Weight loss should be recommended for all overweight or obese patients with OSA, as it may confer not only a benefit in reducing OSA severity, but also a positive impact on other obesity-related diseases such as type 2 diabetes mellitus T2DM.

Patients with more severe OSA derive more benefit from weight loss than those with milder disease Several studies have explored weight loss as a therapeutic option for OSA and approaches evaluated include behavioral methods dietary modification and exercise , pharmacological methods and bariatric surgery The results for behavioral modification have been mixed.

Results from other studies showed no change in AHI however 29 , Sibutramine, an oral anorexiant, has been evaluated in a number of studies in OSA patients, but any positive benefit it may have has now been superseded by concerns related to increased cardiovascular morbidity nonfatal myocardial infarction and stroke associated with its use Studies on the effects of bariatric surgery appear promising.

m -2 compared to 0±3 kg. m -2 in the control group There was also a marked improvement in OSA symptoms and a lower 2-year incidence of T2DM and hypertriglyceridemia. Laparoscopic adjustable gastric banding in a cohort of severely obese patients with moderate to severe OSA resulted in significant weight loss and a decrease in AHI when evaluated at However, the majority of patients will still have residual OSA after surgery and care should be taken to ensure CPAP is not inappropriately discontinued 33 , The prevalence of OSA increases with age in adults 5.

This age-related increase in prevalence may be attributable to parapharyngeal fat deposition, lengthening of the soft palate and changes in other anatomic parapharyngeal structures The Sleep Heart Health Study demonstrated that the prevalence of OSA plateaued after the age of 60 years 36 , and the increased risk of all-cause and cardiovascular mortality associated with OSA is mainly limited to middle-aged adults, especially men Some researchers have suggested that the mortality risk with sleep apnea may even decrease in the elderly as a result of preconditioning cardioprotective adaptations to chronic intermittent hypoxia Elderly patients with and without excessive daytime somnolence may represent different phenotypes that explain the conflicting data on mortality risk with increasing age in OSA; the presence of concomitant excessive daytime somnolence in OSA patients may increase the risk of mortality whereas the same severity of OSA without symptoms may not It is well recognized that there is a higher prevalence of OSA in men than women, with most population-based studies demonstrating a 2- to 3-fold higher prevalence of OSA in men 4.

Men are also more likely to be referred for clinical assessment for OSA 40 , perhaps because physicians appear to have a higher index of suspicion for considering the disorder in men.

This tendency may contribute to the underdiagnosis of OSA in women in clinical practice, a bias which may be compounded by the fact that women often do not present with the classical symptoms of OSA loud snoring, witnessed apneas and excessive daytime somnolence but instead may complain of poor energy levels and fatigue Furthermore, the female bed partners of male patients may be more likely to perceive and report snoring or nocturnal breathing abnormalities than male bed partners of female patients.

Sex hormones may also play an important role in the pathogenesis of OSA. OSA is more prevalent in post-menopausal women than pre-menopausal women, and hormone replacement therapy in post-menopausal women may protect against the disorder 42 , Given its complexity as a disorder with multiple predisposing factors, the likelihood of a single governing genetic factor causing OSA is extremely low.

Anatomic risk factors for OSA, such as obesity and upper airway soft tissue structure, demonstrate familial aggregation.

A case-control study in a Scottish cohort identified a strong familial component to OSA and suggested that differences in facial structure were more important than obesity in this regard The lateral pharyngeal wall volume, tongue volume and total upper airway soft tissue volume have a significant level of heritability after adjusting for sex, age, ethnic background, craniofacial properties and neck fat deposition.

A number of candidate gene associations have been investigated in OSA including different alleles for apolipoprotein E4 ApoE4 , tumour necrosis factor TNF , and angiotensin-converting enzyme ACE but only one TNF polymorphism TNFA rs was significantly associated with OSA under an allele frequency model OSA has a significant economic impact on healthcare systems and society.

OSA-related healthcare cost includes the direct costs of OSA diagnosis and treatment and the indirect costs of associated conditions obesity, diabetes and sequelae cardiovascular disease, depression. Patients with sleep disorders are less productive workers than those without sleep disorders and have a higher level of absenteeism and decreased productivity at work due to fatigue Occupational injuries are also more common in patients with OSA Several studies have shown that QOL is adversely affected in patients with OSA and that it improves with therapy 51 - The QOL of bed partners also improves significantly when OSA is treated 54 , Untreated patients with OSA are at an increased risk of motor vehicle accidents MVAs.

Patients with OSA have a 2- to fold increased risk of MVAs and the severity of accident may be greater compared to controls 56 , Treatment with CPAP therapy reduces this risk in compliant patients to that of controls The results of cost-effectiveness analyses support the utilization of CPAP therapy in patients with moderate to severe OSA relative to other commonly accepted medical interventions.

The most robust evidence supporting an independent role for OSA in promoting adverse cardiovascular outcomes is to be found in studies addressing its relationship with hypertension 1.

