Weight loss and lifestyle intervention for cardiorespiratory fitness in obstructive sleep apnea: The INTERAPNEA trial.

INTRODUCTION: Although recent trials have shown benefits of weight loss and lifestyle interventions on obstructive sleep apnea (OSA) severity and comorbidities, the effect of these interventions on cardiorespiratory fitness (CRF) remains unknown. This study aimed to investigate the effects of an interdisciplinary weight loss and lifestyle intervention on CRF and self-reported physical fitness in adults with OSA. METHODS: Eighty-nine men aged 18-65 years with moderate-to-severe OSA and a body mass index ≥25 kg/m2 were randomly assigned to a usual-care group or an 8-week interdisciplinary weight loss and lifestyle intervention. CRF was assessed through the 2-km walking test, and the International Fitness Scale (IFIS) was used to assess self-reported physical fitness. RESULTS: As compared with usual-care, the intervention group had greater improvements at intervention endpoint in objective CRF (6% reduction in 2-km walking test total time, mean between-group difference, -1.7 min; 95% confidence interval, -2.3 to -1.1), and self-reported overall physical fitness (18% increase in IFIS total score, mean between-group difference, 2.3; 95% CI 1.2 to 3.3). At 6 months after intervention, the intervention group also had greater improvements in both 2-km walking test total time (10% reduction) and IFIS total score (22% increase), with mean between-group differences of -2.5 (CI 95%, -3.1 to -1.8) and 3.0 (CI 95%, 1.8 to 4.1), respectively. CONCLUSIONS: An 8-week interdisciplinary weight loss and lifestyle intervention resulted in significant and sustainable improvements in CRF and self-reported physical fitness in men with overweight/obesity and moderate-to-severe OSA. STUDY REGISTRATION: ClinicalTrials.gov registration (NCT03851653).

Interdisciplinary Weight Loss and Lifestyle Intervention for Daily Functioning and Psychiatric Symptoms in Obstructive Sleep Apnea: The INTERAPNEA Randomized Clinical Trial.

Objective: Impaired daily functioning and psychiatric symptoms are highly prevalent in obstructive sleep apnea (OSA); however, the effects of weight loss and lifestyle interventions on these symptoms remain uncertain. This study aimed to evaluate the efficacy of an interdisciplinary weight loss and lifestyle intervention on impaired functioning, psychological distress, anxiety, and depression among men with moderate-to-severe OSA and obesity.Methods: This study was a randomized clinical trial conducted from April 2019 to October 2020. Men aged 18-65 years with moderate-to-severe OSA and obesity were randomly assigned to usual care (continuous positive airway pressure) or an 8-week weight loss and lifestyle intervention. Primary outcomes were changes from baseline to intervention endpoint and 6 months after intervention in daily functioning (measured by the Functional Outcomes of Sleep Questionnaire [FOSQ]); psychological distress (evaluated through the General Health Questionnaire [GHQ]); and anxiety and depression symptoms (measured by the State-Trait Anxiety Inventory [STAI], State-Trait Depression Inventory [STDI], and Beck Depression Inventory [BDI]).Results: Eighty-nine participants underwent randomization (mean [± SD] age, 54 ± 8 years; mean apnea-hypopnea index, 41 ± 22 events/h); 49 were assigned to usual care and 40 to the intervention. As compared with usual care, the intervention group had greater improvements in daily functioning (mean between-group difference in FOSQ score, 2.3; 95% confidence interval, 1.5 to 3.2), psychological distress (GHQ score, -10.3; -15.3 to -5.1), state anxiety (STAI-State score, -7.0; -11.0 to -3.0), trait anxiety (STAI-Trait score, -6.1; -9.5 to -2.8), state depression (STDI-State score, -2.4; -4.3 to -0.4), trait depression (STDI-Trait score, -3.8; -5.6 to -2.1), and general depression (BDI score, -2.0; -3.2 to -0.8) at intervention endpoint. Similar changes were observed at 6 months after intervention.Conclusions: This study provides the first evidence suggesting that an interdisciplinary weight loss and lifestyle intervention improves OSA-related impaired daily functioning and psychiatric symptoms. These findings should be considered when evaluating the potential benefits of this behavioral approach for OSA.Trial Registration: ClinicalTrials.gov Identifier: NCT03851653.

Effect of a Weight Loss and Lifestyle Intervention on Dietary Behavior in Men with Obstructive Sleep Apnea: The INTERAPNEA Trial.

