According to the Centers for Disease Control and Prevention (CDC), approximately 65 percent of Americans are overweight, while approximately 35 percent are obese. Additionally, according to the National Heart, Lung and Blood Institute (NHLBI), more than 12 million Americans suffer from obstructive sleep apnea and more than 70 percent of these patients are overweight. The relationship between obstructive sleep apnea and being overweight is complex and consideration of each is critical in the management of patients suffering with sleep apnea.
What is Obstructive Sleep Apnea?
More than 50 million Americans suffer from a variety of sleep disorders and obstructive sleep apnea is the most common. During sleep, certain individuals are predisposed to collapse of the airway in the back of the throat. This occurs during stages of deep sleep when the muscles surrounding the airway relax. When the airway collapses the flow of air shuts off, and the individual stops breathing. The body, needing to either breath or die, then reflexively emerges from sleep in order to open the airway and take a breath. This may happen many times per hour preventing sufferers from ever achieving restful sleep.
Consequences of Obstructive Sleep Apnea
The phenomenon of repetitive emergence from sleep leaves sufferers with a number of problems and risks.
- Excessive daytime sleepiness
- Inability to concentrate
- Diminished emotional and mental function
- Heart disease
- Congestive heart failure
- Vascular disease
Weight and Obstructive Sleep Apnea
Excess weight worsens obstructive sleep apnea in two major ways:
- Increased abdominal mass makes it more difficult to inhale, as the diaphragm with every breath must lift this weight.
- Increased tissue mass of the neck compresses the airway making it smaller and increasing the potential for collapse.
However, it is important to note that a significant number of sleep apnea patients are not overweight and that some overweight people do not suffer from sleep apnea.
Weight Loss Before Surgery?
Patients being considered for surgical treatment of obstructive sleep apnea are historically required to demonstrate needed weight loss prior to surgery. For many patients, this is however a struggle because of the dynamic interaction between sleep deprivation and weight. The sleep deprivation resulting from sleep apnea creates a spectrum of complex changes affecting not just energy level, mood and motivation, but hormonal balance that controls appetite and related drives. Although weight loss prior to surgery is of benefit on many levels, the underlying disease process may complicate this effort for many patients.
Sleep Apnea Affects Hormones That Influence Dietary Habits
Unfortunately, the relationship between sleep apnea and obesity is a complex interrelationship. While gaining weight can make sleep apnea symptoms worse, suffering from sleep apnea may contribute to the process of weight gain. The disrupted sleep that results from chronic OSA can affect hormones in your body that are related to hunger, satiety, and appetite. This can make it more difficult to lose weight with untreated sleep apnea.
- Known as the “Satiety Hormone”
- Inhibits hunger and tells brain to cease being hungry
- Decreased morning leptin production seen in OSA patients, possibly stimulating increased calorie consumption.
- Known as the “Hunger Hormone”
- Sends signal to the brain to be hungry
- Is increased in patients with OSA
- The more severe the OSA, the greater the increase in Ghrelin levels.
- Likely produces compulsion to increase calorie consumption in OSA patients
What Should Be Treated First, Excess Weight Or Obstructive Sleep Apnea?
For those patients who are able to do so, weight loss in addition to CPAP will enhance the benefit of CPAP and reduce the needed pressures. For those patients who are able to do so, weight loss prior to surgical treatment will enhance the outcome of surgery. For those patients unable to tolerate CPAP, and unable to lose weight prior to surgical treatment, surgical correction as a next step may make future weight loss much easier to achieve.
For More Information About Sleep Apnea Surgery
The experienced doctors at the Surgical Arts Centre specialize in the surgical treatment of obstructive sleep apnea and have developed revolutionary techniques to cure OSA in approximately 95 percent of patients. For more information about our treatment model, please visit our sleep apnea treatment page or call (406) 549-6600 to schedule a consultation today.