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Obstructive sleep apnea and Obesity

February 10, 2021
Obstructive sleep apnea is a common chronic disease. It is a serious sleep disorder which causes breathing to stop repeatedly for brief periods of time during sleep. It occurs when the muscles that support soft tissues in the throat temporarily relax. The relaxation of these muscles causes the airway to narrow or close, which momentarily cuts off breathing. Obstructive sleep apnea adversely affects various organs and systems, especially the cardiovascular system. Obstructive sleep apnea is closely related to other conditions, such as reduced sleep duration and obesity. Obesity is a major risk factor of obstructive sleep apnea. The occurrence of obstructive sleep apnea in obese or severely obese individuals is about twice than that of normal-weight individuals. People with mild obstructive sleep apnea who gain about 10% of weight have about 6 times risk of disease progression. Moreover, obstructive sleep apnea is not limited to adults, obese children have an incidence of 46% of obstructive sleep apnea when compared to healthy weight children. Children and adolescents with obstructive sleep apnea may have more than six fold risk of developing metabolic syndrome than children without obstructive sleep apnea.

How can obesity cause obstructive sleep apnea?

Obesity can cause and worsen obstructive sleep apnea due to fat deposition at specific sites. When fat deposition occurs in the tissues surrounding the upper airway, it results in a smaller lumen and increases the ability of the upper airway to collapse, which further leads to apnea. Also, fat deposition around the thorax reduces chest compliance and functional residual capacity, which may increase oxygen demand. The association of obstructive sleep apnea and obesity is quite complex. Obesity, as well as visceral obesity may cause obstructive sleep apnea, and losing the excess weight can result in improvement of apnea. However, recent research suggests that obstructive sleep apnea itself can cause weight gain. Poor sleep quality induces production of hormones related to appetite, especially for refined carbohydrates. Obstructive sleep apnea can result in daytime sleepiness and thus decreases activity levels.

Complications of obstructive sleep apnea and obesity

Obesity and obstructive sleep apnea have adverse effects on several organs, particularly the cardiovascular system. The possible adverse effects include high blood pressure, insulin resistance (a condition in which the body doesn’t respond to insulin), systemic inflammation (activation of a type of immune attack that results in inflammation), high blood cholesterol levels.

Children with obesity and obstructive sleep apnea have problems in learning, retarded growth and behavioural problems.

Can weight loss reduce obstructive sleep apnea?

Obstructive sleep apnea is usually treated with Continuous Positive Airway Pressure (CPAP) therapy, which helps in lowering blood pressure and improving associated cardio-metabolic complications and quality of life. CPAP therapy along with weight loss has shown decrease in insulin resistance, blood pressure and triglyceride levels.

Weight loss has found to be highly effective in treating sleep apnea for long-term. A weight loss of just 10% of body weight has shown 20% improvement in the severity of OSA. Bariatric surgical procedures have gained popularity in recent years for treating severe obesity. These procedures have also shown significant reduction in sleep apnea severity. However, these procedures are recommended as a last resort.

Lifestyle modifications for obstructive sleep apnea and obesity

Shedding a few kilograms helps with the symptoms of obstructive sleep apnea, as well as resolves other obesity-related issues. The weight-loss should be maintained for long term, as sleep apnea may return with regaining of the lost weight. Thus, weight management with proper diet and exercise routine is essential.

Here are some measures to manage obstructive sleep apnea and obesity:

  • A healthy diet: Consume ample amount of fresh fruits and vegetables. Avoid having refined carbohydrates and other complex carbohydrates. Reduce portion size and have meals at regular intervals. Consult a dietician to make a concrete diet plan for losing weight.
  • Exercise regularly: Do not hit the gym and perform high-intensity exercises while starting your weight loss journey. Start low and increase the intensity gradually. Moderate-intensity physical exercises should be sufficient to lose weight over a long period of time. The weight lost this way will not easily return. Also, keep lipid levels in check to avoid the risk of sudden cardiac arrest.
  • Say no to tobacco and alcohol: Consuming alcohol and smoking tobacco can do a lot harm than one can imagine. It can affect almost all organs of the body. When adapting to healthy lifestyle, avoiding alcohol and tobacco can go a long way in reducing the recurrence of obstructive sleep apnea.
  • Some medicines: Medications like sleeping pills must be avoided in patients with obstructive sleep apnea or must be taken after consultation with a professional. Sleeping pills tend to relax the muscles in the back of the throat and obstruct airway.

Outlook

Obesity and obstructive sleep apnea have a complex relationship. Individuals with both obesity and obstructive sleep apnea require a multi-type approach to manage these conditions. Losing weight improves sleep apnea by warranting ease of mobility, better sleep, positive mood, high energy levels, and reduced discomfort while sleeping. One can consult a healthcare professional to help lose weight and improve sleep apnea.

References :

  1. Jehan S, Zizi F, Pandi-Perumal SR, et al. Obstructive Sleep Apnea and Obesity: Implications for Public Health. Sleep Med Disord. 2017;1(4):00019.
  2. Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010;137(3):711-719.
  3. Schwartz AR, Patil SP, Laffan AM, Polotsky V, Schneider H, Smith PL. Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc. 2008;5(2):185-192.
  4. Nousseir HM. Obesity: the major preventable risk factor of obstructive sleep apnea. J Curr Med Res Pract 2019;4:1-5
  5. https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090
  6. https://www.webmd.com/sleep-disorders/sleep-apnea/obstructive-sleep-apnea-causes
  7. https://www.sleepfoundation.org/articles/connection-between-weight-and-sleep-apnea
  8. https://obesitymedicine.org/obesity-and-sleep-apnea/
  9. https://obesitymedicine.org/obstructive-sleep-apnea-and-obesity/

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