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Dr Oz on Sleep Apnea
Dr. Oz had a couple on today (Friday, March 5) who both have sleep apnea. He had some video of the man snoring, then put both in theTruth Tube. Issues discussed were neck size, weight, blood pressure, daytime sleepiness, headaches, BMI.
He had them both take an at-home test (not shown, just the guy with a thing strapped to his head).
Results, man had 67 incidents per hour, woman had not as many but enough for diagnosis.
A Dr. whose name and credentials I did not catch, then discussed 3 steps everyone should take to determine if they have sleep apnea and what to do about it.
Step 1: Do a sleep reality check. Are you getting what you need, based on how you feel daily? You must get enough sleep for a healthy body.
Step 2: Make lifestyle changes to reduce the physical causes of sleep apnea (for instance, losing 10% of your body weight will reduce sleep apnea effects by 33%)
Step 3: Use CPAP to keep airways open. (They put a mask on him but didn't fit it etc) For mild to moderate OSA, you may be able to use an appliance in your mouth at night to pull the jaw forward.
Midwest Sleep Diagnostics clinic in St. Louis MO will be setting them up with CPAP machines, and they will be back on the show at a later date, to see how they are doing.
This is my paraphrasing of what went on, it was pretty fast as is a lot of his stuff, but had all the basics. Will be interesting to see the show when they come back after receiving therapy.
Here is the link to the show, the video of the OSA segment isn't on there yet but probably will be shortly.
http://www.doctoroz.com/
He had them both take an at-home test (not shown, just the guy with a thing strapped to his head).
Results, man had 67 incidents per hour, woman had not as many but enough for diagnosis.
A Dr. whose name and credentials I did not catch, then discussed 3 steps everyone should take to determine if they have sleep apnea and what to do about it.
Step 1: Do a sleep reality check. Are you getting what you need, based on how you feel daily? You must get enough sleep for a healthy body.
Step 2: Make lifestyle changes to reduce the physical causes of sleep apnea (for instance, losing 10% of your body weight will reduce sleep apnea effects by 33%)
Step 3: Use CPAP to keep airways open. (They put a mask on him but didn't fit it etc) For mild to moderate OSA, you may be able to use an appliance in your mouth at night to pull the jaw forward.
Midwest Sleep Diagnostics clinic in St. Louis MO will be setting them up with CPAP machines, and they will be back on the show at a later date, to see how they are doing.
This is my paraphrasing of what went on, it was pretty fast as is a lot of his stuff, but had all the basics. Will be interesting to see the show when they come back after receiving therapy.
Here is the link to the show, the video of the OSA segment isn't on there yet but probably will be shortly.
http://www.doctoroz.com/
Views: 544
Replies to This Discussion
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Permalink Reply by Melinda Hertel on
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You crack me up, Jeff! Here's my thought....at least the subject is getting out there so people become aware of the problem. What disturbs me more is sitcoms that make snoring and apnea the subject of the show, but it's treated with Breathe-Right strips only. I can't think of the name of the show...just saw it last week. That really tall, deep-voiced guy that used to be in Everybody Loves Raymond--Brad something. Has anyone seen the episode?
j n k said:I think Banyon has developed a style that is designed to grab attention on an Internet board. And I think Dr. Oz, and many such TV personalities, have developed a style that is designed to capture, and hold, the short, shallow attention span of the average channel surfer who doesn't want to have to think too hard or be challenged. Both styles have purpose and limitations. Properly directed, both styles can do a lot of good.
I, on the other hand, have made it a point to be completely devoid of all style. This keeps my life particularly entertaining for me in that it seems to irritate the living daylights out of everyone around me.
jeff
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Permalink Reply by RockRpsgt on
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I think that for the most part that they have done a decent job with sleep disorders on television. We have to remember that these tv spokespeople are not sleep experts. The majority of the people on this site are better educated than most of them. Every now and then we get lucky and get a personality that is passionate and knowledgable about sleep due to past experiences. I think it is important that we embrace the education that is available to us and not try to belittle it. As I did with Banyon's message. Sorry Banyon, my passion gets the best of me too.
