Improving obstructive sleep apnea in a morbidly obese woman: Role of dietary modification and physical activity

Abstract

Introduction: With obstructive sleep apnea (OSA) present in over 50% of those who are morbidly obese and the well-documented effects of OSA on health and functioning, proper management of this condition is an important consideration among treatment providers. Weight loss is a common goal for patients, though bariatric surgery carries significant risk for those with OSA. As a means of achieving weight loss, lifestyle interventions have been shown to significantly reduce OSA severity with minimal side effects. However, whether these controlled studies can be effectively applied to clinical practice for treating OSA is unknown. We describe how an intensive lifestyle intervention was successfully employed for the treatment of severe OSA in clinical practice.

Case presentation: The patient, a 27 year old morbidly obese Caucasian woman (body mass index [BMI] = 56.2 kg/m², neck circumference = 42 cm), presented with severe OSA (apnea-hypopnea index = 42) to our obesity clinic after refusing bariatric surgery. She was treated with a very-low-calorie diet for 6 months followed by a low-calorie diet for another 10 months combined with a progressive moderate-intensity exercise program and close medical supervision by a multidisciplinary management team. With treatment, she was able to reduce her weight by 38% (current BMI = 34.6 kg/m²), decrease her neck circumference by 17% (currently 35 cm), and discontinue OSA treatment with continuous positive airway pressure.

Conclusion: This case demonstrates that the use of dietary modification combined with physical activity may be a safe and effective option for improving OSA in obese patients. In particular, physical activity may be beneficial for the management of OSA for reasons beyond facilitating weight loss.