introduce
The prevalence of obesity is rising globally; it has risen to about 30% in Asian countries. There is a linear correlation between obesity and OSA. In obese people, fat deposits in the upper respiratory tract can narrow the airways; muscle activity in this area is reduced, leading to hypoxia and episodes of apnea, ultimately leading to sleep apnea. These hypoxic/apnea events result in reduced oxygen availability in the body's tissues and blood vessels. Reduced oxygenation leads to tissue hypoxia, which is a major factor in atherosclerosis, a major risk factor for cardiovascular disease (CVD).
A four-year longitudinal study of overweight and obese U.S. adults shows that changes in weight are proportional to sleep-disordered breathing (SDB). Those who gained the most weight had more severe apnea-hypopnea index (AHI). The risk of OSA increases with age and body mass index (BMI); other associated factors found in a group of Australian men included a sedentary lifestyle, tobacco abuse and heavy alcohol consumption. OSA is closely associated with multiple disease conditions, including type 2 diabetes mellitus (T2DM), hyperlipidemia, hypertension, heart failure, cardiovascular disease (CVD), and depression.
Obesity and sleep
Obesity is defined as a BMI ≥ 30, while a BMI ≥ 25.0 means the person is overweight. Women are less likely to be overweight or obese than men. The main factors that contribute to obesity include the environment, eating behaviors and physical inactivity. Psychosocial environmental and genetic factors also play important roles in obesity.
Obese people (BMI over 30) who slept shorter hours had twice as many subjective sleep problems compared to non-obese people. Being obese or overweight is associated with a reduced amount of sleep compared with non-obese patients. Obesity is associated with poor sleep quality and sleep quality; therefore, losing weight can improve sleep problems. Therefore, preventing weight gain has a positive impact on sleep quality and duration in adult black women.
Weight gain is a slow process influenced by lifestyle factors such as lack of sleep, sedentary lifestyle, excessive caloric intake and genetics. People with short sleep duration and obesity are at high risk for severe depression. Among Chinese male subjects, obesity was also associated with shorter sleep duration (less than 6 hours) and longer work hours (more than 9 hours). Short sleep duration and dietary intake can lead to hormonal imbalances. One such imbalance is a decrease in melatonin, leading to changes in metabolic circadian rhythms, leading to weight gain and metabolic syndrome. The effects of the hormones leptin and insulin are also altered. Obese people become resistant to both hormones. These hormones reduce food requirements and increase energy metabolism. Ghrelin released from the stomach stimulates appetite and is also affected by sleep disorders. Elevated ghrelin levels and decreased leptin levels have also been noted in chronic short sleepers. due to associated increased food intake. Obesity-prone factors such as poor sleep and excessive caloric intake are also major triggers for diabetes and other components of metabolic syndrome. The consequences of OSA go beyond simple tiredness. In people with OSA, excessive daytime sleepiness, anxiety, and lack of concentration due to lack of sleep can lead to traffic accidents.
obstructive sleep apnea syndrome
In obstructive sleep apnea syndrome (OSAS), patients experience repeated pauses and hypopneas due to complete or partial collapse of the upper airway. In obese people, the muscles of the upper airways become narrower due to the accumulation of fatty tissue. Respiratory disturbance due to narrowing of the upper airway leads to a significant increase in intrathoracic pressure and triggers apnea and hypoxia. Sympathetic activation is increased due to apneic/hypoxic episodes in patients with OSAS. Hypoxemia/apnea episodes can reduce oxyhemoglobin saturation from 95% to 80%, depending on the length of the apnea. OSA is an independent risk factor for cardiovascular and cerebrovascular diseases. Due to hypoxia associated with OSAS, oxidative stress leads to overproduction of reactive oxygen species, which leads to endothelial dysfunction and contributes to atherosclerosis. The inflammatory markers C-reactive protein (CRP), tumor necrosis factor alpha (TNF alpha), and interleukin 6 (IL-6) were elevated in OSA patients and were significantly elevated when the AHI was greater than or equal to 15.
Leptin is a hormone involved in eating and energy metabolism. Elevated leptin levels are found in OSAS patients. Leptin hormone levels correlate with OSAS severity. Another study showed that patients with obesity and obstructive sleep apnea had elevated levels of the hormone leptin, with leptin levels being proportional to the severity of the syndrome. In OSA patients, serum leptin levels were 50% higher than controls.