This study investigated the effects of an eight-week interdisciplinary weight loss and lifestyle intervention on dietary behavior in men who were overweight/had obesity and moderate-to-severe obstructive sleep apnea (OSA). It was based on data from INTERAPNEA (ClinicalTrials.gov ID: NCT03851653); a randomized clinical trial conducted from April 2019 to April 2020. Men aged 18-65 years with moderate-to-severe OSA and a body mass index ≥25 kg/m2 were randomly assigned to a usual-care group or an eight-week interdisciplinary weight loss and lifestyle intervention combined with usual-care. Dietary behavior was assessed through the Food Behavior Checklist (FBC) and the Mediterranean Diet Adherence Screener (MEDAS). Of the 89 participants who underwent randomization, 75 completed the intervention endpoint assessment, 89 participants being therefore included in the intention-to-treat analyses, and 75 in the per-protocol approach. As compared with usual-care, the intervention group had greater improvements at intervention endpoint in dietary behavior, as measured by the FBC total score (20% increase in FBC total score, mean between-group difference, 8.7; 95% confidence interval, 5.7 to 11.7), and MEDAS total score (33% increase in MEDAS total score, mean between-group difference, 2.1; 95% CI 1.3 to 2.9). At 6 months after intervention, the intervention group also had greater improvements in both the FBC total score (15% increase) and MEDAS total score (25% increase), with mean between-group differences of 7.7 (CI 95%, 4.4 to 10.9) and 1.7 (CI 95%, 0.9 to 2.6), respectively. An eight-week interdisciplinary weight loss and lifestyle intervention resulted in meaningful and sustainable improvements in dietary behavior, including adherence to the Mediterranean diet in men who were overweight/ had obesity and CPAP-treated moderate-to-severe OSA.

Effect of an Interdisciplinary Weight Loss and Lifestyle Intervention on Obstructive Sleep Apnea Severity: The INTERAPNEA Randomized Clinical Trial.

Importance: Obesity is the leading cause of obstructive sleep apnea (OSA); however, the effects of weight loss and lifestyle interventions on OSA and comorbidities remain uncertain. Objective: To evaluate the effect of an interdisciplinary weight loss and lifestyle intervention on OSA and comorbidities among adults with moderate to severe OSA and overweight or obesity. Design, Setting, and Participants: The Interdisciplinary Weight Loss and Lifestyle Intervention for OSA (INTERAPNEA) study was a parallel-group open-label randomized clinical trial conducted at a hospital-based referral center in Granada, Spain, from April 1, 2019, to October 23, 2020. The study enrolled 89 Spanish men aged 18 to 65 years with moderate to severe OSA and a body mass index (calculated as weight in kilograms divided by height in meters squared) of 25 or greater who were receiving continuous positive airway pressure (CPAP) therapy. The sole inclusion of men was based on the higher incidence and prevalence of OSA in this population, the differences in OSA phenotypes between men and women, and the known effectiveness of weight loss interventions among men vs women. Interventions: Participants were randomized to receive usual care (CPAP therapy) or an 8-week weight loss and lifestyle intervention involving nutritional behavior change, aerobic exercise, sleep hygiene, and alcohol and tobacco cessation combined with usual care. Main Outcomes and Measures: The primary end point was the change in the apnea-hypopnea index (AHI) from baseline to the intervention end point (8 weeks) and 6 months after intervention. Secondary end points comprised changes in other OSA sleep-related outcomes, body weight and composition, cardiometabolic risk, and health-related quality of life. Results: Among 89 men (mean [SD] age, 54.1 [8.0] years; all of Spanish ethnicity; mean [SD] AHI, 41.3 [22.2] events/h), 49 were randomized to the control group and 40 were randomized to the intervention group. The intervention group had a greater decrease in AHI (51% reduction; change, -21.2 events/h; 95% CI, -25.4 to -16.9 events/h) than the control group (change, 2.5 events/h; 95% CI, -2.0 to 6.9 events/h) at the intervention end point, with a mean between-group difference of -23.6 events/h (95% CI, -28.7 to -18.5 events/h). At 6 months after intervention, the reduction in AHI was 57% in the intervention group, with a mean between-group difference of -23.8 events/h (95% CI, -28.3 to -19.3 events/h). In the intervention group, 18 of 40 participants (45.0%) no longer required CPAP therapy at the intervention end point, and 6 of 40 participants (15.0%) attained complete OSA remission. At 6 months after intervention, 21 of 34 participants (61.8%) no longer required CPAP therapy, and complete remission of OSA was attained by 10 of 34 participants (29.4%). In the intervention vs control group, greater improvements in body weight (change, -7.1 kg [95% CI, -8.6 to -5.5 kg] vs -0.3 kg [95% CI, -1.9 to 1.4 kg]) and composition (eg, change in fat mass, -2.9 kg [95% CI, -4.5 to -1.3 kg] vs 1.4 kg [95% CI, -0.3 to 3.1 kg]), cardiometabolic risk (eg, change in blood pressure, -6.5 mm Hg [95% CI, -10.3 to -2.6 mm Hg] vs 2.2 mm Hg [95% CI, -2.1 to 6.6 mm Hg]), and health-related quality of life (eg, change in Sleep Apnea Quality of Life Index, 0.8 points [95% CI, 0.5-1.1 points] vs 0.1 points [95% CI, -0.3 to 0.4 points]) were also found at the intervention end point. Conclusions and Relevance: In this study, an interdisciplinary weight loss and lifestyle intervention involving Spanish men with moderate to severe OSA and had overweight or obesity and were receiving CPAP therapy resulted in clinically meaningful and sustainable improvements in OSA severity and comorbidities as well as health-related quality of life. This approach may therefore be considered as a central strategy to address the substantial impact of this increasingly common sleep-disordered breathing condition. Trial Registration: ClinicalTrials.gov Identifier: NCT03851653.

