Clinical Edge

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Long-term CPAP use not linked to weight gain

Key clinical point: The SAVE trial found no evidence of clinically concerning levels of weight gain among patients with obstructive sleep apnea and comorbid cardiovascular disease.

Major finding: The difference in weight change for CPAP versus control in men was 0.07 kg and in women was –0.14 kg.

Study details: Post hoc analysis of the SAVE trial included 2,483 adults enrolled at 89 centers in seven countries.

Disclosures: The senior author of the study reported disclosures related to Philips Respironics, ResMed, Fisher & Paykel, Air Liquide, and the National Health and Medical Research Council of Australia.

Citation:

Ou Q et al. Chest. 2019 Apr;155(4):720-9.

Commentary:

This analysis of the Sleep Apnea Cardiovascular Endpoints (SAVE) trial had several strengths and a reassuring conclusion regarding lack of weight gain with long-term use of CPAP in patients with obstructive sleep apnea (OSA) and comorbid cardiovascular disease. However, the findings may be difficult to extrapolate to Western countries, according to authors of an editorial.

“It is conceivable that the results of the study would have been different if the predominant race of the participants had been Caucasian and had a higher BMI,” said Rohit Budhiraja, MBBS, and Stuart F. Quan, MD, in the editorial. Two-thirds of the patients in the were enrolled in China, the authors said, noting that it is “well established” that Asians with OSA are less often obese compared with Caucasians with OSA in Western countries.

For clinicians, the most important message of this analysis of the SAVE trial should be that weight loss did not occur, according to Dr. Budhiraja and Dr. Quan.

“A comprehensive approach to weight loss should be used, instead of the optimistic view that improved sleep quality and daytime symptoms will automatically translate into increase physical activity, better nutrition and weight loss,” they concluded in their editorial.

Dr. Budhiraja is affiliated with the Brigham and Women’s Hospital, and Harvard Medical School, both in Boston; Dr. Quan is affiliated with Harvard Medical School, Boston, and the University of Arizona Tucson. Their editorial appears in Chest ( 2019 Apr;155[4] 657-8 ). Dr. Budhiraja reported no conflicts of interest. Dr. Quan reported serving as a consultant for Jazz Pharmaceuticals and Best Doctors, along with grant funding from the National Institutes of Health.