Obesity and the risk of sleep apnea

From heart problems to joint pain to Type 2 diabetes, many health issues are caused or made worse by obesity. These serious conditions trigger the most medical attention and can leave other symptoms, such as fatigue or chronic headaches, overlooked. However, these symptoms could indicate a serious, even deadly condition: sleep apnea.

What is sleep apnea?
Sleep apnea is a condition that causes breathing to stop repeatedly throughout sleep. Obstructive sleep apnea (OSA) is the most common of the three types of sleep apnea. OSA occurs when the tongue or throat muscles relax and block the airway.

Sleep apnea is not unique to individuals who are obese. Nearly 22 million American adults are diagnosed with one or more types of sleep apnea; however, 70% of those individuals diagnosed with sleep apnea are also obese. This is due in large part to excess fatty tissue around the throat and upper torso, predisposing individuals to this condition.

Dr. Julie Ellner, a board-certified surgeon affiliated with Sharp Grossmont Hospital who specializes in both nonsurgical and surgical weight loss, knows just how common it is for her patients to have issues achieving quality sleep. “I have seen that 93% of women and 98% of men with a BMI over 40 experience some degree of sleep apnea,” she says.

This condition is likely more prevalent than statistics show, but many individuals remain undiagnosed. Dr. Ellner recommends looking out for these common indicators of sleep apnea:

• Chronic snoring

• Waking up tired and with a headache

• Waking up throughout the night, gasping for air

• Excessive tiredness, especially midafternoon

It would be easy to attribute these symptoms to the daily grind of modern life. However, if people find that their drowsiness seems excessive or is affecting daily activities, they should notify their doctor.

Risks of sleep apnea for obese individuals
When an individual experiences sleep apnea, they are temporarily suffocating throughout the night. The brain will then rouse the body to resume breathing, resulting in poor quality sleep that puts the body in a state of continual stress. Untreated sleep apnea is associated with glucose intolerance and insulin resistance, increased blood pressure, atrial fibrillation (AFib), increased cortisol (stress hormone) levels, higher levels of triglycerides (“bad” cholesterol) and even depression. This not only has negative effects on your general health, but also can lead to sudden death due to suffocation if the airway remains closed for too long.

Clearly, the side effects of sleep apnea should not be ignored, especially for someone who is obese. Untreated sleep apnea is likely to hinder the effectiveness of treatments for other conditions such as diabetes or heart problems. Poor sleep and elevated stress hormones also trigger weight gain, creating a cycle of poor sleep due to excess weight and the poor sleep causing more weight gain.

There is hope, though, according to Dr. Ellner. “As patients lose weight after the stomach balloon procedure or bariatric surgery, I generally see that the patient’s sleep apnea goes away. It's actually a common reason people come to me wanting to lose weight.”

How to know and what to do
To be diagnosed with sleep apnea, you must undergo a sleep study either at home or in a sleep lab. “A home sleep study involves taking home a diagnostic machine, hooking it up to yourself at bedtime, sleeping with it on, and then returning it. An in-lab sleep study involves spending the night in a sleep lab, where you are monitored in a hotel-like room,” explains Dr. Victoria Sharma, medical director of the Sharp Grossmont Hospital Sleep Disorders Center.

Treatment options depend on the type and severity of sleep apnea. The most well-known treatment is the use of a device called a continuous positive airway pressure (CPAP) machine. This requires the user to wear a mask that is connected to a machine that helps supply filtered, pressurized air while they sleep.

“Besides a CPAP, mild to moderate sleep apnea can sometimes be treated with an oral appliance worn at night that pulls the lower jaw out, enlarging the airway,” say Dr. Sharma. Another possible treatment is hypoglossal nerve stimulation therapy — commonly referred to as Inspire. It consists of an implantable impulse generator — similar to a pacemaker — that sends a signal to move the tongue forward with breaths. It can be successful in appropriately selected patients for moderate or severe obstructive sleep apnea.

People who are experiencing or living with someone with sleep apnea should talk with their doctor. Quality sleep may be the key to leading a healthier life.