Losing To Gain

2,763. That’s the number of pounds that was weighing down the Season 7 contestants on NBC’s “The Biggest Loser: Couples Edition.” But those pounds no longer exist. The reality show’s rigorous regimen of weight training, exercise, diet and education gave its 22 contestants the means to lose, in some cases, almost half their body weight. They are also on their way to a better night’s sleep.

Show producers “considered the idea of getting sleep treatment for the contestants after someone wrote in about it,” says Pam Minkley, a clinical trainer for Murrysville, Pa.-based Philips Respironics. So in the fall of 2008, Minkley and other members of the company’s team set up a diagnostic system for the obese cast using a hotel as a 10-bed sleep center, complete with a monitoring station, for full overnight testing.

“We got great studies and great results,” Minkley says. “Sixteen of the 22 tested positive for OSA. Ultimately, 14 were on CPAP and two were on BiPAP.” Along with the sleep studies, the participants were given an overall health assessment and extensive education about sleep-disordered breathing.

The testing was done before the contestants’ move to the Biggest Loser Ranch, a Calabasas, Calif., location with a pool, gym and 588 acres of land. During filming, which can last up to 17 weeks, members of Minkley’s team stayed at the ranch for the first four weeks to guide the new sleep therapy patients.

“While they exercised on the first day, I was putting CPAP machines in their rooms, waiting for them to come back and do a setup. We were like a DME on the road, but patients didn’t come to us — we went to them,” she says. “We knew these people were in an unusual and stressful environment, so we felt we had to be right there to check the equipment’s efficacy.”

Philips Respironics provided the diagnostic tools (ProTech sensors, oximeters, electrodes and setup materials) and Alice 5 Diagnostic Sleep Systems. Therapeutic equipment from the company included the REMstar Auto M Series with A-Flex and BiPAP Pro with Bi-Flex, the EverFlo Q oxygen concentrator and a variety of masks. The contestants diagnosed with OSA were monitored using the Web-based patient compliance management system EncoreAnywhere with a combination of SmartCard downloads and modems.

“Through download, we could address any immediate needs to keep them treated,” Minkley says. “We then followed them intermittently throughout their time on the ranch with a monthly visit.”

Dr. Robert Huizenga, associate professor of Clinical Medicine at UCLA and onsite doctor for the show, could also view the patients’ results at any time.

As the contestants left for home, Minkley’s goal was maximum compliance. “We used our network of home care companies and sleep centers so we could find local help for [the contestants] at home,” Minkley says. “Some of the cast will still need to be on therapy, even after their weight loss.”

According to Minkley, providing information about healthy living is “a big thing” for “The Biggest Loser.” And now, so is getting the word out about OSA and restful sleep.

“It’s a huge public service for sleep centers and DME,” she notes, adding that none of the contestants had previously been tested for OSA. In one example she cites, before appearing on the show, one contestant literally had his wife call him on the phone to keep him awake as he drove to work everyday.

After seeing the contestants’ progress, Minkley says, “Hopefully, there will be people out there now who want to embark on a healthier lifestyle. They see the importance of the acceptance of apnea and give that as much thought as exercise and food.”

Positive Outcome

The 16 contestants with OSA were retested for the show’s finale.

Among the most notable results:

• At initial testing, the longest apnea was close to a minute. Now most of the 16 OSA patients do not have episodes that last longer than 10 seconds.
• The lowest oxygen saturation was around 50; now most are above 92.
• Beginning therapy, the highest CPAP pressure was 15 cmH20; now all contestants are below 8 cmH20.