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SLEEP: Mary S. M. Ip, Bing Lam, Ian J. Lauder, Kenneth W. T. Tsang, Ka-fai Chung, Yuk-wan Mok, and Wah-kit Lam A Community Study of Sleep-Disordered Breathing in Middle-aged Chinese Men in Hong Kong Chest 2001; 119: 62-69 [Abstract] [Full text] [PDF]

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Obstructive sleep apnea (OSA) and weight loss

Murat Enoz   (25 March 2005)

Obstructive sleep apnea (OSA) and weight loss 25 March 2005
Murat Enoz, Department of Otolaryngology, Head&Neck Surgery Istanbul University, School of Medicine, Turkey. Send letter to journal: Re: Obstructive sleep apnea (OSA) and weight loss muratenoz{at}yahoo.com Murat Enoz	Dear Editor, Obstructive sleep apnea is an increasingly well-recognized disease characterized by periodic collapse of the upper airway during sleep. This leads to either complete or partial obstruction of the airway, resulting in apneas, hypopneas, or both. This disorder causes daytime somnolence, neurocognitive defects, and depression. It affects almost every system in the body, resulting in an increased incidence of hypertension, cardiovascular disease, stroke, pulmonary hypertension, cardiac arrhythmias, and altered immune function. It also increases the risk of having an accident, presumably as a result of associated somnolence. The gold standard for the diagnosis of sleep apnea is an overnight polysomnogram. Split-night studies are becoming increasingly common and allow for quicker implementation of therapy at a reduced cost. Treatment options for sleep apnea include weight loss, positional therapy, oral devices, continuous positive airway pressure (CPAP), and upper airway surgery. CPAP is the most efficacious and widely used therapy. Its complications include nasal congestion or dryness, mask discomfort, and claustrophobia. Heated humidifiers, newer types of masks, and nasal steroids have improved tolerance of this therapy. Bilevel positive- pressure therapy can be considered for patients who find it difficult to exhale against the consistently increased pressure of CPAP. The disease requires aggressive treatment to improve quality of life and prevent its complications (1) . Obstructive sleep apnea (OSA) is characterized by periodic complete or partial upper airway obstruction during sleep, causing intermittent cessations of breathing (apneas) or reductions in airflow (hypopneas) despite ongoing respiratory effort. This disorder has been described for decades, but its recognition has remained a problem. Prevalence studies of OSA with coexistent daytime somnolence (obstructive sleep apnea hypopnea syndrome) have reported an incidence of 2% in middle-aged women and 4% in middle-aged men (2). Obesity is one of the major risk factors for sleep apnea. In fact, clinical and epidemiological studies demonstrate a strong correlation between obesity and OSA (3,4). Potential mechanisms of OSA include alterations in upper airways structure and function. Moreover, the multiple effects of obesity interact to provoke pharyngeal instability and collapse (4). A considerable increase in fatty tissue in the neck can cause pressure changes as well as induce adipose degeneration and may predispose toward upper airway occlusion during sleep (5) by altering the anatomical and mechanical properties of the upper airway, particularly at the level of the velopharynx. In fact, obese patients with a large neck have a more collapsible velopharynx even while awake, which may predispose to snoring and upper airways obstruction during sleep. An increase in adipose tissue in the thorax is another factor that can aggravate symptoms further. In all weight loss rehabilitation programs in patients with Sleep disordered breathing (SDB) has not been investigated what role increased physical activity plays beside weight reduction through dieting. There are very few data on this topic, but some studies show that physical exercise alone could play a role in ventilatory improvement at night (6). Further investigations with control groups are needed to distinguish the effects of long-term weight loss programs with and without physical exercise. Sincerely Dr. Murat Enoz References 1- Qureshi A, Ballard RD. Obstructive sleep apnea. J Allergy Clin Immunol. 2003 Oct;112(4):643-51; quiz 652. Review. 2- Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep disordered breathing among middle aged adults. N Engl J Med 1993;328:1230-5. 3- Vgontzas AN, Tan TL, Bixler EO, Martin LF, Shubert D, Kalesb A. Sleep apnea and sleep distruption in obese patients. Arch Intern Med 1994;154:1705–1711 4- Grunstein RR, Wilcox I. Sleep-disordered breathing and obesity. Bailliere’s Clin Endocr Metab 1994;8(3):601–628. 5- Davies RJO, Stradling JR. The relationship between neck circumference radiographic pharyngeal anatomy, and the obstructive sleep apnea syndrome. Eur Respir J 1990;3:509–514. 6- Netzer N, Lormes W, Giebelhaus V, et al. Physical excercise in patients with sleep apnoea syndrome. Pneumologie 1997;51: 779–782.