Self-directed lifestyle intervention yields limited benefit in obstructive sleep apnea

The POWER pragmatic randomized trial enrolled 696 people with obstructive sleep apnea and a body mass index of 30–45 kg/m² at Veterans Affairs sites nationwide. Participants were assigned to usual care or a self-directed lifestyle intervention based on the Diabetes Prevention Program, delivered through video sessions, readings and regular coaching reminders. Co-primary outcomes were change in body weight and Functional Outcomes of Sleep Questionnaire (FOSQ) score at 12 months; significance was prespecified at p=0.025.

At 12 months, mean weight declined by 2.1 kg in the intervention group and 0.9 kg with usual care. The adjusted between-group difference was −1.1 kg (95% CI, −2.0 to −0.1; p=0.037), which did not meet the prespecified threshold. FOSQ scores improved by 1.4 and 0.9 points, respectively; the adjusted difference was 0.6 points (95% CI, 0.2 to 1.0; p=0.001). The investigators characterized the quality-of-life improvement as of limited clinical importance.

The findings do not establish a clinically important benefit from this self-directed program. Twelve-month outcome availability varied between groups, particularly for FOSQ scores. The trial was conducted in VA settings, and the abstract does not provide further details on generalizability to other populations.