Body composition changes and their relationship with obstructive sleep apnoea symptoms, severity: The Sleeping Well Trial

Kaitlin Day; Kay Nguo; Bradley A Edwards; Denise M O'Driscoll; Alan C Young; Terry P Haines; Garun S Hamilton; Ladan Ghazi; Claire Bristow; Helen Truby

doi:10.1016/j.clnu.2023.07.006

Body composition changes and their relationship with obstructive sleep apnoea symptoms, severity: The Sleeping Well Trial

Clin Nutr. 2023 Sep;42(9):1661-1670. doi: 10.1016/j.clnu.2023.07.006. Epub 2023 Jul 22.

Authors

Affiliations

¹ School of Agriculture, Food and Ecosystem Sciences, Faculty of Science, The University of Melbourne, Australia; Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Australia. Electronic address: kaitlin.day@unimelb.edu.au.
² Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Australia.
³ Department of Physiology, Biomedicine Discovery Institute, Monash University, Australia; Department of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Australia.
⁴ Department of Respiratory and Sleep Medicine, Eastern Health, Australia; Eastern Health Clinical School, Monash University, Australia.
⁵ School of Primary and Allied Health Care, Monash University, Australia.
⁶ School of Clinical Sciences, Monash University, Australia; Monash Lung, Sleep, Allergy and Immunology Department, Monash Health, Australia.
⁷ School of Public Health and Preventive Medicine, Monash University, Australia.
⁸ School of Human Movement and Nutrition Sciences, University of Queensland, Australia.

PMID: 37515844
DOI: 10.1016/j.clnu.2023.07.006

Abstract

Background & aims: Obstructive sleep apnoea (OSA) and obesity share a complex bi-directional relationship as location of body fat and changes in regional body composition may be more important for OSA improvement than changes in total body weight only. The aim of this study was to evaluate the impact of a 6-month weight loss intervention for adults newly diagnosed with moderate-severe OSA and obesity on regional body composition. The secondary aims evaluated the relationship between changes in OSA symptoms and severity and anthropometry and regional body composition during the first 12-months after commencing CPAP and explored differences in outcomes between males and females.

Methods: Participants (n = 59) received CPAP overnight at home alongside a 6-month modified fasting intervention with 12-months follow up. Regional body composition was measured by Dual X-ray absorptiometry, (DXA) and anthropometry before and after the lifestyle intervention. OSA severity was measured using the apnoea hypopnea index via overnight polysomnography and OSA symptoms were measured using the Epworth Sleepiness scale.

Results: Forty-seven adults (74% male) had complete measures available with a mean age of 50.0 y (SD 11.0) and BMI 34.1 kg/m² (SD 5.0). Following the intervention average fat mass changed by -5.27 kg (5.36), p < 0.001) and visceral adipose tissue (-0.63 kg (0.67), p < 0.001) significantly decreased in males only with a maintenance of fat-free mass (mean -0.41 kg (1.80), p = 0.18). Females (n = 12) had significant decreases in waist circumference (mean -3.36 cm (3.18) p < 0.01), android lean (-0.12 kg (0.04), p < 0.05) and android total mass (-0.28 kg (0.39), p < 0.05) only. Regional body composition changes in males were positively associated with improvements in OSA severity (p < 0.01) but not OSA symptoms.

Conclusion: Improvements in regional body composition were seen in males only which were related to improvements in OSA severity but not OSA symptoms. Females may exhibit different OSA pathophysiology and may require different treatment approaches.

Trial registration: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369975&isReview=trueAACTRN12616000203459 ACTRN12616000203459.

Keywords: Body composition; Obesity; Obstructive sleep apnoea; Sex differences; Waist circumference.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Body Composition
Female
Humans
Male
Middle Aged
Obesity / complications
Obesity / therapy
Polysomnography
Sleep / physiology
Sleep Apnea, Obstructive* / complications
Sleep Apnea, Obstructive* / therapy

Associated data

ANZCTR/ACTRN12616000203459