Obesity and Obstructive Sleep Apnea Syndrome

Abstract

Obstructive sleep apnea (OSA) is a common condition that forms part of the spectrum of sleep disordered breathing (SDB). It may affect between 6 and 17% of all adults, but the risk rises with increasing body weight and it is very common in people with obesity. OSA causes symptoms of daytime sleepiness which can be disabling for patients, and this is currently the main criterion used to determine if treatment should be offered. Although obesity itself is associated with hypertension, hyperlipidaemia and dysglycaemia, emerging evidence shows that those with sleep apnoea are more likely to have all of these abnormalities at any given weight, and subsequently have a higher risk of developing cardiovascular disease. OSA is particularly common in people with type 2 diabetes, affecting at least a quarter of patients, and is associated with a higher risk of developing microvascular complications such as retinopathy. The main treatment used for OSA is continuous positive airway pressure ventilation (CPAP), and this has been shown to reduce daytime sleepiness and lower blood pressure, but no prospective randomised controlled trials have shown reduction in CV risk or improvement in diabetes. Weight loss is also an effective treatment, and some patients can stop CPAP treatment after bariatric surgery.