Medical Barriers: Obstructive Sleep Apnea

Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.

This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.

OBSTRUCTIVE SLEEP APNEA

Poor sleep and sleep deprivation increase blood cortisol levels and decrease serum leptin levels, leading to metabolic changes that promote weight gain and increase appetite. Obstructive sleep apnea (OSA), an important cause of sleep disruption, is highly prevalent among obese patients as obesity causes anatomic and functional alterations in the pharyngeal airway and central nervous system. A 10% increase in weight is associated with a six-fold increase in the risk of developing moderate to severe OSA.

OSA increases a patient’s risk for cardiovascular complications such as hypertension, nocturnal arrhythmias, sudden death, etc. It may predispose to worsening obesity through sleep deprivation, daytime somnolence, and metabolic disruptions that limit a patient’s ability to engage in physical activity and make the dietary changes needed for sustainable weight management.

To diagnose OSA, the clinician must be aware of the spectrum of acute and chronic neurocognitive, psychiatric, and nonspecific symptoms it can cause, even when patients are unaware that their sleep is disturbed. The Berlin Questionnaire (widely available, as are other validated checklists and questionnaires) is a useful screening tool, though simple questions can also be used, such as, “If you were on vacation, sleeping seven or more hours per night, would you expect to feel well rested?” Other indicative symptoms are loud snoring, awakenings coupled with gasping for breath, frequent awakening during the night, abnormal daytime sleepiness or fatigue, morning headaches, limited attention and memory loss.

Polysomnography is the gold standard in diagnosing OSA and assessing the effects of treatment. Although not curative, nasal continuous positive airway pressure (CPAP) is the treatment of choice for most patients because it is non-invasive and technically efficacious. It is important to note that many patients find falling asleep with high CPAP pressures to be difficult. Those patients may find that using automated positive airway pressure (APAP) devices is more comfortable as they will deliver high pressures on demand rather than continuously. For patients with mild to moderate sleep apnea who are unable to tolerate CPAP, a dental device called the Thornton Adjustable Positioner (TAP) may be worth trying.

© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.

The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.

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