Sleep apnea and obesity

Written by Paris Kazemian
Obstructive sleep apnea (OSA) is a sleep disorder in which breathing repeatedly stops and starts during sleep. The most common type of sleep apnea is obstructive sleep apnea, which occurs when the muscles in the back of the throat fail to keep the airway open, despite the effort to breathe. This can lead to a drop in oxygen levels in the blood and a disruption in sleep quality.

Symptoms of OSA may include loud snoring, gasping or choking during sleep, excessive daytime sleepiness, morning headaches, and difficulty concentrating or remembering. Left untreated, sleep apnea can increase the risk of health problems such as high blood pressure, heart disease, stroke, and diabetes.

Why does sleep apnea occur?

OSA occurs when the muscles in the back of the throat fail to keep the airway open during sleep. There are several factors that can contribute to this, including:

1. Physical obstructions: Some people may have physical obstructions in the airway, such as enlarged tonsils, a deviated septum, or a narrow airway.
2. Obesity: Excess weight and obesity can contribute to sleep apnea because the extra fat around the neck can obstruct the airway during sleep.
3. Age: Sleep apnea is more common in older adults due to changes in muscle tone and the aging process.
4. Genetics: Sleep apnea may be more common in people with a family history of the condition.
5. Lifestyle factors: Smoking, alcohol consumption, and sedative use can all increase the risk of sleep apnea.
6. Medical conditions: Sleep apnea may be associated with certain medical conditions such as high blood pressure, heart disease, and diabetes.
7. Sleeping position: Sleeping on your back may increase the risk of sleep apnea because the tongue and soft tissues in the back of the throat can fall back and block the airway.

It’s important to note that not everyone who has these risk factors will develop sleep apnea, and some people may have OSA without any identifiable risk factors.

Sleep apnea statistics in Australia

Obstructive sleep apnea (OSA) is a prevalent medical disorder that affects a large portion of the general population. When defined as disordered breathing detected in a sleep study, the prevalence ranges from 9% to 38%, with higher rates in men and older individuals. However, when combined with symptoms of excessive daytime sleepiness, the prevalence drops to 4% to 6%.

prevalence of sleap apnea in Australia

The prevalence of sleep apnea, as diagnosed by health professionals, increases with age. Self-reported rates of sleep apnea were 2.2% in the 18-25 age group and increased to 7.8% in the 45-55 age group. Individuals with sleep apnea had worse physical and mental health, self-rated health, and subjective well-being compared to those without the condition. They also had poorer concentration abilities. These findings suggest that sleep apnea has a significant negative impact on overall health and well-being and may worsen with age. Therefore, it’s important to address OSA to prevent its adverse effects on health and quality of life.

Risks of sleep apnea!

Sleep apnea is a dangerous condition that can lead to a variety of negative health outcomes. The repeated disruptions in breathing during sleep can result in decreased oxygen levels, which can lead to high blood pressure, heart disease, and stroke. Additionally, OSA has been linked to an increased risk of diabetes, obesity, and depression. It can also cause excessive daytime sleepiness, which can impair cognitive function and increase the risk of accidents, including motor vehicle accidents. Left untreated, OSA can have a severe impact on overall health and quality of life, so it’s important to seek medical attention if you suspect you have this condition.

How can I know if I have sleep apnea (OSA)?

If you suspect you may have sleep apnea, the first step is to speak with your doctor or a sleep specialist. They can evaluate your symptoms and recommend tests to determine if you have sleep apnea.

Some common diagnostic tests for sleep apnea include:

1. Polysomnography (PSG): This is an overnight sleep study that monitors various body functions during sleep, including brain activity, eye movements, heart rate, and breathing.
2. Home sleep apnea testing (HSAT): This is a simplified version of the PSG that can be done at home using a portable device that measures breathing patterns, oxygen levels, and heart rate.

Your doctor may also ask about your medical history, conduct a physical exam, and ask you to keep a sleep diary to track your symptoms and sleep patterns.

OSA and obesity

While obstructive sleep apnea (OSA) is widely known that weight gain is a significant risk factor for OSA, there’s increasing evidence of a bidirectional relationship between obesity and OSA. OSA can lead to more rapid weight gain, creating a vicious cycle of increasing weight and worsening OSA. Therefore, it’s essential to treat both conditions to improve patient outcomes. Health professionals should be aware of this relationship and address both obesity and OSA to break the cycle and improve overall health.

Does CPAP therapy work?

During periods of rapid weight gain, snoring and symptoms of obstructive sleep apnea (OSA) tend to worsen. It’s common for people diagnosed with OSA to also have obesity and metabolic factors such as hypertension, hyperlipidemia, and insulin resistance. Severe OSA is an independent risk factor for cardiovascular disease and stroke. Continuous positive airway pressure (CPAP) treatment is a safe and effective way to reduce sleepiness, improve mood, and enhance quality of life; however, it’s unclear if CPAP provides any cardiovascular benefits. Weight loss can lead to varying degrees of improvement in OSA and is especially effective for milder cases. Losing weight also has greater cardiovascular benefits than CPAP. These health problems affect millions of Australians and place a significant burden on the healthcare system, with nearly 28% of adults classified as obese and another 35.5% classified as overweight in 2014-15.

New research suggests that the cardiovascular benefits of continuous positive airways pressure (CPAP) treatment for obstructive sleep apnea (OSA) may have been overestimated. Therefore, healthcare providers should focus not only on managing OSA symptoms but also on addressing obesity and its associated cardiometabolic comorbidities in patients

Weight Loss is the key!

Since CPAP has not been proven to aid in weight loss or significantly improve cardiovascular health, it is important for patients with OSA to receive effective management for obesity. Losing weight has been shown to have numerous benefits for improving blood pressure, insulin resistance, lipid profile, and vascular inflammation. In fact, a recent study found that weight loss has a greater impact on reducing cardiovascular risk factors compared to CPAP therapy. Therefore, it is recommended to combine both weight loss and CPAP therapy for optimal results.

Treatment for OSA by weight loss

The impact of weight loss on OSA depends heavily on the severity of the condition at the time of diagnosis. Medical weight loss resulting in a reduction of approximately 10% excess weight can lead to improvements in symptoms and metabolism in patients with mild-to-moderate OSA. For those with mild OSA, further treatment may not be necessary unless ongoing symptoms and disruptive snoring persist. However, for those with severe OSA, weight loss may have an unpredictable effect on the condition.

weight loss can improve sleep-related symptoms and quality of life, as well as provide well-established cardiovascular benefits. Therefore, actively addressing obesity at the time of OSA diagnosis is essential.

Bottom line

Consistent CPAP usage (>4 hours/night) may also reduce cardiovascular and stroke risks for those with severe OSA. However, there is currently no clear evidence that CPAP alone can modify cardiovascular risk. Therefore, addressing obesity through a dedicated weight-loss program is essential for improving overall cardiometabolic health. For patients with severe OSA, aggressive management of cardiovascular risk factors is recommended due to the strong link between severe OSA and cardiovascular disease. Additionally, intervening with lifestyle measures early in the weight-gain trajectory, before obesity and OSA become severe, is a logical approach to addressing these common and significant health issues.

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