Epidemiology, prevalence, and gender differences in OSA
The prevalence of OSA in the general population ranges from 3% to 7% in men and 2% to 5% in women. Rates are particularly high among obese people. The reverse is also true: People with OSA are at risk for obesity. Lack of sleep at night and daytime sleepiness can cause patients to gain weight. Among obese people who underwent bariatric surgery, the prevalence of sleep apnea was 77%. Polysomnography (PSG) testing is recommended for all obese people who are candidates for bariatric surgery.
The incidence of OSA varies depending on a woman's menopause. Among premenopausal women, the prevalence of OSA is very low at 0.6%. The prevalence among postmenopausal women taking hormone replacement therapy (HRT) was 0.5%; however, the prevalence among postmenopausal women not using HRT was higher: 2.7%. The incidence of OSA in postmenopausal women not receiving HRT is almost the same as in men. The prevalence of OSA is higher in men than in women, except in postmenopausal women. Although the prevalence of sleep apnea increases in men, women experience increased comorbidities, including morning headaches, insomnia, mood problems, and anxiety.
racial differences
Most research on racial differences and OSA has been conducted between blacks and whites. In a cross-sectional study comparing the prevalence of OSA in South Asian patients with T2DM compared with European whites, whites were almost twice as likely to have OSA (36.2% vs. 51.4%). Additionally, South Asians experience less severe disease than Europeans. In the Sleep Heart Health Study, a multiethnic cohort was studied to explore SDB symptoms associated with race and ethnicity. Frequent snoring is more common among Hispanic men and women and black women than among others. Among African Americans, the risk for OSA occurs at younger ages than among whites. In a study comparing Far East Asian men with white men, OSA was more common and more severe in Far East Asian men, although their BMI was lower. The authors suggested that craniofacial differences may be one reason for the increased incidence of OSA in Far Eastern Asian men. In the Middle East, obesity plays a more important role in OSA. A review article exploring the topic found that studies conducted in countries such as Dubai, United Arab Emirates, found that up to 22% of participants were at risk of developing OSA.
Therapeutic significance
Weight loss, physical exercise and diet control
Obesity and low levels of physical activity are associated with moderate to severe OSA. Exercise can help reduce weight, blood pressure, depression, anxiety and fatigue. Eating disorders such as bulimia may also be contributors to obesity; these psychological and psychological issues should be addressed to overcome obesity and its comorbidities in early childhood or at the earliest age of diagnosis. To prevent adult obesity, early prevention in children at home is key to controlling this global problem. Unfortunately, there is a paucity of high-quality research in this area.
positive pressure ventilation
The conventional treatment for OSA is continuous positive airway pressure (CPAP). This therapy uses a machine to deliver a constant flow of air to the patient's airways through a nasal, facial or oral device to keep the airways open during sleep. CPAP therapy significantly relieves OSAS symptoms and improves functional status in both men and women. Physiological changes during pregnancy and menopause lead to different sleep patterns and clinical manifestations of OSAS in women compared with men.
Avoiding supine positioning or using topical nasal corticosteroids are other treatments. The psychoactive drug modafinil is also used in patients who do not respond effectively to CPAP.
Losing weight through surgery
In primary care settings, the number of physicians performing BMI screening increased significantly from 54% to 73% from 2008 to 2013. However, the management and impact of obesity in primary care settings still needs to be improved, and behavior-based treatments should be prioritized.
Weight loss is a key factor in treating OSA. It can be achieved through exercise, dietary changes, and/or medications. One study showed that people with short sleep duration (less than 7 hours) had improved metabolic index and greater weight loss after increasing their sleep duration beyond 7 hours. Short sleepers (6 hours or less) who go to bed later tend to eat later in the evening, thereby increasing their daily calorie intake and are more likely to gain weight.
Surgical procedures are more beneficial than medical procedures when it comes to weight loss and addressing obesity-related complications. If diet and increased sleep fail, bariatric surgery may be another treatment option for weight loss. OSA and metabolic disorders improve significantly after weight loss through bariatric surgery. Although combining CPAP and surgical weight loss has beneficial effects in the treatment of OSA, patients require close monitoring to prevent surgical complications.
OSA was found to be significantly improved on polysomnography studies before and after surgery; metabolic syndrome was also improved. Bariatric surgery is becoming the primary treatment option for patients whose weight loss treatments with diet, exercise, and CPAP have failed. In obese kidney transplant patients, LSG (laparoscopic sleeve gastrectomy) surgery significantly reduces post-transplant complications. Another study showed that bariatric surgery reduces microvascular complications, especially prediabetes.
Heme oxygenase concentrations are elevated in patients with severe OSA and morbid obesity; bariatric surgery decreases this enzyme concentration. As a result, inflammatory processes and insulin resistance are reduced. Obesity-related OSA is best treated with a combination of surgery and CPAP therapy. OSAS and obesity are related problems; in patients with obesity, obesity should be addressed at the same time as OSAS, even if that means using surgery.
