Link between OSA and the "beer gut"

split_city wrote:Hi all. This is my first post in this forum. I'm currently a PhD student working in the area of sleep apnoea.

Daniel

Welcome to the forum Daniel, and good luck with your research.
Please keep us posted!
regards
Di

DP wrote:Rosemary, how old are you? The reason I ask is because women will typically develop sleep apnea during and after menopause. Now this is not to say younger women don't have sleep apnea, it is just that the incidence levels is not has high and usually specific to being obese.

I'm well past menopause. However, I suspect that I had sleep problems before menopause, but certainly they got worse after it.

I'm wondering how many of the memory problems, mood swings, etc. have an OSA component that are just chalked up to menopause.

split_city wrote:I can only study so much in 3 years!!

I have one other question (at the moment)......
Where are you going to find your "subjects" to study.....bars, taverns and saloons?

In reality, it's sort of a serious question. There have been "studies" claiming that only about 50% of the CPAP patients are compliant with their therapy. In a discussion on the forum last year, we were of the opinion that CPAP users who were more involved with their therapy (monitoring with machines that recorded nightly statistics and using the software to interpret it) were far more compliant than the patients who were given the cheapest machines and masks by their doctors.....and who didn't have a clue how their therapy was working. BUT.....how would one do a study to prove it?
In order to do a study, you'd have to have access to patient information and that sort of thing is (supposedly) protected by the doctor-patient privileges.

Just wondering.....

Den

split_city wrote:Hi all. This is my first post in this forum. I'm currently a PhD student working in the area of sleep apnoea. I have been looking at one potential mechanism which might explain why sleep apnoea is predominant in males.

Hi Daniel,

Thanks for the thought provoking theory. Not being obese myself, I'm not sure I fit your pattern theory, but I will tell you that my OSA is definitely related to GERD. Have you studied that association yet?

Also, out of curiosity, is this theory directly related to your dissertation, and what is your major field of study? (MD's don't study this stuff.)

Regards,
Bill

I'd also like to throw in my personal reply that it's been my personal experience that Weight Gain is caused by Sleep Apnea and not the other way around. Since my sleep Apnea has become succesful I have gone down from 190 to 183 lbs.

.

.

split_city wrote:
The problem with these types of forums is that I'm sure many unhappy OSA patients who have undergone unsuccessful surgical procedures would want to let off their "steam" via this type of medium. I'm sure it would be biased towards them compared to patients who have been successfully treated.

Problems??

boy for a doctor you are as dumb as rock aren't ya? FYI: These forums got started because not because we were obese or "surgery rejects" but because we were patients seeking common sense answers to questions we were NOT getting or couldn't get from our doctors. You may know them, the ones with the same philosophy as yours wearing the same white coat.

I would say the people that regularly visit here are not from any phat farm but have white coat syndrome. But instead of it being hypertension it was where the BS factor skyrockets. So they ended up here to help each other because the allotted 2-5 minutes by their doctor for answers just wasn't quite long enough.

People that come here already know they have OSA and probably know more about it than you ever will. Most that visit here can easily smoke any sleep doctor I know when it comes to knowledge about their disorder and/or therapy. Telling them the risk factors over and over isn't going to change that fact any.

If you really want to help patients with OSA, go find a solution to preventing the tongue from falling into the back of the throat, or stop their legs from kicking during sleep or find the reason they don't sleep uninterrupted throughout the night from spontaneous arousals because we have enough sleep doctors with the same ole stereotypes. But the first place to start would be with listening, most doctors are not very good at that so you are not alone.

Say you weren't that white coat in front of me at Costco in a beat up toyota corolla pumping his own gas were ya?

FYI...

I am underweight...
What gives?

I get the impression that obesity is highly correlated to apnea. (See below, for example.) But I also thought about 30 percent of OSA patients are of normal weight. I'm a 5'10" male and weigh 165, work out with weights and run regularly, don't smoke, have no faciocranial abnormalities or enlarged tonsils. But I have had (treated) moderate apnea for about seven years. No one in my family has it - though I do have a marathon runner friend who has it, as do many of his family members.

Department of Otorhinolaryngology, Head and Neck Surgery, Hacettepe University Faculty of Medicine, 06100 Hacettepe, Ankara, Turkey.

OBJECTIVE: To investigate body fat composition, measured by bioelectrical impedance assay (BIA), for predicting the presence and severity of obstructive sleep apnea-hypopnea syndrome (OSAHS). Body fat composition was also compared with other well-known OSAHS predictors such as body mass index (BMI), neck circumference, and abdominal visceral fat. STUDY DESIGN: A prospective study was designed. Fifty-one patients (41 male, 10 female), who were referred to Hacettepe University Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery with suspected OSAHS, between April 2003 and June 2004, were included in the study. METHODS: All patients underwent polysomnography (PSG) and were classified according to their apnea-hypopnea index (AHI) into four groups. The cross-sectional area of abdominal visceral fat was measured by computed tomography (CT) scanning in 33 of the patients. Neck circumference and BMI was measured for all patients. BIA was performed to determine body fat composition. The groups were compared, and correlation of the variables with AHI was investigated. RESULTS: Of the variables, BMI and percentage of body fat (determined by BIA) were found to be significantly correlated with AHI (r = 0.782, r = 0.647). CT of cross-sectional area of abdominal visceral fat provided 100% sensitivity and specificity (P < .001) in differentiating simple snorers from OSAHS patients. By combining percentage of body fat and body fat mass, higher levels of sensitivity (95%) and specificity (100%) were achieved for diagnosis of OSAHS. CONCLUSION: It was concluded that the BIA could be an inexpensive and practical alternative to prePSG screening tests and should be included in the evaluation of OSAHS patients.

