo bariatric surgical evaluation

“When weight loss is achieved, there is a homogeneous improvement in OSA severity,” said the study authors. “Furthermore, weight loss benefits may include the actual resolution of OSA, betterment or prevention of type 2 diabetes mellitus, lowering of blood pressure, and enhanced quality of life.”

As another potential mechanism considered to play a mediating role in the exacerbation of OSA, smoking has been indicated in prior research to alter sleep architecture via nicotine-stimulated relaxation of the upper airway muscles, upper airway inflammation due to smoke inhalation, and nicotine-induced increase in sleep arousal threshold.

Although studies have provided conflicting accounts on whether smoking itself may contribute to worsening severity of OSA, most research highlights the impact of smoking on metabolic disorders associated with the condition. In fact, a study found that smoking aggravated metabolic disorders such as diabetes in patients with OSA, causing additional risk on glucose abnormality.

“Depression and mood disorders are common in patients with OSA and may represent a reason for individuals with OSA to be addicted to smoking,” noted the researchers.

Alcohol cessation was also referenced in the review as heavy drinkers, defined by 15 or more drinks for men and 8 or more glasses for women, may be at an expanded risk for OSA, distinctly when they snore. For even moderate amounts of alcohol, authors say that this can significantly increase the frequency and severity of apneas among people with OSA.

“Alcohol ingestion increases the duration and frequency of apnea episodes in patients with OSA and improves hypoxemia in the first hour of sleep,” expand the study authors. “Alcohol consumption depresses the genioglossus muscles' respiratory activity and reduces arousal response time, thereby exacerbating OSA during sleep.”

Ultimately, researchers say that treatment of OSA depends on addressing the underlying cause of the disease, with accurate diagnosis recommended to begin an appropriate treatment plan.

“As several lifestyle changes have been applied to the successful control of weight loss and metabolic diseases, a comprehensive behavioral intervention addressing OSA therapy, including smoking cessation and alcohol intake, may improve the quality of life for the patients suffering from OSA.”

Reference

Kaleelullah RA, Nagarajan PP. Cultivating lifestyle transformations in obstructive sleep apnea. Cureus. Published online January 26, 2021. doi:10.7759/cureus.12927