Obesity is among the leading risk factors for the development and worsening of obstructive sleep apnea (OSA), a condition with intermittent nighttime breathing cessation. As an individual gains weight, particularly in the upper airway and neck, fat buildup causes the airway to tighten. The airway is also more prone to collapse while asleep, which causes breathing to be interrupted. Moreover, the excess of fat in the abdominal area reduces lung capacity and the flow of air into the lungs, which complicates the respiratory mechanism of the body while asleep. The lower muscle tone in the neck and throat when asleep also causes collapse of the airway.
Common signs of sleep apnea in obese individuals include heavy noisy snoring, night gasping or choking, daytime sleepiness, morning headaches, decreased concentration, and mood swings. The symptoms have a direct impact on daily activities because the constant disruption of sleep causes fatigue, mental disorganization, and mood change. Sleep apnea caused by obesity is linked with various life-threatening medical complications such as type 2 diabetes, high blood pressure, heart failure, cardiovascular disease, and depression.
Treatment of sleep apnea and obesity is multifaceted, with initial focus on lifestyle modification and weight control. One of the key interventions is weight loss that reduces fat reserves in the neck and abdominal region and enhances airway function, thereby reducing severity of OSA. Lifestyle changes such as a well-balanced diet and activity are also beneficial for a symptomatic improvement. Evening abstinence from alcohol and sedatives is also important, as these drugs will relax the muscles of the throat and set one up for airway collapse.
In unresponsive patients, Continuous Positive Airway Pressure (CPAP) therapy is commonly recommended. The equipment delivers a steady flow of air through a mask to keep the airway open during sleep. Bariatric surgery may also be provided in more severe instances of people with severe obesity, and significant weight loss following surgery will have a tendency to lead to a marked relief of symptoms of OSA and overall well-being.
Studies have established that a weight loss of 10% is sufficient to decrease severity in OSA by more than 20%. Obesity is the primary risk factor for OSA; however, untreated sleep apnea can lead to further weight gain, thus creating a cycle. Treatment of both diseases through weight loss, modification of lifestyle, and, when needed, surgery is thus important in order to enhance sleep and overall well-being.
Dr. Aparna Govil Bhasker, Consultant Bariatric and Laparoscopic Surgeon, Saifee Hospital, Mumbai
