Literature Review: A Roundup of Important Recent Studies

—Reviewed by Stacey Ishman, MD

Improvements in OSA After Weight Loss in Obese Diabetic Patients Even After Weight Regain

Do improvements in obstructive sleep apnea after initial weight loss persist over time in adults with type 2 diabetes and obesity?

Background: Weight loss has been shown to improve OSA in obese adults; however, there is little data looking at the long-term effect of an initial significant weight loss on these patients.

Study design: Multi-center randomized controlled trial (Look AHEAD-Action for Health in Diabetes) evaluating an intensive behavioral weight management (BWM) program with a diabetes education (DE) program. Patients had body mass index (BMI) higher than 25 kg/m2 and underwent unattended home studies to evaluate the effect of weight loss on OSA over four years.

Setting: Four academic medical centers involved in the Look AHEAD trial.

Synopsis: OSA was seen in 264/305 adults aged 45 to 76 (59 percent female); 165 completed year four follow-up. The overall baseline BMI was 36.6 ± 5.7. The BWM group dropped 10.7 ± 0.7, 7.4 ± 0.7 and 5.2 ± 0.7 kg at one, two and four years, respectively, while the DE group dropped less than 1 kg at each time point (p <0.001). Additionally, the apnea-hypopnea index (AHI) was lower in the BWM group by 9.7 ± 2.0, 8.0 ± 2.0 and 7.7 ± 2.3 events/hour at one, two and four years (p <0.001). Those in the BWM group were significantly more likely to improve AHI than those in the DE group. Few study participants were treated for OSA despite identification in this study. Limitations include the fact that those without baseline OSA were excluded and that there was a 38 percent dropout rate over time; it is also unknown whether these patients developed OSA over time.

Bottom line: Improvements in OSA disease severity appear to persist over time in obese diabetic adults despite moderate weight regain. Behavioral medical interventions are much more likely to result in weight loss than diabetes education programs.

Reference: Kuna ST, Reboussin DM, Borradaile KE, et al. Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep. 2013;36:641-649.

—Reviewed by Stacey Ishman, MD

ESS a Viable Choice for Children with CRS and Failed Therapies

Is endoscopic sinus surgery (ESS) a viable alternative for children with chronic rhinosinusitis (CRS)?

Background: CRS is a common problem in children, and multiple treatment strategies exist. When medical therapies fail, surgical options, including adenoidectomy, balloon catheter sinuplasty (BCS) and ESS, can be used. There are concerns, however, that ESS may cause growth retardation of the face in children.