I think that the overall message of Dr. Oz, Oprah, Dr. Phil, The doctors, The Biggest Loser, and even Regis' story helps to inform our communities better despite their info not always being that great. Prior to the biggest loser CPAP had never been a mainstay on tv. Today I went in and did apnea screening at the hospital I work in.Two years ago I had to chase people down to get them to listen to me talk about sleep. Today people were approaching us without encouragement to get our accessment of their situation. This is huge. The word is getting out, and tv is part of the reason.
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Permalink Reply by Banyon on
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Rock Hinkle said:You and jnk always keep me thinking. :)
Banyon said::) I like to think of it as passion not anger. I leave Aristotle's "golden mean" for others.
If I can get a rise out of Rock, I smile.
Take it or leave it - your choice.
Our positions on the TV show in question are likely similar. I am happy that sleep apnea gets more attention, even if from Dr. Lite.
But I also think members on this forum should point out mistakes and inaccuracies on the shows.
I have two friends who are working on curing their sleep apnea by losing weight. I think they will both fail. Both have BMIs around 35. Both, in my estimate, do not have well-developed jaws. Both of them have trouble keeping a regular, rigorous exercise schedule because they are tired constantly. Both have refused CPAP.
I seriously doubt that many people ever lose enough weight to cure their apnea. There was a study out of D.C. on gastric-bypass patients and despite losing major amounts of weight, very few of them were cured of sleep apnea.
I have seen other examples where someone lost weight and their AHI went from about 50 to 25. Of course that is not good enough. Doctors should not be prescribing weight loss as a cure for sleep apnea.
Are there any threads here about weight loss and apnea cure?
BTW, never apologize about putting me on the spot. I enjoyed a long career "on the spot" and I still love it. (Well, except when my wife is doing it.)
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Weight loss may not be the cure, but it is a good place to start. Cutting your AHI in half could lower your pressure needs and help improve compliance. If you are over weight your doc should prescribe weight loss for whatever reason he can think of. I think that you underestimate the importance of this prescription.
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Permalink Reply by Mike on
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to your point of it being silly just to tell people to lose a little weight to cure Sleep Apnea, that's precisely what our man Dr. Oz is telling people here: http://www.doctoroz.com/videos/1-minute-better-health-advice-sleep-...
Banyon said:Rock Hinkle said:You and jnk always keep me thinking. :)
Banyon said::) I like to think of it as passion not anger. I leave Aristotle's "golden mean" for others.
If I can get a rise out of Rock, I smile.
Take it or leave it - your choice.
Our positions on the TV show in question are likely similar. I am happy that sleep apnea gets more attention, even if from Dr. Lite.
But I also think members on this forum should point out mistakes and inaccuracies on the shows.
I have two friends who are working on curing their sleep apnea by losing weight. I think they will both fail. Both have BMIs around 35. Both, in my estimate, do not have well-developed jaws. Both of them have trouble keeping a regular, rigorous exercise schedule because they are tired constantly. Both have refused CPAP.
I seriously doubt that many people ever lose enough weight to cure their apnea. There was a study out of D.C. on gastric-bypass patients and despite losing major amounts of weight, very few of them were cured of sleep apnea.
I have seen other examples where someone lost weight and their AHI went from about 50 to 25. Of course that is not good enough. Doctors should not be prescribing weight loss as a cure for sleep apnea.
Are there any threads here about weight loss and apnea cure?
BTW, never apologize about putting me on the spot. I enjoyed a long career "on the spot" and I still love it. (Well, except when my wife is doing it.)
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Rock Hinkle said:Weight loss may not be the cure, but it is a good place to start. Cutting your AHI in half could lower your pressure needs and help improve compliance. If you are over weight your doc should prescribe weight loss for whatever reason he can think of. I think that you underestimate the importance of this prescription.
Rock, You underestimate the danger of this prescription. Both of my friends are convinced they will lose weight and cure their sleep apnea. I seriously doubt they will be able to achieve even one of the goals.
On the other hand, if the doc had told them, "Use CPAP or you are on your own with your bad health", they might have gotten the message, adopted CPAP, improved their energy level and a lot of other things and eventually lost weight.
