Change in weight and central obesity by positive airway pressure treatment in obstructive sleep apnea patients: Longitudinal data from the European Sleep Apnea Database (ESADA)

Abstract

Introduction: The effect of continuous positive airway pressure (CPAP) treatment on body weight and central obesity in obstructive sleep apnea (OSA) patients is still unclear. Objectives: We aimed to study body composition change during CPAP treatment in the European Sleep Apnea Database (ESADA). Methods: OSA patients with a CPAP treatment follow-up time of more than 30 days in the ESADA registry were selected (n=2015). Body mass index (BMI), body weight, waist-, hip- and neck-circumferences were assessed at baseline and follow-up (median [interquartile range], 242 [380] days). Predictors for body composition changes with CPAP were analyzed adjusting for confounders. Results: Overall, there were no systematic changes in weight and central obesity measures from baseline to follow-up in patients treated with CPAP. Independent predictors of individual weight gain included higher CPAP compliance, lower BMI, shortened sleep time (≤5 hours), use of antidepressive medication and coexisting metabolic disease (diabetes and hyperlipidemia). A gain in body weight was associated with an attenuation of the CPAP induced reduction in sleepiness (Epworth Sleepiness Scale score in patients with 2% weight loss -5±5 versus patients with 2% weight gain -4±5, p=0.003). Conclusions: Standard CPAP treatment was not associated with a systematic, unidirectional body weight change in OSA patients. Active weight reduction therapy should therefore be considered in overweight and obese OSA patients receiving CPAP. Future studies to identify clinical OSA phenotypes predisposed to weight change after CPAP are warranted.