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