Sleep Apnea After 1 Year Domiciliary Nasal-Continuous Positive Airway Pressure and Attempted Weight Reduction: Potential for Weaning From Continuous Positive Airway Pressure

Abstract

Study objective To assess the effect of 1 year of therapy for sleep apnea syndrome (SAS) combining domiciliary nasal-continuous positive airway pressure (N-CPAP) and attempted weight loss on the severity of disease and to evaluate the potential for weaning from continuous positive airway pressure (CPAP). Methods and procedures Ninety-five patients having a baseline apnea hypopnea index (AHI) greater than 10/h were prescribed N-CPAP at home. Weight loss was attempted by dietary counseling and by single ring vertical gastroplasty in those patients with a body mass index (BMI) greater than 40 kg/m2. Subjects were asked to return after 1 year for a full-night polysomnography (PSG) without CPAP and the results were compared with baseline PSG. Results Thirty-nine patients compliant to CPAP were evaluated. Weight had decreased from 108.3±29.0 to 99.7±17.7 kg as a result of dietary counseling (n=36) or gastroplasty (n=3). A significant improvement was found in AHI (66.5±28.7 → 50.3±38.4/h; p<0.05), maximal duration of apnea or hypopnea (66± 22 → 47±18 s; p<0.001), minimal oxyhemoglobin saturation (62±16 → 78±7%; pcO.OOl), and stage shift index (SSI) (76±29 → 62±28/h; p<0.05). The drop in AHI correlated with the reduction in BMI (r=0.47; p<0.01) and with the decrease in SSI (r=0.50; p<0.001). Weaning from CPAP was proposed to six patients and succeeded in four (three with 29, 93, and 94 kg weight loss, respectively, and one subject with a normal unchanged weight). Conclusion In 39 patients with SAS, 1-year domiciliary N-CPAP combined with weight loss resulted in a significant improvement in breathing during sleep and in sleep fragmentation, as judged from PSG without CPAP. Four subjects were successfully weaned, three of whom had in parallel a substantial decrease in weight. To assess the effect of 1 year of therapy for sleep apnea syndrome (SAS) combining domiciliary nasal-continuous positive airway pressure (N-CPAP) and attempted weight loss on the severity of disease and to evaluate the potential for weaning from continuous positive airway pressure (CPAP). Ninety-five patients having a baseline apnea hypopnea index (AHI) greater than 10/h were prescribed N-CPAP at home. Weight loss was attempted by dietary counseling and by single ring vertical gastroplasty in those patients with a body mass index (BMI) greater than 40 kg/m2. Subjects were asked to return after 1 year for a full-night polysomnography (PSG) without CPAP and the results were compared with baseline PSG. Thirty-nine patients compliant to CPAP were evaluated. Weight had decreased from 108.3±29.0 to 99.7±17.7 kg as a result of dietary counseling (n=36) or gastroplasty (n=3). A significant improvement was found in AHI (66.5±28.7 → 50.3±38.4/h; p<0.05), maximal duration of apnea or hypopnea (66± 22 → 47±18 s; p<0.001), minimal oxyhemoglobin saturation (62±16 → 78±7%; pcO.OOl), and stage shift index (SSI) (76±29 → 62±28/h; p<0.05). The drop in AHI correlated with the reduction in BMI (r=0.47; p<0.01) and with the decrease in SSI (r=0.50; p<0.001). Weaning from CPAP was proposed to six patients and succeeded in four (three with 29, 93, and 94 kg weight loss, respectively, and one subject with a normal unchanged weight). In 39 patients with SAS, 1-year domiciliary N-CPAP combined with weight loss resulted in a significant improvement in breathing during sleep and in sleep fragmentation, as judged from PSG without CPAP. Four subjects were successfully weaned, three of whom had in parallel a substantial decrease in weight.