People living with obstructive sleep apnoea (OSA) experience frequent sleep disturbances and overnight awakenings due to recurrent collapse of the upper airway during sleep. With 76% of people with OSA presenting with overweight/obesity,1 weight loss interventions serve as guidelines of standard care.2 Late food intake has been identified as a potential risk factor associated with sleep disturbances and apnoea severity,3 whereby patients with moderate to severe OSA were more likely to engage in overnight food intake.4 Time-restricted eating (TRE) involves limiting the daily eating window up to 10 hours and extending the overnight fast, promoting weight loss and the alignment of intake timings with circadian rhythms of sleep and energy metabolism. However, the feasibility of implementing TRE within sleep-disrupted lifestyles such as OSA is unclear. To explore this, we conducted a qualitative study to explore the potential enablers and barriers of implementing/adhering to TRE among people with OSA and overweight/obesity.
Two groups of participants were recruited: (1) individuals with OSA (and their partners, if applicable), and (2) health professionals working with clients with OSA. Semi-structured interviews were conducted, along with a brief presentation on the background and applications of TRE, to gather the perceived motivations/challenges from participants. An inductive thematic analysis was conducted, with identified themes then mapped to the Social Ecological Model (SEM) and Capability, Opportunity, Motivation-Behaviour (COM-B) frameworks to facilitate interpretation of findings.
Twenty-eight individuals with OSA (10M/18F; age 56.2 ± 12.2 y; BMI 34.4 ± 5.1 kg/m2), 10 including their bed partners, and seven health professionals (five sleep clinicians, and two dietitians) completed the interviews. Analysis resulted in three emerging themes and 20 subthemes: (1) Impacts of OSA, lifestyle and individual motivation; (2) Influences from partner, family and social connections; and (3) Gaps and potential areas for support in multidisciplinary OSA patient care. Overall, TRE was well-received for uptake among individuals with OSA, with simplicity, flexibility and reasonable adjustments to current dietary patterns cited as key enablers. Health professionals also highlighted the role of TRE in minimizing night intake. However, potential barriers include the lack of motivation and noticeable changes in health; social influences, comorbidities and tiredness that impede adherence; and limited guidance and resources pertaining to TRE/OSA in dietetic settings. While most participants expressed interest towards a later TRE window, concerns towards breakfast skipping and diet quality were raised among health professionals. Suggested measures to address these barriers include establishing internal motivation, satiety management, support from partners and family, and personalized guidance from health professionals. The availability of evidence-based resources was deemed important to guide both patients and professionals in the implementation of TRE. These findings could guide the design and implementation of future dietary intervention trials assessing the effectiveness of TRE among individuals with OSA.