The Relationship Between Sleep Apnea and Obesity

About 70% of sleep apneics are either overweight or obese. The majority of these are noted, on retrospective examination of their charts, to have put on weight significantly in the year prior to diagnosis. One of the reasons for this is the resistance that develops to leptins (appetite suppressant hormones). This is similar to the resistance that develops to insulin (there is a ten fold increase likelihood of Diabetes Mellitus developing in a sleep apneic). There are doubtless other reasons why apneics tend to put on weight, but whatever they may be, the effect of the added weight is to worsen the sleep apnea. A particularly vicious and dangerous cycle ensues.

Many of the serious pathological consequences of obstructive sleep apnea have been shown to be reversible with CPAP therapy. These include hypertension, risk of heart disease, and risk of road accidents. It is surprising therefore that obesity is not more often corrected by CPAP therapy. Less than 10% of patients successfully lose weight even on full correction of their obstructive sleep apnea with CPAP, over a period of 2 years. Nevertheless, we believe that OSA in these patients cannot be treated as a separate entity from obesity. Moreover there seems to be a window of treatment opportunity at the beginning of CPAP therapy which clearly is absent prior to the therapy, and dissipates after some time. CanSleep has instituted a center where integrated diagnosis and treatment is provided, and as part of that we are providing a nutrition and lifestyle counseling service. Patients are encouraged in this direction once they are established on CPAP, or having failed CPAP, have received another form of therapy. Those patients who manage to correct their obesity over 1 or 2 years are often able to discontinue their CPAP therapy.

Nicole Beattie is a highly trained dietitian who works in both clinical and community settings. We are honoured to have her as one of the CanSleep consultants, and she is readily available to your patients whether or not they have sleep apnea. Please use the enclosed prescription form or call Vicki directly at the CanSleep office.

Richard R.J. Smyth, M.B.B.S., F.R.C.S.
October/November 2004

Sleep Surgery Centre Inc. 303 - 2963 Glen Drive, Coquitlam, Vancouver, B.C. Canada V3B 2P7
Tel: 604-941-2344 Fax: 604-941-2455 E-mail: info@sleepsurgerycentre.com