Obesity and Obstructive Sleep Apnea
Obstructive sleep apnea is a common and serious disorder in which Although childhood obesity may cause obstructive sleep apnea. Obesity has long been recognised as the most important reversible risk factor for A number of trials have demonstrated no substantial impact of CPAP on. The majority of our patients are obese. There seems to be a relationship between obesity and obstructive sleep apnea; however, we have to point out that not.
Our understanding of the implications of obstructive sleep apnea OSA on disease pathophysiology has been evolving rapidly.Sleep Apnea Obesity
OSA is thought to adversely affect multiple organs and systems and may be especially relevant to cardiovascular disease. The prevalence of OSA and its consequences are likely to increase in light of the current obesity epidemic.
Obesity and Obstructive Sleep Apnea - Obesity Medicine AssociationObesity Medicine Association
However, despite the benefits of CPAP therapy seen in numerous clinical trials, 16 noncompliance is evident in a significant proportion of patients, 1718 suggesting that other therapies are needed. Epidemiology of OSA The best prevalence estimates of OSA in the general population are derived from six large studies conducted worldwide.
OSA is also affected by age, as prevalence increases until age 65 years, when for unclear reasons the prevalence reaches a plateau.
However, these results might be explained by the poor diagnostic performance of BMI in detecting an excess of body fat in the elderly. However, because of the important interaction between OSA and body weight, this subject is discussed below in greater detail.
- Interactions Between Obesity and Obstructive Sleep Apnea
- The relationship of obesity and obstructive sleep apnea.
These findings highlight the need to develop screening and prevention for these conditions, even as early as in childhood. It is possible that obesity may worsen OSA because of fat deposition at specific sites.
Fat deposition in the tissues surrounding the upper airway appears to result in a smaller lumen and increased collapsibility of the upper airway, predisposing to apnea.
Although there is compelling evidence showing that obesity, as well as visceral obesity, may predispose to OSA, and that losing weight results in OSA improvement, recent studies suggest that OSA may itself cause weight gain. Patel et al 40 reported a significant correlation between AHI and anthropomorphic adiposity measures ranging from 0.
Obesity and Obstructive Sleep Apnea
Specific molecular signaling pathways encode differences in the distribution and metabolic activity of adipose tissue. These differences can produce alterations in the mechanical and neural control of upper airway collapsibility, which determine sleep apnea susceptibility. Although weight loss reduces upper airway collapsibility during sleep, it is not known whether its effects are mediated primarily by improvement in upper airway mechanical properties or neuromuscular control.
A variety of behavioral, pharmacologic, and surgical approaches to weight loss may be of benefit to patients with sleep apnea, through distinct effects on the mass and activity of regional adipose stores.
Interactions Between Obesity and Obstructive Sleep Apnea
Examining responses to specific weight loss strategies will provide critical insight into mechanisms linking obesity and sleep apnea, and will help to elucidate the humoral and molecular predictors of weight loss responses. It is characterized primarily by recurrent occlusion of the upper airway that results in oxyhemoglobin desaturation and periodic arousals from sleep 2.
It now appears that even mild to moderate sleep apnea is associated with the development of hypertension, diabetes mellitus 3and cardiovascular risk 45.
With increasing obesity, sleep apnea can contribute to the development of daytime alveolar hypoventilation obesity hypoventilation syndromecor pulmonale, and frank respiratory failure 67. Thus, given its high prevalence and morbidity, sleep apnea poses a significant clinical burden to Western society.
Concerns about the health impact of sleep apnea have been increasing in light of the growing epidemic of obesity in Western society and worldwide 89. Current data from the Behavioral Risk Factor Surveillance System indicate that increases in severe obesity have disproportionately affected African Americans, women, young adults, and those of lower socioeconomic status in American society 89and clinical data from bariatric case series document the presence of sleep apnea in the vast majority of the severely obese Nevertheless, the mechanisms linking obesity to the development and progression of sleep apnea remain unclear.
Among these, obesity is one of the strongest sleep apnea risk factors 12 — Mild to moderate obesity has been associated with markedly increased sleep apnea prevalence 314 It is well recognized that male sex also constitutes a particularly strong risk factor and confers a two- to threefold increased risk of sleep apnea in the population at large 14 This increased risk may be related to the differences in the distribution of adipose tissue in men 28 — 30who exhibit a predominantly central fat deposition pattern around the neck, trunk, and abdominal viscera compared with women 31 ,