Complications of surgery
Microvascular complications seen in bariatric surgery are rare. For patients with prediabetes, it is actually more beneficial to prevent microvascular complications such as diabetic nephropathy, neuropathy, and retinopathy. Obese patients who had prior bariatric surgery and subsequent cardiac surgery were at higher risk for coronary complications compared with patients who had not had prior bariatric surgery.
People who have bariatric surgery are also at increased risk for developing vitamin deficiencies, depending on the type of surgery. Vitamin B deficiencies are frequently reported after bariatric surgery, and patients may develop neurological complications such as muscle weakness, polyneuropathy, and gait abnormalities. Wernicke-Korsakoff neuropathy is an irreversible side effect; other complications can be treated with vitamins. After bariatric surgery, bleeding, ulceration, fistula formation, and anastomotic stricture can occur; all of these complications can be repaired endoscopically or with open surgery.
public health impact
To prevent obesity and its serious complications, patients, as well as policymakers, health care workers, marketing and the food industry, all have a role to play. In order to prevent obesity and its complications, early childhood development intervention mediated by parents and family education is also very important. Prepare healthy meals, increase physical activity, and encourage lifestyle changes from an early age. Early childhood education about what a healthy lifestyle is and how to adopt it is very important. Parents can get their children more active by involving them in household chores or encouraging them to play activities other than video games. There should also be an emphasis on healthier cooking methods, such as baking or grilling, rather than fried foods. It's also important to avoid foods containing high-fructose corn syrup, such as juice or soda. Ironically, in Australia, obesity persists despite a national diet campaign that has led to a reduction in sugary drink consumption. Local community campaigns can gain attention and inspire people to avoid sugary drinks and other sugary drinks and foods. This avoidance and awareness may be detrimental to the soda industry and other sugar-based products globally, but it will allow us to appropriately address this growing global problem and its comorbidities around the world. Involving the entire family in making healthy choices leads to a healthier society in the future.
To improve public health, health care professionals must address important lifestyle changes such as diet and exercise, as well as appropriate sleep duration and quality. Public information should be issued highlighting the harmful effects of excessive food intake and lack of physical activity. Primary care physicians can play an important role in preventing obesity and related comorbidities by educating patients, recommending different strategies, and engaging a multidisciplinary team of health care workers to provide patients with effective obesity treatment and prevention. A dietitian can be an integral part of the team, as a dietitian can help patients develop balanced eating habits by providing education on healthy foods. Nutritionists can help patients develop balanced eating habits by providing education on healthy foods. With a proper diet, greater weight loss can be achieved.
To achieve a better quality of life, specific and concrete measures should be taken to address the underlying factors associated with obesity. Surgery is an important treatment option and may provide better options for overcoming obesity and its associated complications. These weight loss surgeries are safe and effective. Guidance and awareness among primary care physicians and health care workers about the costs and side effects of these procedures can impact better public health.
Can sleep apnea cause weight gain?
The answer is yes! The relationship between sleep apnea and weight gain is a vicious cycle—weight gain leads to the development of sleep apnea, and sleep apnea leads to weight gain.
Breathing disorders can increase the risk of weight gain for several reasons:
Low energy and chronic fatigue
Just one night of poor sleep can leave you feeling terrible the next day, so imagine how you feel when you don't get enough sleep for months or years. Lack of sleep can cause you to feel chronically tired and lower your energy levels.
When you don't have the energy, you prioritize tasks based on what's important and what's extra. For example, you could postpone grocery shopping and meal prep and opt for a drive-thru instead. And, when you don't have the energy to cook, you probably don't have the energy to go to the gym, so you tend to sit longer and live a more sedentary lifestyle.
All of these factors can cause you to gain weight.
slow metabolism
Did you know that when you feel tired and less active, your metabolism slows down? When you sit more, you burn fewer calories, which means you're more likely to gain weight even if you don't eat more. This helps with weight gain.
hormonal changes
When you are sleep-deprived due to upper airway obstruction, not only do you experience sleep deprivation, but you also never achieve the level of sleep your hormones regulate. The result is hormonal imbalance and weight gain. It also makes losing weight nearly impossible.
In particular, when you don't get enough sleep, your body interrupts production of the hormone leptin. Leptin is a hormone that tells you your stomach is full after eating. Additionally, ghrelin, a hormone that makes you want to eat more, increases. Therefore, high levels of ghrelin mean you will eat more and gain weight.
