What are the risks associated with obstructive sleep apnea and obesity?

Obstructive sleep apnea is associated with glucose intolerance and insulin resistance, thereby exacerbating health risks in obese patients.

Research supports the importance of quality sleep to overall well-being, noting its important role in mental health, cognitive functioning, metabolic health, and cardiovascular health.^1: One less talked about cause of poor sleep is unhealthy weight. As research on sleep quality continues to grow, we are learning more about the health risks of poor sleep quality in obese patients.

For obese patients, fatty deposits found in the upper respiratory tract cause narrowing of the airways, which in turn leads to decreased muscle activity in the muscle groups involved in breathing.^2: These fat deposits, combined with decreased muscle activation, lead to intermittent hypoxia, which leads to impaired respiration and oxygen levels, as well as sleep fragmentation and systemic inflammation.^3: Because of the risks to metabolic activity, it is important to further consider these relationships and explore strategies to mitigate obstructive sleep apnea.

Obstructive sleep apnea and type 2 diabetes

Type 2 diabetes and: obstructive sleep apnea are risk factors for each other. their relationship is bilateral.^1: As 2018 is celebrated^3:There is a higher risk of type 2 diabetes in patients with moderate to severe obstructive sleep apnea.

Hypoxic episodes that lead to sleep fragmentation cause hormonal changes that activate the sympathetic nervous system (SNS). Because catecholamine is released during SNS activation, glycogenesis occurs with decreased insulin sensitivity.^3: Elevated cortisol levels due to stimulation of the hypothalamic-pituitary-adrenal axis also increase insulin resistance. Inflammatory markers such as TNFα: and IL-6 and oxidative stress are also implicated in the inflammatory processes leading to the metabolic syndrome.^3: As 2016 is celebrated^4:In a male cohort without type 2 diabetes, obstructive sleep apnea independently predicted the development of insulin resistance. In a longitudinal study with participants from North America, Australia, and Europe, an increased risk of type 2 diabetes was observed in participants with moderate to severe obstructive sleep apnea.

Screening and treatment of obstructive sleep apnea

Because people with obesity and type 2 diabetes are at increased risk for obstructive sleep apnea, they should be screened.^3: This screening should include assessment of snoring, daytime sleepiness, and apneic events. International Diabetes Federation Working Group on Epidemiology and Prevention.^3: Because weight or BMI do not take into account body fat distribution, they should not be considered as the sole assessment criteria.^3: Let’s face it, snoring and daytime sleepiness are not foolproof indicators. Obesity and poor sleep quality in patients with type 2 diabetes may also be a consequence of diabetic neuropathy. Clinicians working with patients at risk for obstructive sleep apnea should consider offering sleep centers for a more thorough evaluation or home devices to detect obstructive sleep apnea.^3:

Lifestyle changes, such as diet and exercise, should be considered to reduce caloric intake while increasing energy expenditure. A 2016 meta-analysis^5:00 found it exercise Useful for patients with obstructive sleep apnea. In addition to training, health care providers should work with their at-risk patients to develop a Low calorie diet (LCD) or Very Low Calorie Diet (VLCD) that is tailored to their weight loss goals and needs. Reducing energy intake and increasing energy expenditure, combined with screening for obstructive sleep apnea, can help mitigate health risks in patients with diabetes and obesity.

Sources::

1. Obstructive sleep apnea and obesity. implications for public health
2. Sleep is important for health. American Academy of Sleep Medicine Position Statement
3. Obesity, obstructive sleep apnea and type 2 diabetes. Epidemiology and pathophysiological insights
4. Sleep apnea in type 2 diabetes
5. Effects of exercise on sleep apnea. systematic review and meta-analysis