10 research outputs found
Cardiometabolic Benefits of a Weight-Loss Mediterranean Diet/Lifestyle Intervention in Patients with Obstructive Sleep Apnea: The “MIMOSA” Randomized Clinical Trial
Although continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnea (OSA), its cardiometabolic benefits are questionable. Our aim was to explore whether the combination of a weight-loss Mediterranean diet/lifestyle intervention with OSA standard care leads to greater cardiometabolic improvements compared with standard care alone. We randomly assigned 187 adult, overweight, polysomnography-diagnosed moderate-to-severe OSA patients to a standard care group (SCG, n = 65), a Mediterranean diet group (MDG, n = 62) or a Mediterranean lifestyle group (MLG, n = 60). All three groups were prescribed with CPAP. Additionally, the SCG only received brief written healthy lifestyle advice, while intervention arms were subjected to a six-month weight-loss behavioral intervention based on the Mediterranean diet. The MLG also received guidance for improving physical activity and sleep habits. Glucose metabolism indices, blood lipids, liver enzymes and blood pressure improved only in intervention arms, and were significantly lower compared to the SCG post-intervention (all p < 0.05). The age-, sex-, baseline- and CPAP use-adjusted relative risk (95% confidence interval) of metabolic syndrome was 0.58 (0.34–0.99) for the MDG and 0.30 (0.17–0.52) for the MLG compared to the SCG. The MLG additionally presented a lower relative risk of metabolic syndrome compared to the MDG (0.52 (0.30–0.89)). After further adjustment for body-weight change, a lower relative risk of metabolic syndrome was still evident for the MLG compared to the SCG. In conclusion, although standard care alone does not improve OSA patients’ cardiometabolic profile, its combination with a weight-loss Mediterranean diet/lifestyle intervention leads to significant cardiometabolic benefits
Associations between Vitamin D Status and Polysomnographic Parameters in Adults with Obstructive Sleep Apnea
Vitamin D deficiency (VDD) may be associated with obstructive sleep apnea (OSA) presence and is more pronounced with increasing OSA severity; however, the relationship between these two entities remains unclear. This was a cross-sectional study among 262 adults with in-hospital-attended polysomnography-diagnosed OSA and no additional major comorbidities, aiming to explore possible associations between serum 25-hydroxyvitamin D [25(OH)D] levels and polysomnographic parameters. Data on demographics, medical history, anthropometric indices, and lifestyle habits were collected at enrolment. Serum 25(OH)D was evaluated using chemiluminescence, with VDD defined as 25(OH)D p 2 [3.38 (1.52–7.52)], but not in the younger and non-obese adults. This study provides further evidence of an inverse association between vitamin D levels and OSA severity and underscores the importance of considering vitamin D status as a potential modifiable factor in the comprehensive management of OSA
Improvements in Plasma Tumor Necrosis Factor-Alpha Levels after a Weight-Loss Lifestyle Intervention in Patients with Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) and systemic inflammation typically coexist within a vicious cycle. This study aimed at exploring the effectiveness of a weight-loss lifestyle intervention in reducing plasma tumor necrosis factor-alpha (TNF-a), a well-established modulator of systematic inflammation in OSA. Eighty-four adult, overweight patients with a diagnosis of moderate-to-severe OSA were randomized to a standard care (SCG, n = 42) or a Mediterranean lifestyle group (MLG, n = 42). Both groups were prescribed continuous positive airway pressure (CPAP), while the MLG additionally participated in a 6-month behavioral intervention aiming at healthier weight and lifestyle habits according to the Mediterranean pattern. Plasma TNF-a was measured by an immunoenzymatic method both pre- and post-intervention. Drop-out rates were 33% (n = 14) for the SCG and 24% (n = 10) for the MLG. Intention-to-treat analysis (n = 84) revealed a significant decrease in median TNF-a only in the MLG (from 2.92 to 2.00 pg/mL, p = 0.001). Compared to the SCG, the MLG exhibited lower follow-up TNF-a levels (mean difference adjusted for age, sex, baseline TNF-a and CPAP use: −0.97 pg/mL, p = 0.014), and further controlling for weight loss did not attenuate this difference (p = 0.020). Per protocol analyses (n = 60) revealed similar results. In conclusion, a healthy lifestyle intervention can lower plasma TNF-a levels in patients with OSA
The effectiveness of a weight-loss Mediterranean diet/lifestyle intervention in the management of obstructive sleep apnea: Results of the ? MIMOSA ? randomized clinical trial
Background & aims: Although continuous positive airway pressure (CPAP)
is the first-line treatment for obstructive sleep apnea (OSA), lifestyle
interventions have also emerged as complementary therapeutic choices. We
aimed to explore whether the addition of a weight-loss Mediterranean
diet/lifestyle inter-vention to OSA standard care, i.e. CPAP
prescription and brief written healthy lifestyle advice, has an
incremental effect on improving OSA severity, over the effect of
standard care alone.
Methods: We designed a parallel, randomized, controlled, superiority
clinical trial. Eligible participants were adult, overweight men and
women, diagnosed with moderate-to-severe OSA [apnea-hypopnea index
(AHI)> 15 events/h] through an attended overnight polysomnography.
Participants were blindly randomized to a standard care group (SCG, n =
65), a Mediterranean diet group (MDG, n = 62) or a Mediterranean
lifestyle group (MLG, n = 60). All three study groups were prescribed
with CPAP. The SCG additionally received written healthy lifestyle
advice, while intervention arms were subjected to a 6-month behavioral
intervention aiming at weight loss and increasing adherence to the
Mediterranean diet. The MLG also received counselling on physical
activity and sleep habits. Polysomnographic data and OSA symptoms were
evaluated pre-and post-intervention.
