Objectives: This longitudinal, clinical intervention study was designed to investigate whether pulmonary departments can set up a cost-effective weight and lifestyle programme as primary treatment of obstructive sleep apnoea syndrome (OSAS).
Setting: A weight reduction programme (1 year) in a pulmonary department for outpatients in Helsinki University Central Hospital.
Subjects: A total of 24 (23 men) moderately obese (body mass index [BMI], 30-40 kg m(-2)) patients with newly diagnosed OSAS. Interventions. The first 6 weeks consisted of a very low-calorie diet (VLCD, 500 kcal day(-1)) and thereafter normal food low in calories. There were altogether 12 group meetings for behavioural management.
Main outcome measures: Daytime somnolence, BMI and oxygen desaturation index of 4% (ODI4) were measured prior to the programme, at the end of the VLCD phase and at 1 year.
Results: The programme was easy to administer without any serious side-effects. At 1 year, patients had lost a mean of 33% of their overweight (mean weight at baseline 110 kg, after 99 kg) and their ODI4 indexes improved significantly (P < 0.005). There was no correlation between the amount of weight loss and improvement in ODI4 indexes. The cost per patient was about half the cost of treatment with nCPAP (nasal continuous positive airway pressure) for 1 year at our hospital.
Conclusions: A nurse-managed programme with VLCD and behavioural management is safe and effective on an outpatient basis. Weight loss should be encouraged in OSAS in patients with moderate overweight. The amount of weight loss needed for improvement of OSAS is unique to each individual.