Obesity is a predisposing factor for obstructive sleep apnea (OSA), and with a global obesity epidemic both are on the rise. OSA is far more common in men than in women and is usually less severe in women, but with age and menopausal changes women are just as susceptible. This is due to metabolic and hormonal changes that alter upper airway muscle tone and fat distribution and incidence increases to 80% in obese postmenopausal women.
Aside from HRT, CPAP and weight loss interventions are the most common treatment pathways, however, with a lowered metabolic rate weight loss can be difficult. Choosing a diet plan can be especially tricky – should you follow the traditional low fat diet? Calorie deficit? Mediterranean? A recent study by Franklin et al. of Umea University Sweden may have the answer in a comparison of weight loss and sleep apnoea improvements in women following either a low-fat or palaeolithic diet.
Subjects were 70 healthy post-menopausal women with a BMI exceeding 27kg/m2. They were assigned to two dietary intervention groups, with half on a low fat diet and half on the palaeolithic diet. Sleep study recordings, daytime sleepiness scores and height and weight measurements were taken prior to intervention, then at 6, 12, 18 and 24 months following. The number of obstructive events (apnoeas and hypopnoeas) recorded during each sleep study were scored on the Apnoea Hypopnoea index (AHI). The relationship between change in weight loss and change in AHI was then calculated to determine if weight loss improved OSA.
Women in the paleo group lost more weight than women in the low fat group, averaging a 7.2 and 3.9 kg loss respectively. In the paleo group weight loss correlated with a linear reduction in AHI, indicating decreased apnoea severity with intervention. In this group, the minimum weight loss required to produce a significant reduction in AHI was 8kg. In the low-fat group there was no significant correlation between change in weight and change in apnoea severity. There was no significant difference in daytime sleepiness between the two groups.
These findings are clinically significant as they highlight that by losing as little as 8 kg, postmenopausal women with OSA can lower their AHI and improve their quality of sleep and life. As a culture we tend to view non-traditional diets with scepticism, but in this instance at least, paleo appears to be the way to go. This emphasises the importance of nutrition education and taking a holistic approach to sleep disorder treatment.
To learn more about this research read the original study at
https://pubmed.ncbi.nlm.nih.gov/35879528/. For more information on the effect of menopause
