2-4% of the adult’s population is suffering from obstructive sleep apnoea. Research showed that sleep apnoea is present in ≈40% of obese individuals and ≈70% of OSA patients is obese. 1
Obstructive sleep apnoea (OSA) is characterized by successive episodes of decreased or stop in respiration airflow. It is a serious sleep disorder due to cyclic collapsing of the soft tissue of the throat during sleep that leads to temporary decreased or stop breathing. OSA causes respiratory insufficiency and leads to the development of pulmonary hypertension and other serious health hazards include premature death, sudden death and traffic accidents. 2
What are the signs and symptoms of OSA?
Loud snoring
Excessive daytime sleepiness
The sudden feeling of choking or gasping during sleep
Dry mouth and sore throat
Morning headache
Mood changes, irritability
High blood pressure
How OSA diagnosed?
It is suspected on the basis of symptoms, however; overnight polysomnography is required to confirm the diagnosis of OSA
What is the management of OSA?
Treatment of OSA includes administration of continuous positive airways pressure (CPAP) and weight loss
OSA, Obesity and Bariatric surgery
It is believed that obesity or overweight may worsen OSA because of fat deposition at specific site especially in the tissue surrounding the upper airway appears leads to the small lumen and increased collapsibility of the upper airways leading apnoea. In obese fat deposits reduced lung expandability and may increase oxygen demand. When fat deposit around your throat, muscles in the back of your throat relax. During sleep, the airway narrows or closes as you breathe in and breathing may be inadequate this results in decreased oxygen in the blood and cause an increased carbon dioxide in the blood that results in a sudden feeling of choking or gasping during sleep.
Metabolic dysregulation such as diabetes mellitus, dyslipidemia and heightened systemic inflammatory state in obese population also contribute to developing OSA. However, the relationship between obesity and OSA is complex.
Weight loss with diet (ketogenic diet, intermittent fasting), physical exercise or by bariatric surgery is the main strategy for the management of sleep apnoea. Different studies have shown that a 10 to 20% reduction in body weight results in a 50% reduction in sleep apnoea. Improvements in sleep apnoea after weight loss is due to loss of fat around the upper airway and decrease in airways collapsibility during sleep after weight loss, that results to reductions in mechanical loads or improvement in pharyngeal muscle.3
Conclusion
In short, Weight loss with bariatric surgery has been proven to be the most effective treatment of OSA in obese people, Bariatric surgery results in improvement and cure of OSA in obese patients. These beneficial effects are evident as early as 1–6 months after surgery.
References:
- Spicuzza L, Caruso D, Di Maria G. Obstructive sleep apnoea syndrome and its management. Ther Adv Chronic Dis. 2015;6(5):273‐285. doi:10.1177/2040622315590318
- 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. doi:10.1378/chest.09-0360
- Priyadarshini P, Singh VP, Aggarwal S, Garg H, Sinha S, Guleria R. Impact of bariatric surgery on obstructive sleep apnoea-hypopnea syndrome in morbidly obese patients. J Minim Access Surg. 2017;13(4):291‐295. doi:10.4103/jmas.JMAS_5_17
