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A very low calorie diet plus lifestyle counselling improved mild obstructive sleep apnoea in overweight patientsCommentary
  1. Diana E McMillan
  1. University of Manitoba, Faculty of Nursing, Winnipeg, Manitoba, Canada

Statistics from


Does a very low calorie diet (VLCD) plus intensive lifestyle counselling improve mild obstructive sleep apnoea (OSA) in overweight patients?



randomised controlled trial (RCT).


unclear allocation concealment.


blinded (outcome assessors).

Follow-up period:

1 year.


Kuopio University Hospital, Kuopio, Finland.


81 patients 18–65 years of age (mean age 51 y, 65% men) who had a body mass index of 28–40 kg/m2 and an apnoea-hypopnoea index (AHI) of 5–15 events/hour. Exclusion criteria were active treatment for OSA, pregnancy, and chronic kidney, thyroid, or liver disease.


a VLCD (600–800 kcal/d) for 12 weeks plus intensive lifestyle counselling for 1 year (n = 40) or general oral and written information about diet and exercise at baseline, 3-month, and 1-year visits (control) (n = 41).


included mild OSA and changes in weight, AHI, Snore Outcomes Survey (SOS), and Epworth Sleepiness Scale (ESS).

Patient follow-up:

89% (intention-to-treat analysis).

Main results

Fewer patients in the VLCD plus counselling group had mild OSA than in the control group (table). A VLCD plus counselling led to a greater reduction in weight and improvements in AHI and SOS scores compared with control (table); groups did not differ for ESS scores (table).

A very low calorie diet (VLCD) plus lifestyle counselling v general diet and exercise information (control) for mild obstructive sleep apnoea (OSA) in overweight patients*


A very low calorie diet plus intensive lifestyle counselling improved mild obstructive sleep apnoea in overweight adults.

Abstracted from

Tuomilehto HP, Seppa JM, Partinen MM, et al. Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med 2009;179:320–7.

Clinical impact ratings: Family/general practice 5/7; General/internal medicine 6/7; Obesity 6/7; Respirology 6/7


1 in 4 adults may be at risk of OSA,1 a disorder marked by frequent transient partial or complete blockage of the upper airway. Adverse consequences include hypertension, stroke, heart failure, glucose intolerance, fatigue, mental and motor impairment, and increased risk of cardiovascular death. Increased prevalence of obesity has contributed to a rise in the prevalence of OSA1 as fat deposits in the neck and submentum directly compress or indirectly narrow the airway, respectively.

Previous RCTs of diet plus behavioural intervention2 or diet plus behavioural intervention with or without continuous positive airway pressure (CPAP)3 provide support for paired weight reduction and lifestyle change regimens as first-line treatment for OSA. The study by Tuomilehto et al offers compelling support and is the first RCT to evaluate this combined approach in patients with mild OSA. This upstream approach has potential for broad positive health effects and reduced healthcare service demand. The intervention intensity seems clinically sound and feasible. Although the intervention is intuitively appealing, an economic analysis is needed to judge its cost-effectiveness compared with CPAP. Healthcare providers should note that OSA because of nasal, tongue, or facial-related obstruction, or low muscle tone is unlikely to be improved by this intervention; that weight loss effects on OSA are variable and not always curative; and that skilled treatment, supervision, and follow-up are required.


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  • Sources of funding Juho Vainio Foundation; Yrjö Jahnsson Foundation; Jalmari and Rauha Ahokkaan Foundation; Finnish Anti-Tuberculosis Foundation.

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