Maintenance diets following rapid weight loss in obstructive sleep apnea: a pilot 1‐year clinical trial

Summary Very low energy diets ( VLED ) appear to be the most efficacious dietary‐based obesity reduction treatments in obstructive sleep apnea ( OSA ); however, effective weight loss maintenance strategies remain untested in this condition. Our study aimed to assess the feasibility, tolerability and efficacy of two common maintenance diets during a 10‐month follow‐up period after rapid weight loss using a 2‐month VLED . In this two‐arm, single‐centre, open‐label pilot trial, obese adult OSA patients received a 2‐month VLED before being allocated to either the Australian Guide to Healthy Eating diet ( AGHE ) or a low glycaemic index high‐protein diet ( LGHP ). Outcomes were measured at 0, 2 and 12 months. We recruited 44 patients [113.1 ± 19.5 kg, body mass index ( BMI ): 37.2 ± 5.6 kg m −2 , 49.3 ± 9.2 years, 12 females]. Twenty‐four patients were on continuous positive airway pressure ( CPAP ) or mandibular advancement splint ( MAS ) therapy for OSA . Forty‐two patients completed the VLED . The primary outcome of waist circumference was reduced by 10.6 cm at 2 months [95% confidence interval ( CI ): 9.2–12.1], and patients lost 12.9 kg in total weight (95%  CI : 11.2–14.6). There were small but statistically significant regains in waist circumference between 2 and 12 months [ AGHE  = 3.5 cm (1.3–5.6) and LGHP  = 2.8 cm (0.6–5.0]. Other outcomes followed a similar pattern of change. After weight loss with a 2‐month VLED in obese patients with OSA , a structured weight loss maintenance programme incorporating commonly used diets was feasible, tolerable and efficacious for 10 months. This programme may be deployed easily within sleep clinics; however, future research should first test its translation within general clinical practice.