Following on from a number of studies where snorers were more likely to also have hypertension than might otherwise be expected 60 , a series of clinical and epidemiological studies identified a dose-response relationship between OSA severity and the likelihood of prevalent hypertension For example, a cross sectional analysis of over 6, North American subjects enrolled in the community-based Sleep Heart Health Study showed that subjects with severe sleep disordered breathing had an OR of 1.

Recent European data underline this association, and suggest that intermittent hypoxemia may be a key factor contributing to co-existent hypertension—among 11, participants in the multi-national the European Sleep Apnea Cohort ESADA study, OSA severity indices, and in particular the oxyhemoglobin desaturation index, were strong independent predictors of hypertension Subsequent longitudinal studies have provided convincing evidence that OSA contributes to an increased risk of clinically-relevant hypertension.

Landmark findings among participants in the Wisconsin Sleep Cohort study demonstrated a strikingly increased propensity for the development of incident hypertension in subjects with sleep disordered breathing In an analysis of subjects, the presence severe OSA at enrollment conferred a nearly threefold risk of being diagnosed with hypertension over a four-year follow-up period, independently of the effects of age, obesity and smoking history.

More recent data from Spain have confirmed this relationship Data from clinic and community based studies generally suggest that CAD is highly prevalent in OSA cohorts 66 , and vice versa that subjects with CAD are more likely to also have sleep disordered breathing, even allowing for the impact of obesity and other confounding factors It is less clear if the presence and severity of OSA actually serve as independent predictors of subsequent CAD, however.

While data from relatively small, but well-conducted studies of hospital patients suggest a robust dose-response relationship between the two 69 , these data have not been reproduced to the same degree at a population level. A relatively modest relationship between OSA and CAD incidence was seen in a community-based study of 4, Within this cohort, severe OSA predicted an increased risk of developing symptomatic CAD, but only in men aged 70 or less HR 1.

However, another analysis of this cohort has shown severe OSA to be an independent predictor of death, and in particular death related to CAD While this relationship was again strongest in men under 70 years of age adjusted HR 2. Were OSA playing a causative role in driving cardiovascular morbidity and mortality, CPAP therapy might be expected to lead to measurable reductions in adverse cardiac outcomes.

In a study of 1, subjects attending a Spanish sleep laboratory, cardiovascular outcomes were assessed over an average of Those with untreated severe OSA In contrast, no significant increased risk of cardiac death was seen in OSA patients who had been successfully commenced on CPAP adjusted OR 1.

As yet there are no published data from large-scale randomised trials in this area, although a number of potentially important studies with this goal are ongoing. Obstructive sleep apnea is highly prevalent in heart failure patients, and is independently associated with increased prevalence of clinically overt heart failure In a cross sectional analysis of the Sleep Heart Health study, severe OSA was associated with increased likelihood of prevalent heart failure, with an adjusted OR of 2.

This option is often too burdensome for some patients for lifelong management of the disorder Peppard et al, Others find the delivery of CPAP intolerable.

In these patients, weight loss is a viable strategy for reduction in severity and progression of sleep apnea. Weight loss has been found to reduce the severity of sleep apnea as well as the development of the disorder. Overweight and obesity remain the most important modifiable causes of sleep apnea Peppard et al, By maintaining a healthy weight, one can potentially avoid sleep apnea and other obesity-related disorders.

While smart watches and fitness trackers with sleep apps are growing in popularity and sophistication, it is always advisable to talk to your healthcare provider if you think you may have sleep apnea. A sleep study in a sleep lab is still the most accurate way to diagnose sleep apnea.

Newer devices, such as the FitBit Ionic, include an oxygen saturation sensor, which increases the accuracy of the data recorded.

Smart watches and activity trackers can also detect movement during sleep, which can suggest the diagnosis of sleep apnea. As the technology becomes more advanced, these devices will likely be used more frequently to diagnose sleep apnea at home. A Continuous Positive Airway Pressure CPAP machine is most commonly the first step in the treatment of sleep apnea.

The CPAP machine has a pump, which provides a positive flow of air into the nasal passages to keep the airway open. The pump is connected by a hose to a nasal or face mask. Most people who use a CPAP machine feel immediate relief of symptoms, including increased energy, improved mood, and relief from morning headaches.

In addition, a highly effective long-term treatment for sleep apnea is weight loss. Sleep Apnea and Obesity: Are They Related?

August 2, Sleep Apnea and Obesity: Are They Related? Share this post. Define Sleep Apnea Sleep apnea is defined, broadly, as the occurrence of five or more breathing-related events per hour, measured by polysomnography sleep study.

Sleep Apnea Symptoms The most notable sleep apnea symptoms include excessive daytime sleepiness and snoring. Why Does Obesity Cause Sleep Apnea? Treatment for Sleep Apnea The most common treatment for sleep apnea is nighttime use of continuous positive airway pressure CPAP.

Frequently Asked Questions Can a FitBit or other fitness tracker detect sleep apnea? Can you treat sleep apnea with CPAP? National Institute of Diabetes and Digestive and Kidney Diseases Overweight and Obesity Statistics.