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Sleep apnea and how it is associated with Obesity

January 13, 2023

Sleep apnea refers to a condition in which breathing stops for a while during sleep and resumes after a few seconds, usually with a snort. The temporary relaxing of muscle supporting the soft tissue of the throat leads to narrowing/closing of the airway, that in turn, cuts off breathing for a brief period.

Types of Sleep Apnea:

There are two types of sleep apnea. 

  1. Obstructive sleep apnea (OSA)
    OSA, the common type of sleep apnea, adversely affects various organs and systems in our body, especially the cardiovascular system. It is also closely related to other conditions, like reduced sleep duration and obesity. Recent studies draw a conclusion that increase in 10% of total body weight might give about six times risk of disease progression. Young children and adults with OSA have more than six folds risk of developing metabolic syndromes when compared to the children of similar age and no OSA. Adults who are mildly obese or severely obese is about twice on risk of developing sleep apnea than the adults with normal body weight.
  2. Central sleep apnea (CSA)
    CSA is a condition in which breathing stops and starts repeatedly during sleep. This happens because of the poor signals sent by the brain to the muscles that control breathing. It is completely different from that of OSA; however, CSA is rarer than OSA.

How is obesity linked with obstructive sleep apnea?

OSA is a global disease with increasing incidence and its complications. One of the main risk factors for OSA is obesity. Obesity can cause and also worsen the OSA due to fat accumulation at specific sites. Fat accumulates in the tissue surrounding the upper airway thereby reducing its lumen and increasing the collapse capacity of the upper airway, further leading to apnea. Moreover, this collapse of upper airway reduces the chest compliance and functional residual capacity, thereby increasing the oxygen demand. The link between both conditions is quite complex. A few recent studies suggest that having sleep apnea can itself cause obesity. Poor sleep quality triggers production of appetite hormones, especially refined carbohydrates. OSA can trigger sleep during daytime thereby decreasing the productivity.

What are the complications associated with obesity induced sleep apnea?

A few complications are listed here that are directly related to Obesity induced sleep apnea:

  • Daytime fatigue
  • Cardiovascular changes
  • Type II Diabetes mellitus
  • High cholesterol

Children with obesity and sleep apnea have learning disabilities, growth retard, and behavioural problems.

How is sleep apnea treated?

OSA is commonly treated with Continuous Positive Airway Pressure (CPAP) therapy. CPAP therapy uses a machine that uses mild air pressure to keep breathing pathways open while you sleep. CPAP along with weight loss has shown very promising effects in treating sleep apnea. A weight loss of just 10% has shown about 20% improvement in the severity of OSA. Lifestyle modifications and dietary changes are two very conventional solutions one may opt. However, people with co-morbidities like hypertension and diabetes, etc and for those who struggle to maintain certain lifestyle, there are few non-surgical cum minimally invasive procedures that help in weight loss. Intragastric Balloon Surgery and Endoscopic sleeve surgery are two procedures that help people struggling with weight loss in a traditional way.

Non-surgical procedures that help in weight loss

Intragastric balloon surgery is a weight-loss procedure in which a silicone balloon, filled with saline is placed inside your stomach. This helps you lose weight by limiting food intake and making you feel full faster.

Endoscopic sleeve gastroplasty is also another option that helps in weight loss. In this procedure, a suturing device is inserted into your throat down to the stomach. Then a few sutures are made in your stomach to make it smaller than actual size, thereby limiting the food intake and giving a feeling of fullness faster.

Both these ways lead to significant weight loss by limiting how much you can eat.

Eligibility criteria

  1. Body mass index (BMI) 30 or more
  2. No previous stomach or oesophageal surgeries
  3. No help from lifestyle modifications
  4. Large hiatal hernia or a condition associated with gastrointestinal bleeding.

Disclaimer: Like any other weight loss procedures, both of these methods require a commitment to a healthier lifestyle and moderate exercise regimen, to ensure the long-term success of the procedures.

References:

  1. Endoscopic sleeve gastroplasty. Mayo Clinic.
    https://www.mayoclinic.org/tests-procedures/endoscopic-sleeve-gastroplasty/about/pac-20393958
  1. Obstructive sleep apnea and obesity: Implications for public health. National library of medicine.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836788/
  1. Intragastric Balloon Versus Endoscopic Sleeve Gastroplasty for the Treatment of Obesity: a Systematic Review and Meta-analysis. National Library of Medicine.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720242/

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