Anxiety and Depression in Patients with Obstructive Sleep Apnoea before and after Continuous Positive Airway Pressure: The ADIPOSA Study.

The prevalence and treatment response of depression and anxiety symptoms in obstructive sleep apnoea (OSA), although widely addressed in research and clinical settings, still remain unclear due to overlapping symptoms. The ADIPOSA study sought to elucidate the presence of non-overlapping symptoms of depression and anxiety in patients with moderate to severe OSA before and after continuous positive airway pressure (CPAP) treatment. Forty-eight adults aged 18-80 (68.75% men) with moderate to severe OSA were enrolled in this twelve-week longitudinal single-arm trial and completed a full-night ambulatory sleep diagnostic test and an assessment of cognitive-affective depression and anxiety symptoms using the Beck-Depression Inventory-Fast Screen (BDI-FS), the State-Trait Depression Inventory (IDER) and the State-Trait Anxiety Inventory (STAI). We found no cognitive-affective depression or anxiety symptoms of clinical relevance at baseline. The amelioration of depression and anxiety symptoms after CPAP use was only statistically significant when considering anxiety-trait (p < 0.01; d = 0.296) and euthymia (p < 0.05; d = 0.402), the distinctive component of depression. Although dysthymia or high negative affect remained unchanged, CPAP may be effective at reducing the lack of positive affect, a well-established health-protective factor. However, not until depression and anxiety disorders related to OSA are accurately measured in clinical and research settings will it be possible to obtain robust conclusions on the occurrence and amelioration of these symptoms after treatment.

Interdisciplinary Weight Loss and Lifestyle Intervention for Obstructive Sleep Apnoea in Adults: Rationale, Design and Methodology of the INTERAPNEA Study.

Obesity is a major risk factor for obstructive sleep apnoea (OSA), the most common sleep-disordered breathing related to neurocognitive and metabolic syndromes, type II diabetes, and cardiovascular diseases. Although strongly recommended for this condition, there are no studies on the effectiveness of an interdisciplinary weight loss and lifestyle intervention including nutrition, exercise, sleep hygiene, and smoking and alcohol cessation. INTERAPNEA is a randomised controlled trial with a two-arm parallel design aimed at determining the effects of an interdisciplinary tailored weight loss and lifestyle intervention on OSA outcomes. The study will include 84 males aged 18-65 with a body mass index of ≥25 kg/m2 and severe to moderate OSA randomly assigned to usual care (i.e., continuous positive airway pressure), or interdisciplinary weight loss and lifestyle intervention combined with usual care. Outcomes will be measured at baseline, intervention end-point, and six-month post-intervention, including apnoea-hypopnoea index (primary outcome), other neurophysical and cardiorespiratory polysomnographic outcomes, sleep quality, daily functioning and mood, body weight and composition, physical fitness, blood biomarkers, health-related quality of life, and cost-effectiveness. INTERAPNEA may serve to establish a cost-effective treatment not only for the improvement of OSA and its vast and severe comorbidities, but also for a potential remission of this condition.

