For most patients with Obstructive Sleep Apnoea (OSA), Continuous Positive Airway Pressure (CPAP) therapy is one of the most successful clinically proven treatment options. Despite an almost 100% success rate when used properly, CPAP therapy remains a therapy, not a cure, and doesn’t address the underlying cause of the disease.

OSA is a sleep disorder that causes breathing to stop and start during sleep, and left untreated, is a risk factor for a number of diseases, including cardiovascular disease, diabetes and some cancers.

“We know that obesity is a risk factor for OSA, and that significant weight loss can see up to a third of patients be ‘cured’ of their OSA,” said Dr Elizabeth Cayanan, an Exercise Physiologist and Nutritionist. She is currently investigating how an intensive weight loss program can be implemented in hospital for obese patients with chronic sleep apnoea.

The weight loss program, previously developed through her PhD, puts patients on a very low energy diet (VLED) for three months, followed by a clinician-led maintenance program of 3 months and then 6 months self-maintenance. Throughout, patients are educated about how to maintain a healthy diet lifestyle after the program ends.

The original pilot trial was a success: on average, each patient lost 13.5kg, with very minimal weight regain during the maintenance period.

“We saw that our patients could sustain their weight loss, and the evidence seemed to suggest that they had improvements in their general cardio-metabolic health and sleep,” she said.

Now, Dr Cayanan has received SHP Rapid Applied Research Translation funding to test whether the tentative improvements in sleep apnoea can be confirmed with a larger group of patients, in a hospital setting.

SLEEP (Sleep, Lifestyle, Eating, Energy, Exercise Program) has been implemented at the Royal Prince Alfred Hospital’s Sleep Disorders Clinic. “We wanted to see whether we could replicate the program in a hospital setting, offering our weight loss program to patients the same way we offer CPAP,” she said. 

Preliminary results show the program is working – a total of 391kg has been lost by 32 patients in less than 12 months, with only a small number of patients dropping out of the study – a bonus for an extreme diet.

“It’s been well-received by both patients and referring clinicians. The department has not seen successful weight loss to this degree in the past in their unit,” Dr Cayanan said.

Aside from helping patients lose weight – and all of the associated health improvements that come with it – the program has helped develop a more collaborative approach to treating patients with sleep apnoea.

“It’s really fostered a lot of communication with other departments of the hospital, and proactively brought the focus to a patient’s weight, which wasn’t the case before,” said Dr Cayanan. “Clinicians were used to seeing a person with sleep apnoea and focused on treating that, without tackling their weight as an issue due to the limited resources available.”

“Weight loss programs also weren’t readily available to all those patients because of hospital waiting lists, so the availability of SLEEEP has been enormously beneficial to this department.”