Effect of a self-directed lifestyle-based weight management program among patients with comorbid COPD and sleep apnea: a secondary analysis of the INSIGHT COPD trial.

RATIONALE: Excess weight contributes to impaired physical function among individuals with chronic obstructive pulmonary disease (COPD) and sleep apnea. Self-directed lifestyle-based weight management programs are an accessible option to promote weight loss and improve physical function, but their effectiveness has not been clearly demonstrated.

OBJECTIVE

To test whether a self-directed lifestyle program improves 6-minute walk test (6MWT) distance among individuals with COPD and comorbid sleep apnea.

STUDY DESIGN AND

METHODS

We performed a subset analysis of participants previously enrolled in the INSIGHT-COPD randomized clinical trial (low-intensity lifestyle intervention vs usual care) who self-reported a diagnosis of sleep apnea. Our primary outcome was between-group differences for change in 6MWT distance (minimally important difference [MID] 30 m). Secondary outcomes included between-group differences in weight (a loss of 3% defines meaningful reduction) and quality of life (SF-12 Physical Component Score [PCS], MID 3-3.5 points). We also tested whether sleep apnea modified the effect of the intervention across the entire INSIGHT-COPD population.

MEASUREMENTS AND MAIN

RESULTS

Among 285 participants with sleep apnea (141 randomly allocated to intervention, 144 to usual care), those randomized to intervention could walk further (difference in 6MWT distance of 25.5 m, 95% CI 8.2 m to 42.9 m; 23.4% vs 20.1% had a MID increase in 6MWT distance) and had a greater reduction in weight (difference in weight of -2.4 kg, 95% CI -3.9 to -0.9 kg; 36.2% vs 23.6% had a 3% reduction in weight) at 12 months. The intervention group also reported a greater physical-function-related quality of life (difference in SF-12 PCS of 1.78 pts, 95% CI 0.10 to 3.49) in comparison to usual care at 12 months.

CONCLUSIONS

Among patients with COPD and sleep apnea, a self-directed video-based weight management program led to favorable changes in 6MWT distance compared to usual care, though this did not meet the threshold of a clinically important improvement. However, fewer participants in the intervention group saw a decline in 6MWT distance, and more achieved meaningful weight loss. To effectively improve function in this population, additional interventions beyond self-directed weight management will be necessary.Clinical trial registered with www.clinicaltrials.gov (NCT02634268).