Chest
Volume 109, Issue 1, January 1996, Pages 138-143
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Clinical Investigations: Miscellaneous
Sleep Apnea After 1 Year Domiciliary Nasal-Continuous Positive Airway Pressure and Attempted Weight Reduction: Potential for Weaning From Continuous Positive Airway Pressure

https://doi.org/10.1378/chest.109.1.138Get rights and content

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.

Section snippets

Study Design

All consecutive patients prescribed N-CPAP at home for idiopathic SAS between January 1989 and December 1992 were invited to participate in a follow-up program, including regular visits to the Chest Clinic and a two-night PSG at least once a year. Informed consent was obtained from each participant. All the patients had been studied in our Sleep Laboratory and showed obstructive apneas and hypopneas, with a baseline apnea hypopnea index (AHI) greater than 10/h. Each patient was studied again in

Patients and N-CPAP

Ninety-five subjects agreed to participate; 32 were enrolled in 1989 and 1990, and a further 63 in 1991 and 1992 (this increase over time being largely due to the fact that N-CPAP has been reimbursed in Belgium since 1991). One patient died from alcoholic pancreatitis. Nineteen patients stopped CPAP therapy or were unavailable for follow-up. In a further 27, PSG could not be obtained after 1 year, for various reasons. Forty-eight subjects were restudied at the Sleep Laboratoiy after 1 year of

DISCUSSION

In the present study, we have treated 95 patients with SAS by domiciliary N-CPAP combined with attempted weight reduction and we have shown a significant reduction in severity of sleep apnea after 1 year in a group of 39 patients highly compliant to CPAP. We used full-night PSG without CPAP rather than, as in some previous studies, PSG without CPAP for part of the night, either following4 or preceeding2, 3 a part with CPAP, and found a mean fall in AHI from 67 to 50/h, with 4 of 39 subjects

ACKNOWLEDGMENTS

The authors thank Dr. J.-C. Yernault for his support and F. Martinez Vadillo for secretarial assistance.

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  • Cited by (0)

    No author has a financial involvement in any organization with a direct financial interest in the subject discussed.

    revision accepted August 9.

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