Valor pronóstico de la pulsioximetría nocturna en pacientes con insuficiencia cardiaca / Prognostic value of nocturnal pulse oximetry in patients with heart failure

Introducción y objetivos: Analizar el valor pronóstico de la hipoxemia nocturna, evaluada mediante pulsioximetría nocturna portátil, en pacientes ingresados por insuficiencia cardiaca y su relación con la mortalidad y el reingreso hospitalario. Métodos: Incluimos a 38 pacientes ingresados de manera consecutiva en nuestra unidad con el diagnóstico de insuficiencia cardiaca descompensada. La pulsioximetría se consideró positiva para hipoxemia cuando se registraron más de 10 desaturaciones a la hora durante el sueño. Se realizó seguimiento durante 30,3 (desviación estándar [DE] 14,2) meses, el objetivo principal fue un endpoint combinado de mortalidad por cualquier causa y reingreso por insuficiencia cardiaca. Resultados: La edad media fue de 70,7 (DE 10,7) años; el 63,3% eran varones. La pulsioximetría fue considerada positiva para hipoxemia en 27 (71%) pacientes. Los pacientes con una pulsioximetría positiva presentaron con mayor frecuencia el endpoint combinado (9.1% [1] vs. 61,5% [16]; p = 0,003). Tras el análisis multivariable, la hipoxemia nocturna continuó estando relacionada con el endpoint combinado (HR = 8,37; 1,19-68,4; p = 0,03). Discusión: Los pacientes ingresados por insuficiencia cardiaca e hipoxemia nocturna medida con pulsioxímetro portátil presentan un riesgo aumentado de reingreso y muerte

Introduction and objectives: To analyze the prognostic value of nocturnal hypoxemia measured with portable nocturnal pulse-oximetry in patients hospitalized due to heart failure and its relation to mortality and hospital readmission. Methods: We included 38 patients who were admitted consecutively to our unit with the diagnosis of decompensated heart failure. Pulse-oximetry was considered positive for hypoxemia when more than 10 desaturations per hour were recorded during sleep. Follow-up was performed for 30.3 (standard deviation [SD] 14.2) months, the main objective being a combined endpoint of all-cause mortality and hospital readmission due to heart failure. Results: The average age was 70.7 (SD 10.7) years, 63.3% were males. Pulse-oximetry was considered positive for hypoxemia in 27 (71%) patients. Patients with positive pulse-oximetry had the most frequent endpoint (9.1% [1] vs. 61.5% [16], P = 0.003). After multivariate analysis, continuous nocturnal hypoxemia was related to the combined endpoint (HR = 8.37, 1.19-68.4, P = 0.03). Discussion: Patients hospitalized for heart failure and nocturnal hypoxemia measured with portable pulse-oximeter have an increased risk of hospital readmission and death

Prognostic value of nocturnal pulse oximetry in patients with heart failure. / Valor pronóstico de la pulsioximetría nocturna en pacientes con insuficiencia cardiaca.

INTRODUCTION AND OBJECTIVES: To analyze the prognostic value of nocturnal hypoxemia measured with portable nocturnal pulse-oximetry in patients hospitalized due to heart failure and its relation to mortality and hospital readmission. METHODS: We included 38 patients who were admitted consecutively to our unit with the diagnosis of decompensated heart failure. Pulse-oximetry was considered positive for hypoxemia when more than 10 desaturations per hour were recorded during sleep. Follow-up was performed for 30.3 (standard deviation [SD] 14.2) months, the main objective being a combined endpoint of all-cause mortality and hospital readmission due to heart failure. RESULTS: The average age was 70.7 (SD 10.7) years, 63.3% were males. Pulse-oximetry was considered positive for hypoxemia in 27 (71%) patients. Patients with positive pulse-oximetry had the most frequent endpoint (9.1% [1] vs. 61.5% [16], P = 0.003). After multivariate analysis, continuous nocturnal hypoxemia was related to the combined endpoint (HR = 8.37, 1.19-68.4, P = 0.03). DISCUSSION: Patients hospitalized for heart failure and nocturnal hypoxemia measured with portable pulse-oximeter have an increased risk of hospital readmission and death.

Results of a Multimodal Program During Hospitalization in Obese COPD Exacerbated Patients.