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First of all i was not talking about weight loss without CPAP. That would never have been my recommendation. i also would have included the word "death" in my explanation to both patients. jnk AHI may not be directly related to the pressure needed, but BMI is. If a person can lose weight it is very probable that their pressure needs will follow suit. A person with a BMI of 40 is more than likely going to need more pressure than someone with a BMI of 25. This is due in part to gravity. The more weight on the airway the more pressure required to open it. Simple physics gentlemen. I klnow that you two like to quote the 1 out of a million studies, but the truth is weight, AHI, and pressure requirements are related.
http://www.nature.com/oby/journal/v17/n1/full/oby2008485a.html
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What about the thousands of people that lost weight, reduced their AHI, and improved the quality of their lives. You also put alot of stock into the tongue being the problem. If this were true more people would see success with an oral device. This is not the case. For the majority of the apneacs the problem is in the airway.
Nobody said anything about anyone not eating healthy. Now you are putting words in my mouth. I do not support diets! I have chosen to be healthy by living healthy. Your overall message to me reads that it is not important to lose weight. If your BMI>30% you are more likely to die at a younger age than someone whom does not have a weight problem despite being on CPAP. A BMI of 30% raises your risk for terminal diseases or stroke by 60%. We should be advising people to continue with PAP therapy and not talking about a doctor's weight loss prescription being a bad decision. Weight loss done through healthy eating and under a doctors supervision is hardly ever bad.
I feel for all pts whom ever got bad advice or follow up from their physicians. As I have said before those same people have to take some responsibility for their situation. You spend 30 years messing up your body and expect a doctor, tech, or surgeon to fix it over night. It is not going to happen like that. This anti-medical establishment message that is not healthy. It is not always the doctors fault. Most are there to help. I will not let you 2 or anyone else tell anyone that losing weight is not a good idea. The best thing you can do for your health is eat healthy, sleep healthy, exercise regularly, and maintain a comfortable weight to your individual needs. FACT
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http://www.ncbi.nlm.nih.gov/pubmed/20202954
Obstructive sleep apnea (OSA) adversely affects multiple organs and systems, with particular relevance to cardiovascular disease. Several conditions associated with OSA, such as high BP, insulin resistance, systemic inflammation, visceral fat deposition, and dyslipidemia, are also present in other conditions closely related to OSA, such as obesity and reduced sleep duration. Weight loss has been accompanied by improvement in characteristics related not only to obesity but to OSA as well, suggesting that weight loss might be a cornerstone of the treatment of both conditions. This review seeks to explore recent developments in understanding the interactions between body weight and OSA. Weight loss helps reduce OSA severity and attenuates the cardiometabolic abnormalities common to both diseases. Nevertheless, weight loss has been hard to achieve and maintain using conservative strategies. Since bariatric surgery has emerged as an alternative treatment of severe or complicated obesity, impressive results have often been seen with respect to sleep apnea severity and cardiometabolic disturbances. However, OSA is a complex condition, and treatment cannot be limited to any single symptom or feature of the disease. Rather, a multidisciplinary and integrated strategy is required to achieve effective and long-lasting therapeutic success.
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http://www.ncbi.nlm.nih.gov/pubmed/19961024
Changes in regional adiposity and cardio-metabolic function following a weight loss program with sibutramine in obese men with obstructive sleep apnea.
Phillips CL, Yee BJ, Trenell MI, Magnussen JS, Wang D, Banerjee D, Berend N, Grunstein RR.
