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Dr. Park's comment was thorough & I agree from a meta perspective, though I would add that the US OSA patient population I have observed, most notably including myself, there are an extraordinary number of subjects who are obese and beyond. That observation leads me to painfully conclude that many, and perhaps most US OSA patients have personally overeaten their way into their condition.
Rock Hinkle has gone all elvis
in tennessee excuse my poor spelling when people get married they say Ha Ha instead of i do
My sleep technician noted that he saw as many thin people as overweight people with sleep apnea. Might I suggest that weight gain and sleep apnea are a "chicken or egg" conundrum. If you aren't sleeping and breathing properly, this can affect proper circulation and processing of food. Once overweight, it's even more difficult to lose weight. Or, being overweight, there is a tendency for the jaw area to move into a position causing obstruction. I've had sleep apnea since very young, but only got overweight later in life. I suspect that many years of sleep deprivation may have contributed to my weight gain and made it more difficult to lose. But now that other parts of my body are functioning better, because I'm being treated properly, I believe I can focus on weight loss with better results.
Rock Conner RRT said:Dr. Park's comment was thorough & I agree from a meta perspective, though I would add that the US OSA patient population I have observed, most notably including myself, there are an extraordinary number of subjects who are obese and beyond. That observation leads me to painfully conclude that many, and perhaps most US OSA patients have personally overeaten their way into their condition.
Thomas,
Sleep apnea is a world wide problem. The incidence in Asians is 24%, Hispanics and Afro-Americans 15-16%, Caucasians 9%.
Dr Christian Guilleminault and coworkers at Standford have done tissue biopsies in the upper airways of patients with OSA and find evidence of neuromuscular pathology. In one of his first reports, I believe from the early 90's, he wasn't certain of the cause. Was it due to the trauma of longstanding vibrations from snoring or was there some as yet undetermined source of the pathology? More recent studies, show the same pathological changes again with no obvious cause. The trauma theory had fallen out of favor, if I remember correctly. So the cause is still unknown.
OSA, the result of pathological collapse of the tissues and musculature in what may already be an anatomically small upper airway, causes obesity and obesity narrows the airway even more. This magnifies the problem, i.e., OSA causes itself to get worse. Loosing the excess weight reduces the AHI, but rarely eliminates all apneas. There are a few cases reported in which the AHI is 0 after dropping to a normal BMI. The assumption here is that the obesity caused their OSA.
Why does OSA cause obesity? The sympathetic nervous systems surges (the "fight or fright mechanism") with each apnea results in elevated levels of many hormones including cortisol which drive the appetite center in the hypothalamus. There is a drop in leptin and a surge in ghrelin, both contributing over stimulation of the appetite center. Treat OSA and these hormone level drop and weight tends to be much easier to lose (some have found their weight drops without even trying).
Twenty percent of OSA patients in the US are not over weight nor obese presumably because of their genetic makeup (look at the Asians). You can be skinny and have an AHI of over 100. There is no fat surrounding the upper airway; there airways were made small and the collapsing tissues have no fat.
Loosing weight is simple. I've done it many times. It is calories in and calories out. One pound of fat contains 3500 calories. Metabolize or use up 3500 calories and you have lost one pound of fat. Because the strong drive for food is part of our instinctual brain located in the hypothalamus, hunger triggered by cortisol, etc., easily overrides the prefontal cortex's control center. But because we are rational and intelligent beings, we have found many inventive ways to overcome this hypothalamic over-stimulation. Portion control works for me. The bottom line: Stop going to the service station when your tank is full.
How do you explain OSA in dogs and cats? And who knows what other animals? I guess when we discover the cause in humans we will have the answer in animals or vice versa.
I do believe that Colin Sullivan (http://www.medfac.usyd.edu.au/museum/mwmuseum/index.php/Sullivan,_C...) did the first research on sleep disordered breathing on dogs and devised the first CPAP in order to treat the disorder in canines:
http://tinyurl.com/yjlbml9
Interesting reading, IMHO.
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