A patient with obstructive sleep apnea was monitored five times during three years while his weight fluctuated within a range of 26 kg. The number of apneas per hour of sleep varied from 59.6 at 111 kg of weight to 3.1 at 85 kg. The relation between apneas per hour of sleep and body weight was a logarithmic function. A modest decrease in weight was thus associated with a disproportionally larger decrease in the rate of apneas. Typical SaO 2 levels during the apneic episodes also had a logarithmic relation with body weight. Apnea-related sinus bradycardia and sinus tachycardia were only present at the highest weight. The results suggested that dieting and weight loss lead to an improvement in sleep apnea and related sequelae.Obstructive sleep apnea syndrome is characterized by a repetitive and periodic occlusion of the upper airway during sleep. The mechanisms involved in this disorder are not well understood at present. 1 Obesity is seen in the majority of patients with sleep apnea. Redundant tissue in the oropharyngeal airway associated with obesity is thought to be a contributing factor. Surgical intervention by tracheostomy or uvulo-palato-pharyngoplasty is the treatment of choice, especially in the presence of apneic-induced cardiac arrhythmias, but case reports have suggested improvement in the obstructive sleep apnea and related sequelae following weight loss. 2-4 The exact relation between this syndrome and body weight remains ambiguous, however, as previous reports are based on single observations following weight reduction. We have monitored the sleep of a patient with obstructive sleep apnea five times during the course of nearly three years while his weight fluctuated from 85 kg to 111 kg. A logarithmic relation between the rate of apneas during sleep and body weight is demonstrated by this patient. Case ReportA 52-year-old white man was referred for evaluation of uncontrolled daytime sleepiness. The patient reported a 19-year history of hypersomnia and falling asleep at inappropriate times. Symptoms were reported as relatively stable over the past ten years. The patient noted loud snoring and excessive sweating during sleep. Although he denied cataplexy, hypnagogic hallucinations and sleep paralysis, narcolepsy was diagnosed two years prior to our evaluation based solely on the reported hypersomnia.Physical examination revealed an obese man (173 cm tall, weighing 111 kg), extremely drowsy, but otherwise in no distress. Pertinent medical disorders included essential systemic

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AM very pleased to have the opportunity to join this Conference of State Chief Psychologists and Psychologists of the United States Public Health Service. Meetings such as this between state professionals and those in the Federal establishment typify our close alliance on behalf of public health, and I speak as a colleague devoted to a cause we share in common.In your strategic posts as administrators and leaders of your profession throughout the states, you have been in key positions to affect the role of the psychologist in that most significant pursuit of interest to us all-the strengthening of the mental health of our society.Today, the swift movement of events in both the fields of mental health and of social action presents all mental health professionals with fresh opportunity and equally fresh challenge. Just a few weeks ago President Johnson signed into law new mental health legislation which brings even closer to realization the community mental health services we have tried for many years to make available to all our citizens.Under this new amendment to the Community Mental Health Centers Act of 1963, Federal aid will help pay the cost of staff as the centers get underway. This support, coupled with the Federal assistance for construction, means that the mental health professions can and must devise within the community mental health center model ways for the most effective practice of their respective disciplines.It was the Roman General Fabius who said of his famous adversary, Hannibal, "You know, Hannibal, how to gain a victory, but not how to use it." If the mental health of this nation has gained a victory in the current move toward community care and prevention of the mental illnesses, we are now called upon to use the skills and knowledge of

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