Interactions Between Obesity and Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea (OSA) adversely affects multiple organs and systems, with particular relevance to cardiovascular disease. Several conditions associated with OSA, such as high BP, insulin resistance, systemic infl ammation, visceral fat deposition, and dyslipidemia, are also present in other conditions closely related to OSA, such as obesity and reduced sleep duration. Weight loss has been accompanied by improvement in characteristics related not only to obesity but to OSA as well, suggesting that weight loss might be a cornerstone of the treatment of both conditions. This review seeks to explore recent developments in understanding the interactions between body weight and OSA. Weight loss helps reduce OSA severity and attenuates the cardiometabolic abnormalities common to both diseases. Nevertheless, weight loss has been hard to achieve and maintain using conservative strategies. Since bariatric surgery has emerged as an alternative treatment of severe or complicated obesity, impressive results have often been seen with respect to sleep apnea severity and cardiometabolic disturbances. However, OSA is a complex condition, and treatment cannot be limited to any single symptom or feature of the disease. Rather, a multidisciplinary and integrated strategy is required to achieve effective and long-lasting therapeutic success.CHEST 2010; 137( 3 ): 711 -719Abbreviations: AHI 5 apnea-hypopnea index ; CPAP 5 continuous positive airway pressure ; HDL 5 high-density lipoprotein ; OSA 5 obstructive sleep apnea

Obstructive sleep apnoea and obesity

“…A number of clinical trials have been conducted to evaluate the usefulness of dietary restriction in patients with OSA, and these have yielded mixed results. 3 Some weight loss, even of a relatively small amount, can lead to a decrease in the patient's AHI. Although the relationship between the amount of weight lost, and the decline in AHI, is not linear, overall, it appears that for each kilogramme lost, the AHI decreases by 0.6-1/ hour.…”

“…26 Untreated OSA patients may have an increased appetite for refined carbohydrates, as well as increased ghrelin levels. 3 A recent trial comparing patients treated with diet alone, CPAP plus diet, and an oral appliance plus diet, found that only the group on CPAP therapy was able to lose a significant quantity of weight. 26 This suggests that CPAP therapy may be useful to treat OSA, and facilitate weight loss in these patients.…”

“…As the prevalence of obesity increases, there is likely to be a parallel increase in the prevalence of OSA. 3 The prevalence of OSA in the adult population is estimated to be about 25%, rising to 45% in obese individuals. 3 OSA is more common in men and the elderly, but can also occur in children and young adults.…”

Effect of laparoscopic Roux-en-Y gastric bypass surgery on obstructive sleep apnea in a Chinese population with obesity and T2DM

“…However, these contents were not taken into account in the present study. Weight loss is accompanied by improvements in characteristics related not only to obesity but also to OSA, suggesting that weight loss may be a cornerstone of the treatment of both conditions [24]. However, a relationship between weight reduction and OSA remission has not been demonstrated previously.…”

Severity of obstructive sleep apnea and metabolic variables: complex relationship needs comprehensive consideration

“…First, physical activity and dietary habits may be associated with metabolic disorders in OSA patients [5], thus these factors should be considered. In addition, confounding effects of gender difference and medications may also have influence in metabolic variables, and these factors should also be taken into account.…”