NHMRC Centre for Sleep Medicine, Woolcock Institute of Medical Research, University of Sydney, Camperdown, Sydney, NSW, Australia. cphillip@mail.usyd.edu.au
BACKGROUND: Although obstructive sleep apnea (OSA) is strongly linked with obesity, both conditions have been associated with increased cardiovascular risk including glucose intolerance, dyslipidemia, and hypertension independent of one another. Weight loss is known to improve both cardiovascular risk and OSA severity. The aim of this study was to evaluate cardiovascular and metabolic changes, including compartment-specific fat loss in obese OSA subjects undergoing a weight loss program. DESIGN: Observational study. PARTICIPANTS: 93 men with moderate-severe OSA. INTERVENTIONS: 6-month open-label weight loss trial combining sibutramine (a serotonin and noradrenaline reuptake inhibitor) with a 600-kcal deficit diet and exercise. MEASUREMENTS AND RESULTS: At baseline and following 6 months of weight loss, OSA was assessed together with CT-quantified intraabdominal and liver fat and markers of metabolic and cardiovascular function. At 6 months, weight loss and improvements in OSA were accompanied by improved insulin resistance (HOMA), increased HDL cholesterol, and reduced total cholesterol/HDL ratio. There were also reductions in measures of visceral and subcutaneous abdominal fat and liver fat. Reductions in liver fat and sleep time spent below 90% oxyhemoglobin saturation partly explained the improvement in HOMA (R2 = 0.18). In contrast, arterial stiffness (aortic augmentation index), heart rate, blood pressure, and total cholesterol did not change. CONCLUSIONS: Weight loss with sibutramine was associated with improvements in metabolic and body composition risk factors but not blood pressure or arterial stiffness. Improved insulin resistance was partly associated with reductions in liver fat and hypoxemia associated with sleep apnea.
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http://www.ncbi.nlm.nih.gov/pubmed/19959590
Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomised controlled trial.
Johansson K, Neovius M, Lagerros YT, Harlid R, Rössner S, Granath F, Hemmingsson E.
Obesity Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. kari.johansson@ki.se
Comment in:
BMJ. 2009;339:b4363.
OBJECTIVE: To assess the effect of weight loss induced by a very low energy diet on moderate and severe obstructive sleep apnoea in obese men. Design Single centre, two arm, parallel, randomised, controlled, open label trial. Blocked randomisation procedure used for treatment allocation. Setting Outpatient obesity clinic in a university hospital in Stockholm, Sweden. Participants 63 obese men (body mass index 30-40, age 30-65 years) with moderate to severe obstructive sleep apnoea (apnoea-hypopnoea index (AHI) >or=15), treated with continuous positive airway pressure. INTERVENTIONS: The intervention group received a liquid very low energy diet (2.3 MJ/day) for seven weeks to promote weight loss, followed by two weeks of gradual introduction of normal food, reaching 6.3 MJ/day at week 9. The control group adhered to their usual diet during the nine weeks of follow-up. MAIN OUTCOME MEASURE: AHI, the major disease severity index for obstructive sleep apnoea. Data from all randomised patients were included in an intention to treat analysis (baseline carried forward for missing data). Results Of the 63 eligible patients, 30 were randomised to intervention and 33 to control. Two patients in the control group were dissatisfied with allocation and immediately discontinued. All other patients completed the trial. Both groups had a mean AHI of 37 events/h (SD 15) at baseline. At week 9, the intervention group's mean body weight was 20 kg (95% confidence interval 18 to 21) lower than that of the control group, while its mean AHI was 23 events/h (15 to 30) lower. In the intervention group, five of 30 (17%) were disease free after the energy restricted diet (AHI <5), with 15 of 30 (50%) having mild disease (AHI 5-14.9), whereas the AHI of all patients in the control group except one remained at 15 or higher. In a subgroup analysis of the intervention group, baseline AHI significantly modified the effectiveness of treatment, with a greater improvement in AHI in patients with severe obstructive sleep apnoea (AHI >30) at baseline compared with those with moderate (AHI 15-30) sleep apnoea (AHI -38 v -12, P<0.001), despite similar weight loss (-19.2 v -18.2 kg, P=0.55). Conclusion Treatment with a low energy diet improved obstructive sleep apnoea in obese men, with the greatest effect in patients with severe disease. Long term treatment studies are needed to validate weight loss as a primary treatment strategy for obstructive sleep apnoea. TRIAL REGISTRATION: Current Controlled Trials ISRCTN70090382
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Now I am just having fun! Happy national Sleep Awareness Week Sleepguide.
The Question
Last month, we examined the neurocognitive effects of obstructive sleep apnea in a patient with an elevated body mass index that was not to the result of muscle hypertrophy. What does the evidence show regarding the link between obesity and OSA?
