Abstract
Background: Evidence suggests that continuous positive airway pressure (CPAP) treatment promotes weight gain in obstructive sleep apnea (OSA) patients. However, it is unclear whether weight gain is influenced by CPAP adherence or comorbid disorders.
Methods: In this systematic review and meta-analysis, we searched PubMed/Medline, Embase and Cochrane through to December 2019. Randomized controlled trials (RCTs) of CPAP versus controls with at least 4 weeks treatment were included. The random or fixed effects model was conducted in presence or absence of heterogeneity respectively. This study is registered with PROSPERO (CRD 42018105839).
Findings: A total of 39 RCTs with 3510 subjects in the CPAP group and 3444 subjects in the control group were included. In intention-to-treat analysis, BMI increased significantly after CPAP treatment compared to controls (WMD=0·148 kg/m2, 95%CI=0·04-0·26, P=0·010). In studies demonstrating an increase in BMI, waist and neck circumferences were also significantly increased. Subgroup-analyses revealed that increased BMI was attributable to CPAP use of ≤5 hours/night (WMD=0·231), but not in those with CPAP use of >5 hours/night (WMD=0·001, between-group P-value=0·049). Furthermore, BMI increased significantly in patients without cardiovascular disease (CVD, WMD=0·200), whereas decreased significantly in those with CVD at baseline (WMD=-0·188, between-group P-value<0·001). Moreover, BMI increased significantly in patients with dysglycemia (WMD=0·499), but not in those without dysglycemia at baseline (WMD=0·100, between-group P-value=0·032). Meta-regression showed that CPAP use of ≤5 hours/night, absence of CVD and presence of dysglycemia at baseline predict post-CPAP BMI increase.
Interpretation: BMI increased significantly in OSA patients after CPAP treatment, especially in those with CPAP use of ≤5 hours/night, without CVD and/or with dysglycemia at baseline. Decreased BMI in CVD patients might be related to favorable effects of CPAP treatment on excess fluid. CPAP use of at least 5 hours/night seems to be necessary in mitigating the risk for weight gain in OSA patients.
Methods: In this systematic review and meta-analysis, we searched PubMed/Medline, Embase and Cochrane through to December 2019. Randomized controlled trials (RCTs) of CPAP versus controls with at least 4 weeks treatment were included. The random or fixed effects model was conducted in presence or absence of heterogeneity respectively. This study is registered with PROSPERO (CRD 42018105839).
Findings: A total of 39 RCTs with 3510 subjects in the CPAP group and 3444 subjects in the control group were included. In intention-to-treat analysis, BMI increased significantly after CPAP treatment compared to controls (WMD=0·148 kg/m2, 95%CI=0·04-0·26, P=0·010). In studies demonstrating an increase in BMI, waist and neck circumferences were also significantly increased. Subgroup-analyses revealed that increased BMI was attributable to CPAP use of ≤5 hours/night (WMD=0·231), but not in those with CPAP use of >5 hours/night (WMD=0·001, between-group P-value=0·049). Furthermore, BMI increased significantly in patients without cardiovascular disease (CVD, WMD=0·200), whereas decreased significantly in those with CVD at baseline (WMD=-0·188, between-group P-value<0·001). Moreover, BMI increased significantly in patients with dysglycemia (WMD=0·499), but not in those without dysglycemia at baseline (WMD=0·100, between-group P-value=0·032). Meta-regression showed that CPAP use of ≤5 hours/night, absence of CVD and presence of dysglycemia at baseline predict post-CPAP BMI increase.
Interpretation: BMI increased significantly in OSA patients after CPAP treatment, especially in those with CPAP use of ≤5 hours/night, without CVD and/or with dysglycemia at baseline. Decreased BMI in CVD patients might be related to favorable effects of CPAP treatment on excess fluid. CPAP use of at least 5 hours/night seems to be necessary in mitigating the risk for weight gain in OSA patients.
| Original language | English |
|---|---|
| Number of pages | 39 |
| DOIs | |
| Publication status | Submitted - 23 Oct 2020 |
| Externally published | Yes |
Publication series
| Name | SSRN |
|---|