The objective of this study was to analyze the results of a multimodal therapeutic program during hospitalization in obese AECOPD patients. This was a randomized, single-blind clinical trial conducted at two university hospitals in Granada, Spain. Forty-nine patients hospitalized due to AECOPD were randomly allocated to a control group (CG), in which patients received standard care, or to an intervention group (IG), in which patients were included in a multimodal therapeutic program, added to the standard care. The main outcome measures were pulmonary, physical (strength and exercise capacity) and perceived (dyspnea, quality of life and psychological distress) variables. Within-group significant improvements (p < 0.05) were found in physical and perceived variables in the IG after the treatment. In the CG, a significant decrease was found in lower limb strength and a significant improvement in dyspnea and in three subscales of the EuroQol-5D questionnaire. The between-groups analysis showed significant differences after the treatment on lower limb strength and exercise capacity values (p < 0.05), in three of the EuroQol-5D subscales, and in the total score and the depression subscale of the Hospital Anxiety and Depression Scale. A multimodal therapeutic program has a beneficial effect on physical functioning and perceived variables in hospitalized obese patients with AECOPD.

Estudio del deterioro psicofísico y funcional en pacientes ingresados con neumonía. Análisis por grupos de edad / Age Group Analysis of Psychological, Physical and Functional Deterioration in Patients Hospitalized for Pneumonia

Introducción: Los ingresos hospitalarios por neumonía oscilan entre el 1,1 y el 4 por 1.000 pacientes, aumentando con la edad. La hospitalización provoca un deterioro en el estado funcional. La falta de condición física resultante perjudica la recuperación y pone a los mayores en alto riesgo de discapacidad y de mortalidad. El objetivo del estudio es evaluar la repercusión de la estancia hospitalaria en pacientes con neumonía en función de su edad. Método: Se incluyeron 116 pacientes con neumonía, divididos en dos grupos de edad: < 75años (n = 68) y ≥ 75años (n = 48). Se evaluó la función respiratoria, la función física y el perfil psicoemocional. Además se recogieron como variables la severidad de la neumonía, el estado nutricional, la independencia y las comorbilidades. Resultados: Los análisis estadísticos revelaron diferencias significativas entre ambos grupos de edad en el grado de la severidad de la neumonía y la presencia de comorbilidades. Se encontraron mejoras significativas (p < 0,05) en la función respiratoria en ambos grupos del ingreso al egreso hospitalario. En el grupo ≥ 75 años se observó una disminución significativa de la fuerza evaluada mediante la dinamometría (p < 0,05). Conclusión: La hospitalización supone un deterioro físico significativo en pacientes ingresados por neumonía aumentando con la edad

Introduction: Hospital admissions due to pneumonia range from 1.1 to 4 per 1,000 patients and this figure increases with age. Hospitalization causes a decline in functional status. Physical impairment impedes recovery and constitutes a higher risk of disability and mortality in elderly people. The objective of this study is to assess the impact of hospital stay in patients with pneumonia related with age. Method: A total of 116 patients with pneumonia were included in this study, and divided into two age groups: < 75 years (n = 68) and ≥ 75 years (n = 48). Respiratory function, physical function and psychological and emotional profile were evaluated. Pneumonia severity, nutritional status, independence and comorbidities were also assessed. Results: Statistical analyses revealed significant differences between both age groups in pneumonia severity and comorbidities. Significant improvements between admission and discharge were found in lung function in both groups (p < 0.05), while a significant decrease (p < 0.05) in strength assessed by dynamometer was found in the ≥ 75 years group. Conclusion: Hospitalization leads to a significant physical impairmentin patients admitted for pneumonia. This deterioration increases with age

Age group analysis of psychological, physical and functional deterioration in patients hospitalized for pneumonia.

INTRODUCTION: Hospital admissions due to pneumonia range from 1.1 to 4 per 1,000 patients and this figure increases with age. Hospitalization causes a decline in functional status. Physical impairment impedes recovery and constitutes a higher risk of disability and mortality in elderly people. The objective of this study is to assess the impact of hospital stay in patients with pneumonia related with age. METHOD: A total of 116 patients with pneumonia were included in this study, and divided into two age groups:<75 years (n=68) and ≥ 75 years (n=48). Respiratory function, physical function and psychological and emotional profile were evaluated. Pneumonia severity, nutritional status, independence and comorbidities were also assessed. RESULTS: Statistical analyses revealed significant differences between both age groups in pneumonia severity and comorbidities. Significant improvements between admission and discharge were found in lung function in both groups (p<0.05), while a significant decrease (p<0.05) in strength assessed by dynamometer was found in the ≥75 years group. CONCLUSION: Hospitalization leads to a significant physical impairment in patients admitted for pneumonia. This deterioration increases with age.