A self-directed weight programme did little for veterans with sleep apnoea

Design

Pragmatic randomised controlled trial

Population

696 US veterans with OSA and BMI 30–45

Primary outcome

Weight and FOSQ change at 12 months

Effect

Weight −1.1 kg (−2.0 to −0.1; p = 0.037, threshold 0.025); FOSQ +0.6 (0.2–1.0)

POWER was a pragmatic trial across US Veterans Affairs sites that randomised 696 patients with OSA and a BMI of 30 to 45 to a self-directed lifestyle programme based on the Diabetes Prevention Program — videos, reading and coaching reminders — or usual care.

At 12 months, weight fell 2.1 kg with the programme and 0.9 kg with usual care (adjusted difference −1.1 kg), which did not meet the trial's significance threshold of p = 0.025. Sleep-related quality of life improved slightly more with the programme (0.6 points on the FOSQ), a difference the authors judged of limited clinical importance. Most participants were men.

Weight loss helps OSA, but self-directed programmes without much human contact produced too little of it here. Patients with OSA and obesity are likely to need more intensive support or pharmacotherapy to lose meaningful weight.

• Do not rely on self-directed lifestyle materials alone for weight loss in OSA.
• Offer more intensive behavioural support or consider pharmacotherapy where weight loss is a goal.
• Continue CPAP or other OSA treatment while working on weight.
• Set realistic expectations: modest weight change rarely resolves OSA.

Why it matters

Low-cost digital programmes are appealing, but this one did not deliver meaningful weight loss.

The statistics, in plain English

A 1.1 kg difference (95% CI −2.0 to −0.1) is small, and with two co-primary outcomes the trial required p below 0.025; p = 0.037 did not meet that.

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