The relationship of obesity and obstructive sleep apnea.
What is the relationship between sleep apnea and weight? Overweight and obese patients are more likely to have excessive fatty tissues Losing weight not only improves tolerable pressure of a CPAP device, but also. Obstructive sleep apnea (OSA) is a disorder that negatively affects many parts of the body. Medical conditions linked to OSA include hypertension, insulin. The number of obese adults (those with a Body Mass Index of 30 or more) is a major concern for another reason: the increased incidence of sleep apnea.
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. Our understanding of the implications of obstructive sleep apnea OSA on disease pathophysiology has been evolving rapidly.
Obesity and Obstructive Sleep Apnea
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. 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. These findings highlight the need to develop screening and prevention for these conditions, even as early as in childhood.
Interactions Between Obesity and Obstructive Sleep Apnea
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.
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 Increases in visceral fat with age may also account for an increase in sleep apnea prevalence in middle-aged and older men and in postmenopausal women Newman and coauthors 34 have compared the effect of weight change on sleep apnea progression in male and female participants in the Sleep Heart Health Study, a multicentered epidemiologic cohort study of cardiovascular correlates of sleep apnea in middle-aged and older Americans.
These authors demonstrated that relatively small increases in body weight were associated with an increasing severity of sleep apnea, and that this increase was particularly striking in men compared with women.
Obesity and Obstructive Sleep Apnea - Obesity Medicine AssociationObesity Medicine Association
Thus, obesity and central obesity constitute potent risk factors for the presence and progression of sleep apnea. Despite the preponderance of evidence linking obesity and central adiposity with sleep apnea, considerable variability exists in the prevalence and severity of this disorder, even among those who are markedly obese.
- The relationship of obesity and obstructive sleep apnea.
In severely obese patients presenting for bariatric surgery, sleep apnea severity did not correlate with the degree of obesity, as assessed by BMI Using specific cutoff values of the AHI to define the prevalence and severity of sleep apnea, we found that sleep apnea was present in Although age was comparable between men and women, indices of central adiposity were substantially higher in men than women, as expected see neck, waist, and sagittal girth in Table 1and remained elevated even after these dimensions were normalized to stature height; data not shown.
Using multiple linear regression, we found that the percentage of variability in AHI explained R2 by age, BMI, and neck circumference was estimated for males and females.