The Analysis
A search of the Cochrane Database of Systematic Reviews (www.cochrane.org/reviews) uncovered no review articles on this topic. We then performed a Medline search combining “sleep apnea” and “risk factors.”
The Evidence
Three relevant review articles were found: CMAJ 2006;174:1293–9; Int. J. Clin. Pract. 2004;58:573–80; and Curr. Opin. Pulm. Med. 2000;6:471–8.
Being overweight or obese is defined as having a body mass index (kg/m2) greater than 25 or 30, respectively. However, using BMI alone to determine obesity may underestimate or overestimate health risks in certain adults, such as those who are highly muscular bodies.
We also looked at several individual studies. In one, Italian investigators performed a controlled trial examining predictors of OSA (Int. J. Obes. Relat. Metab. Disord. 2001;25:669–75).
A total of 161 obese patients (104 women and 57 men with a mean BMI of 43.4) were enrolled with 40 control subjects (25 women and 15 men with a BMI less than 27). After polysomnography, subjects were divided into three categories: no apnea, moderate sleep apnea, and severe sleep apnea.
Moderate sleep apnea was seen in 26% of the obese subjects, and severe sleep apnea was seen in 25%. Most of the subjects with moderate to severe sleep apnea had BMIs greater than 40. Stepwise multiple regression analysis showed that neck circumference in men and BMI in women were the strongest predictors of sleep apnea. In men, BMI correlated with sleep apnea to a lesser extent.
In a similar study conducted several years earlier, researchers at Pennsylvania State University, Hershey, recruited 200 women and 50 men with a mean BMI of 45.3 and 128 controls (BMIs not given) who were matched for age and sex (Arch. Intern. Med. 1994;154:1705–11).
The frequency of severe sleep apnea in morbidly obese patients (BMI greater than 39) was about twice as high as the frequency in severely obese patients (BMI 35–39) for both men and women (50% vs. 20% for men; 3.5% vs. 2.4% for women).
Belgian investigators evaluated the effect of continuous positive airway pressure (CPAP) and weight loss on the severity of sleep apnea in 95 patients with a baseline apnea-hypopnea index (AHI) of 10 per hour (Chest 1996;109:138–43).
Of the 95 patients originally enrolled, 39 were compliant with CPAP and thus remained in the study. Average weight loss was 9 kg, excluding three patients who underwent gastroplasty during the study. A significant improvement was found in terms of reducing the AHI and the duration of each episode.
The drop in number of apneic episodes correlated with the reduction in BMI. (AHI is an index of sleep apnea severity that is calculated by dividing the number of apnea and hypopnea events by the number of hours of sleep.)
In a prospective 4-year study conducted by investigators at the University of Wisconsin, Madison, 690 subjects with a baseline BMI of 29 (56% male) were evaluated to determine the effect of weight change on sleep-disordered breathing (JAMA 2000;284:3015–21).
A 10% weight gain predicted an approximate 32% increase in the AHI, whereas a 10% drop in weight predicted a 26% decrease in the AHI. A 10% increase in weight also predicted a sixfold increase in the odds of developing moderate to severe OSA, which was defined as an AHI of 15 per hour.
Sleep-disordered breathing was also examined in a group of 52 National Football League players (N. Engl. J. Med. 2003;348:367–8). The authors of this letter to the editor estimated a league prevalence of 14% overall—remember, last month we noted that the prevalence is 2%–3% in the general population—with 85% of cases occurring in offensive and defensive linemen, who also had the largest neck circumferences (average of 19.1 inches) and highest BMIs (average 36.6).
The Conclusion
Obesity alone is not sufficient to cause OSA, but it is one risk factor.
The data in this area are limited by several factors, including study size, but we can draw the following conclusions: For patients with elevated BMIs (without muscle hypertrophy) of 30, a further increase in body fat raises the risk of developing OSA; those with severe obesity (BMI of 35) have about a 25% chance of having OSA; those with morbid obesity (BMI greater than 40) have about a 50% chance of having OSA; and those with BMIs greater than 50 are almost assured of having OSA.
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