Results: A total of 187 OSA patients were recruited. Seven patients were
excluded post-randomization and 53/180 (29%) were lost to follow-up. No
harms from the interventions applied were reported. Ac-cording to
intention-to-treat analysis (n = 180), mean (95% confidence interval)
AHI change was-4.2 (-7.4,-1.0) for the SCG,-24.7 (-30.4,-19.1) for the
MDG and-27.3 (-33.9,-20.6) for the MLG. Post-intervention age-, sex-,
baseline-and CPAP use-adjusted AHI was significantly lower in the MDG
and the MLG compared to the SCG (mean difference:-18.0, and-21.2,
respectively, both P < 0.001), and the differences remained significant
after further adjustment for body-weight change (P = 0.004 and 0.008,
respectively). Other respiratory event indices, daytime sleepiness and
insomnia were also significantly lower in both intervention arms
compared to the SCG (all P < 0.05). The MLG only presented higher
percent rapid-eye-movement sleep and lower daytime sleepiness compared
to the MDG (both P < 0.05). Results were similar in the per-protocol
analysis (n = 127).
Conclusions: A dietary/lifestyle intervention on top of standard care
leads to greater improvements in OSA severity and symptomatology
compared to standard care alone. Benefits are evident regardless of CPAP
use and weight loss. Trial registration: Clinicaltrials.gov NCT02515357,
https://clinicaltrials.gov/ct2/show/NCT02515357.
(c) 2020 Elsevier Ltd and European Society for Clinical Nutrition and
Metabolism. All rights reserved
Cardiometabolic Benefits of a Weight-Loss Mediterranean Diet/Lifestyle Intervention in Patients with Obstructive Sleep Apnea: The “MIMOSA” Randomized Clinical Trial
Although continuous positive airway pressure (CPAP) is the first-line
treatment for obstructive sleep apnea (OSA), its cardiometabolic
benefits are questionable. Our aim was to explore whether the
combination of a weight-loss Mediterranean diet/lifestyle intervention
with OSA standard care leads to greater cardiometabolic improvements
compared with standard care alone. We randomly assigned 187 adult,
overweight, polysomnography-diagnosed moderate-to-severe OSA patients to
a standard care group (SCG,n= 65), a Mediterranean diet group (MDG,n=
62) or a Mediterranean lifestyle group (MLG,n= 60). All three groups
were prescribed with CPAP. Additionally, the SCG only received brief
written healthy lifestyle advice, while intervention arms were subjected
to a six-month weight-loss behavioral intervention based on the
Mediterranean diet. The MLG also received guidance for improving
physical activity and sleep habits. Glucose metabolism indices, blood
lipids, liver enzymes and blood pressure improved only in intervention
arms, and were significantly lower compared to the SCG post-intervention
(allp< 0.05). The age-, sex-, baseline- and CPAP use-adjusted relative
risk (95% confidence interval) of metabolic syndrome was 0.58
(0.34-0.99) for the MDG and 0.30 (0.17-0.52) for the MLG compared to the
SCG. The MLG additionally presented a lower relative risk of metabolic
syndrome compared to the MDG (0.52 (0.30-0.89)). After further
adjustment for body-weight change, a lower relative risk of metabolic
syndrome was still evident for the MLG compared to the SCG. In
conclusion, although standard care alone does not improve OSA patients’
cardiometabolic profile, its combination with a weight-loss
Mediterranean diet/lifestyle intervention leads to significant
cardiometabolic benefits
A weight-loss Mediterranean diet/lifestyle intervention ameliorates inflammation and oxidative stress in patients with obstructive sleep apnea: results of the “MIMOSA” randomized clinical trial
Purpose Inflammation and oxidative stress are implicated in obstructive
sleep apnea (OSA) pathophysiology. We aimed at exploring whether the
combination of a weight-loss Mediterranean diet/lifestyle intervention
with OSA standard care, i.e., continuous positive airway pressure (CPAP)
prescription, can lead to greater improvements in inflammation and
oxidative stress, compared to standard care alone. Methods This was a
randomized controlled clinical trial in 187 adult, overweight patients
with moderate-to-severe OSA. Participants were randomized to a standard
care (SCG, n = 65), a Mediterranean diet (MDG, n = 62) or a
Mediterranean lifestyle group (MLG, n = 60). All groups received OSA
standard care. Intervention arms participated in a 6-month behavioral
weight-loss intervention based on the Mediterranean diet, while the MLG
also received counselling on physical activity and sleep habits. Results
Seven patients were excluded and 53/180 were lost to follow-up. In
intention to treat analysis (n = 180), the SCG did not exhibit changes
in any of the markers assessed. Post-intervention age-, sex-, baseline-
and CPAP use-adjusted plasma high sensitivity C-reactive protein levels
(mg/L) were lower in the MDG and the MLG compared to the SCG (mean
difference - 1.33, P = 0.039 and - 1.68, P = 0.007, respectively). The
MLG also exhibited lower urinary 8-iso prostaglandin F2a levels (ng/mg
creatinine) compared to the SCG and the MDG (mean difference - 1.10, P <
0.0001 and - 0.80, P = 0.001, respectively). Adiponectin and oxidized
guanine levels were not altered in any of the study groups. Results were
similar in per protocol analysis (n = 127). Conclusion A weight-loss
Mediterranean diet/lifestyle intervention on top of CPAP has
anti-inflammatory and antioxidant benefits in OSA. Registration The
trial was prospectively registered at ClinicalTrials.gov (NCT02515357)
on August 4, 2015