Obstructive sleep apnea, a potentially serious condition that causes breathing to repeatedly stop and restart while asleep, is one of the most common chronic health conditions worldwide.
And its prevalence is on the rise.
According to a 2024 study conducted by researchers from McGill University in Montreal, 28 per cent of Canadian adults, aged 45 to 85, are estimated to be living with moderate or severe obstructive sleep apnea (OSA).
What’s more, one in four Canadians are at high risk for developing obstructive sleep apnea, according to the Canadian Lung Association.
Reducing excess weight, even modestly, has been shown to reduce sleep apnea severity.
Difficulty sleeping? Consider your diet
Recently, though, mounting evidence has shown that improving overall diet quality, regardless of calorie intake, can lessen sleep apnea symptoms, as well as the risk of its associated health conditions.
Here’s a look at the evidence, along with diet and lifestyle recommendations to help reduce obstructive sleep apnea.
What is obstructive sleep apnea (OSA)?
OSA occurs when the upper airways get completely or partially blocked during sleep, causing breathing pauses, called apneas, that can happen many times throughout the night.
Symptoms of OSA can include excessive daytime sleepiness, morning headache, difficulties with memory and concentration, moodiness, loud snoring and awakening due to gasping or choking during sleep.
Obesity is the strongest risk factor for OSA. Fat deposits in the neck can block upper airways and obstruct breathing during sleep.
A large or thick neck (greater than 41 cm for women and 43 cm for men) is also a risk factor as it can narrow the upper airway.
Other risk factors include older age, being male, postmenopause, family history, smoking and drinking alcohol.
Sleep apnea complications, treatments
Breathing disruptions during sleep can result in body tissues being exposed to low levels of oxygen, too much carbon dioxide in the bloodstream, inflammation and oxidative stress.
OSA is associated with considerable increased risks of hypertension, coronary heart disease, stroke and type 2 diabetes.
Treatments for OSA can include sleeping with a CPAP (continuous positive airway pressure) machine and mask, wearing a dental appliance that keeps airways open during sleep, positional therapy that keeps you sleeping on your side and lifestyle changes.
Diet + lifestyle changes reduce sleep apnea severity
The INTERAPNEA randomized clinical trial from Spain, published in 2022, found that among 89 men with moderate or severe OSA receiving CPAP therapy, those who were assigned to an eight-week healthy lifestyle program experienced considerable and sustained improvements in OSA severity.
Participants were counselled to eat more fruits and vegetables, pulses, nuts, fish, extra virgin olive oil and herbs and reduce consumption of ultra-processed foods, red and processed meats and alcoholic beverages.
They were also advised to increase aerobic physical activity, quit smoking and improve sleep hygiene.
The control group received general tips on weight loss and lifestyle changes in the form of a brochure, along with CPAP therapy.
After eight weeks, the healthy lifestyle group achieved a 51-per-cent reduction in apnea episodes during sleep. As well, 45 per cent of participants no longer required CPAP therapy and 15 per cent achieved complete remission of OSA. They also lost an average of 16 pounds.
Six months later, improvements were sustained – 62 per cent no longer needed CPAP therapy, 29 per cent had remission of OSA and weight loss was maintained.
The control group experienced little to no improvement in apnea episodes and body weight.
A 2021 clinical trial involving 180 overweight men and women with moderate-to-severe OSA using CPAP therapy showed that the addition of a “Mediterranean/lifestyle intervention” led to greater improvements in OSA severity and symptoms.
The benefits were evident regardless of CPAP use or weight loss.
The “Mediterranean lifestyle” group was given advice to increase adherence to the Mediterranean diet, add physical activity and improve sleep hygiene.
Observational studies published in 2022 have also linked a pro-inflammatory diet to a significantly higher risk of having obstructive sleep apnea.
On the other hand, eating a high-quality diet, especially one with a higher anti-inflammatory potential, has been associated with protection from OSA.
Takeaways
Growing evidence supports lifestyle recommendations – and in particular diet – on top of standard care for reducing OSA severity.
A high-quality diet that’s made up of anti-inflammatory foods is thought to reduce the chronic inflammation and metabolic dysfunction that’s involved in the development and progression of OSA.
The researchers of the INTERAPNEA trial concluded that healthy lifestyle interventions and weight loss should be considered “as a central strategy to address obstructive sleep apnea.”
Obstructive sleep apnea is often undiagnosed or diagnosed after many years of experiencing symptoms. Consult your health care provider if you think you may have sleep apnea.
Leslie Beck, a Toronto-based private practice dietitian, is director of food and nutrition at Medcan. Follow her on X @LeslieBeckRD
