COMPREHENSIVE EVALUATION OF ADIPO-METABOLIC AND INFLAMMATORY RESPONSES TO CONTINUOUS POSITIVE AIRWAY PRESSURE COMBINED WITH STRUCTURED LIFESTYLE MODIFICATION AND PRANAYAMA IN OBESE NON-DIABETIC PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

Abstract

Background: Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder closely associated with obesity, chronic low-grade inflammation, and adipokine dysregulation. Although continuous positive airway pressure (CPAP) effectively alleviates upper airway obstruction and improves sleep-disordered breathing, its effects on obesity related metabolic abnormalities are often limited. Adjunctive lifestyle interventions and breathing exercises may enhance therapeutic outcomes by improving metabolic homeostasis, inflammatory status, and sleep quality. Objectives: To evaluate and compare the effects of CPAP alone, CPAP combined with structured lifestyle modification, and CPAP combined with pranayama on polysomnographic parameters, anthropometric indices, adipokines, inflammatory biomarkers, and lipid profile in obese non-diabetic patients with obstructive sleep apnea. Methods: This prospective interventional study included 61 obese non-diabetic adults with obstructive sleep apnea confirmed by overnight polysomnography. After confirmation of eligibility and obtaining written informed consent, participants were consecutively enrolled and allocated to one of the three intervention groups according to the predefined treatment protocol. Group 1 received CPAP alone (n = 17), Group 2 received CPAP combined with structured lifestyle modification (n = 24), and Group 3 received CPAP combined with pranayama (n = 20). Anthropometric measurements, polysomnographic indices (apnea-hypopnea index, sleep efficiency, sleep stages, mean oxygen saturation and Epworth Sleepiness Scale), adipokines (leptin, adiponectin and ghrelin), interleukin-6, and lipid profile were assessed before and after the intervention. Data were analyzed using paired Student's t-test, one-way ANOVA with appropriate post-hoc comparisons, and Pearson correlation analysis. A p value <0.05 was considered statistically significant. Results: All three interventions markedly improved polysomnographic, anthropometric, metabolic, inflammatory, and adipokine parameters (p<0.05). Significant reductions were observed in apnea-hypopnea index, Epworth Sleepiness Scale scores, leptin, ghrelin, interleukin-6, body mass index, and atherogenic lipid indices, accompanied by significant increases in adiponectin, sleep efficiency, rapid eye movement sleep, and mean nocturnal oxygen saturation. Overall, the CPAP plus structured lifestyle modification group demonstrated the greatest improvements in anthropometric measurements, adipokine profile, inflammatory status, and lipid parameters, whereas the CPAP plus pranayama group showed the most pronounced improvement in apnea-hypopnea index, rapid eye movement sleep, mean oxygen saturation, and selected sleep architecture parameters. Correlation analysis demonstrated significant associations between reductions in apnea hypopnea index and improvements in sleep efficiency, oxygen saturation, Epworth Sleepiness Scale scores, adipokines, and inflammatory markers. Conclusion: CPAP therapy significantly improved respiratory function, metabolic profile, inflammatory status and adipokine homeostasis in obese non-diabetic patients with obstructive sleep apnea. The addition of structured lifestyle modification produced the greatest overall improvement in cardiometabolic and anthropometric outcomes, while adjunctive pranayama provided additional benefits in selected polysomnographic and oxygenation parameters. These findings support the integration of structured lifestyle modification with CPAP as a comprehensive management strategy for obesity-associated OSA, while suggesting a complementary role for pranayama in optimizing sleep physiology and nocturnal oxygenation.