~ by Linda M. Girgis, MD

We have started to explore the complications obesity can cause. This post will look at its association with sleep apnea. The role of obesity in sleep apnea has been well established in adults and children alike. Its rate has been climbing.

The prevalence of OSA in obese patients is nearly twice that of normal weight patients. Patients with mild OSA who gain 10% of their baseline weight have at a sixfold-increased risk of progression of OSA.  Similarly, a loss of an equal amount of weight can lead to more than 20% improvement in OSA severity. Some recent studies show that obese children have a 46% prevalence of OSA when compared with children seen in a general pediatric clinic (33%).

Why does obesity cause OSA?

It is felt that deposits of fat in specific areas play a key in determining whether someone develops OSA. For instance, fat deposits in the tissues surrounding the upper airways can result in a narrower lumen and increased collapsibility of the upper airway.  In addition, truncal obesity reduces chest compliance, functional residual capacity, and increased demand for oxygen.  Nevertheless, the relationship between OSA and obesity is much more complex.  Patients with OSA tend to have reduced physical activity and cravings for carbohydrates that tend to exacerbate the obesity.  CPAP has been shown to reduce the visceral fat in some patients.  There have been some studies showing an interplay of obesity and OSA as a result of genetic factors, specifically polymorphisms of the leptin receptor.

It is even more alarming that we see  this more frequently in children and adolescents.  In one study, 46 children were evaluated. These subjects were recruited from a pediatric obesity clinic at a university hospital. They had been referred there by their primary care providers. They were compared to 44 normal weight subjects who were matched for other characteristics, such as sex and age.  This study showed that mild breathing disruptions, however, they were more significant in obese subjects. It was also shown that many of them had enlarged tonsils and adenoids, so suggested ENT consult in cases of OSA in children despite their BMI. An interesting observation in this study is that oxygen desaturations were not as severe as in adults with OSA and, therefore, children with OSA did not suffer from daytime sleepiness as much.

The Sleep AHEAD study showed that there was a clear improvement in OSA in patients who lost weight.  This study included 264 subjects in 4 different centers.  Their average BMI was 36.7 and average apnea-hypopnea index (API) 23.2 events per hour. This study showed that clearly weight loss improved OSA, especially in men and those with higher AHI scores.   In patients who maintained their weight for one year, they maintained their benefits of their weight loss as evidenced by their repeated AHI scores.

Obesity clearly plays an etiologic role in OSA in both adults and children. We are learning the dangers of OSA as time goes on, in terms of hypertension and cardiovascular disease.  While obesity itself has a clear cause of producing OSB, it appears to be multi-factorial. Weight loss has been clearly demonstrated to improve OSA in many studies. The treatment should start with lifestyle changes and weight loss.

We discuss this and a myriad of clinical topics inside SERMO. If you’re an M.D. or D.O., please join us.

Bio

Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University, UMDNJ, and other institutions.  Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University.  She has appeared in US News and on NBC Nightly News.

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The Boston Marathon, for those who don’t know, ends on Boylston street, nearly equi-distant to several hospitals that form the world’s largest hub of medical research and treatment, including Mass General Hospital, Boston Children’s, Brigham and Women’s, BU Medical Center, BIDMC and Tufts Medical Center. The Marathon is an elite international sporting event, but it is also an event of immense hometown pride and local celebration.  As such, many of the thousands of health care professionals who work in that area turned out to cheer their family members, friends and all other runners onto finish the race, not counting the many who, as believers for their respective causes, actually ran the race to fundraise for research in their  specialties.  As such, the streets were teeming with spectators and runners who also happened to be medical professionals; and like our military heroes in combat, they came running into the blast zones to help the victims, commandeering wheelchairs, blankets and first aid kits from the post-race tents, and tying tourniquets quickly to prep people for the EMS responders and transport to local emergency units.  Victims were marked for amputation on the scene.  Patients were inside emergency rooms within 15 minutes of the explosion. This phenomenal response started on the street.

Days like yesterday  remind all of us of what the world sees in doctors, what a medical community can accomplish together, and that despite differences of opinion, you are all part of a calling that warrants respectful and honorable interactions among you.  We are so very proud to host just such a community.  For yesterday’s great work and for the service of all our medical heroes who help make the world a better place, we thank you.

Welcome to Sermo.

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