Article record

阻塞性睡眠呼吸暂停减重自我导向干预的实用性试验（POWER）

Pragmatic trial of a self-directed intervention for weight loss in obstructive sleep apnea (POWER).

临床研究耳科IF 21.2Q1

文献信息

PMID	42960868
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Lucas M Donovan 查看其他 14 位作者 Jennifer A McDowell；Pramit Maskey；Kevin Josey；Anthony F Bais；Robert Plumley；Krista Dashtestani；Aristotle G Leonhard；Travis Hee Wai；Anna P Pannick；James Pai；Steven B Zeliadt；Katherine D Hoerster；Jun Ma；David H Au
作者单位	Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA. 查看其他 5 条单位信息 University of Washington, Seattle, WA.；University of Colorado Anschutz Medical Campus, Aurora, CO.；Washington Center for Bleeding Disorders, Seattle, WA.；Tulane University, School of Medicine. New Orleans, LA.；University of Illinois Chicago, Chicago, IL.
期刊	American journal of respiratory and critical care medicine
SCI 分区	Q1
IF	21.2
研究类型	临床研究 · 临床
所属专科	耳科

中文摘要

背景： 自我导向的生活方式干预可能改善阻塞性睡眠呼吸暂停（OSA）患者获得减重照护的机会，但其在常规实践中的有效性尚不清楚。
目的： 检验主动提供的自我导向生活方式干预与常规照护相比，是否能改善体重和睡眠相关生活质量。
方法： POWER研究纳入OSA且体重指数为30-45 kg/m2的患者，从全国退伍军人事务（VA）中心招募，并将参与者随机分配至基于糖尿病预防计划的自我导向干预（包括视频课程、阅读材料和定期教练提醒）或常规照护。共同主要结局为从基线至随机化后12个月功能性睡眠结局问卷（FOSQ）的变化和临床体重（千克，kg）的变化。鉴于有两个主要结局，我们将显著性定义为p = 0.025。
测量与主要结果： 本试验随机分配了696名参与者。平均年龄为56.2岁（SD 12.2），19.7%自认为女性。12个月时临床体重数据在干预组可获得81.9%、对照组可获得83.6%。未校正体重在干预组下降2.1 kg（SD 6.8），对照组下降0.9 kg（SD 5.9）（校正组间差异：-1.1 kg，95%CI -2.0, -0.1；p = 0.037）。12个月时FOSQ数据在干预组可获得78.2%、对照组可获得90.5%。从基线至12个月，未校正FOSQ在干预组改善1.4分（SD 2.7），对照组改善0.9分（SD 2.9）（校正组间差异：0.6分，95%CI 0.2, 1.0；p = 0.001）。
结论与意义： 在OSA合并肥胖的参与者中，自我导向生活方式干预未改善减重，并导致睡眠相关生活质量的改善，但临床重要性有限。
试验注册： Clinicaltrials.gov NCT05104450，注册日期2021年10月19日。

英文摘要

RATIONALE: Self-directed lifestyle interventions may improve access to weight loss care in obstructive sleep apnea (OSA), but effectiveness in routine practice is unknown.
OBJECTIVE: Test whether a proactively delivered self-directed lifestyle intervention improves weight and sleep-related quality of life versus usual care.
METHODS: POWER enrolled patients with OSA and body mass index of 30-45 kg/m2, recruited from Veteran Affairs (VA) sites nationwide, and randomized participants to a self-directed intervention based on the Diabetes Prevention Program with video-based sessions, readings, and regular coaching reminders or usual care. Co-primary outcomes were change in Functional Outcomes of Sleep Questionnaire (FOSQ) and clinical weight in kilograms (kg) from baseline to 12 months post-randomization. Given two primary outcomes, we defined significance at p = 0.025.
MEASUREMENTS AND MAIN RESULTS: This trial randomized 696 participants. Mean age was 56.2 years (SD 12.2), with 19.7% identifying as female. Clinical weights at 12 months were available for 81.9% of intervention and 83.6% of control participants. Unadjusted weight declined 2.1 kg (SD 6.8) in intervention and 0.9 kg (SD 5.9) in control (adjusted between-group difference: -1.1 kg, 95%CI -2.0, -0.1; p = 0.037). FOSQ measures were available at 12 months for 78.2% of intervention and 90.5% of control participants. From baseline to 12 months, unadjusted FOSQ improved 1.4 (SD 2.7) points in intervention and 0.9 (SD 2.9) points in control (adjusted between-group difference: 0.6 points, 95%CI 0.2, 1.0; p = 0.001).
CONCLUSION AND RELEVANCE: Among participants with OSA and obesity, a self-directed lifestyle intervention did not improve weight loss and led to improvements in sleep-related quality of life that are of limited clinical importance.
TRIAL REGISTRATION: Clinicaltrials.gov NCT05104450, registered 10/19/2021.