Laryngoscope. 2005 Aug;115():1493-8.

Snoredog wrote:

split_city wrote:
The problem with these types of forums is that I'm sure many unhappy OSA patients who have undergone unsuccessful surgical procedures would want to let off their "steam" via this type of medium. I'm sure it would be biased towards them compared to patients who have been successfully treated.

Problems??

boy for a doctor you are as dumb as rock aren't ya? FYI: These forums got started because not because we were obese or "surgery rejects" but because we were patients seeking common sense answers to questions we were NOT getting or couldn't get from our doctors. You may know them, the ones with the same philosophy as yours wearing the same white coat.

I would say the people that regularly visit here are not from any phat farm but have white coat syndrome. But instead of it being hypertension it was where the BS factor skyrockets. So they ended up here to help each other because the allotted 2-5 minutes by their doctor for answers just wasn't quite long enough.

People that come here already know they have OSA and probably know more about it than you ever will. Most that visit here can easily smoke any sleep doctor I know when it comes to knowledge about their disorder and/or therapy. Telling them the risk factors over and over isn't going to change that fact any.

If you really want to help patients with OSA, go find a solution to preventing the tongue from falling into the back of the throat, or stop their legs from kicking during sleep or find the reason they don't sleep uninterrupted throughout the night from spontaneous arousals because we have enough sleep doctors with the same ole stereotypes. But the first place to start would be with listening, most doctors are not very good at that so you are not alone.

Say you weren't that white coat in front of me at Costco in a beat up toyota corolla pumping his own gas were ya?

Wow, it seems someone is getting pretty defensive here. Calling me a dumb doctor is really mature now isn't it?

By the way i am NOT a physician! I am working in research. I do NOT run clinics to see patients. While it seems there are problems with doctors world wide, I know that this is not always the case. These forums are great but obviously there will be many unhappy people out there who have undergone surgery or lost weight and their OSA didn't go with it. As I keep repeating, there is no number one cause of OSA.

You call me dumb yet you are naive enough to think that collapse is ONLY caused by the tongue flopping backwards. How wrong you really are. How do you know my background about OSA? Are you one of these people who think you know more about the disease than me? Obviously you don't given the fact you think OSA only has one cause. This white coat stuff is quite funny. I'm not a crazy scientist. I'm out there trying to help the OSA community because as you said, not all people get rid of their OSA following surgery. You do realise that OSA patients do have tongue reduction surgery? This doesn't always help now does it. There are studies out there looking at all the things you described. These studies take time (and lots of money)

Oh and I do listen to the patients I recruit for that matter.

What is your hidden agenda?

split_city wrote:Calling me a dumb doctor is really mature now isn't it?

If you click Search at the top and then type Snoredog in as the author (Display posts. It's easier to skim than topics), you'll see this is a common technique of his. He doesn't mean anything by it.

The reason for the cat picture was to try to get him off the pissing contest, but here we are. Oh well.

RosemaryB wrote:

split_city wrote:Hi all. This is my first post in this forum. I'm currently a PhD student working in the area of sleep apnoea. I have been looking at one potential mechanism which might explain why sleep apnoea is predominant in males.

Hello Daniel, and welcome to the forum. I'm wondering if you could study the same thing in females as well (or instead).

My story is that I went to my GP 4-5 years ago and asked to be tested. He talked me out of it, since I'm a female, BMI of 21.5 based on weight, with a thin neck, and I don't snore, or only rarely and then gently. I suspect that there are many undiagnosed women out there due to confirmation bias, a problem not only in diagnosis, but also in research.

I finally got diagnosed recently, but am thinking of the large impact untreated OSA has had on my professional and personal life in the years since I made this request. Obviously I feel strongly about this.

Having done doctoral level research myself, I can appreciate the need to narrow one's topic! However, narrowing one's topic in a way that perpetuates confirmation bias results in flawed research.

If you wish to study a link between OSA and hip/waist measurement, including both genders (or even studying women) would make a significant contribution and would strengthen your research. If I were on your committee, this is certainly one thing I would want to explore with you. Including gender would make a more sophisticated contribution to the field, and probably a more original one.

One thought is that after menopause, many women also get a gut and this is when the incidence of OSA increases in women (supposedly). In my own case, my weight is average but my waist is not what it once was. KWIM?

Good luck on your research. You will find some good dialogue on this site that may help you refine your study.

Hi Rosmary,

You're correct. There are many undiagnosed women out there and there is research being done to try and determine the % of undiagnosed women.

There were a number of reasons why we only studied males in my particular study:
1) Hormone levels change during the month in women. To study women, I would be required to study each of them at the same time of their menstural cycle. Therefore, the study would have taken a lot longer.
2) These hormones are known to protect the airway against the collapse. Therefore, we believed that the compressive effects of this abdominal cuff may have had little influence on upper airway collapsibility
3) Males are the ones which store their fat centrally. I counducted a similar study in healthy-weight males and found that abdominal compression had no impact upon airway collapsibility. We believed that the actual intra-abdominal fat would have important effects on diaphragm position and that further compression would greatly influence the impact that this fat has on diaphragm position.

The decreased levels of estrogen following menopause is thought to be the primary reason for increased OSA severity during this time. Furthermore, the actvity of muscles which surround the airway also decreases with age.

blarg wrote:

split_city wrote:Wow, it seems someone is getting pretty defensive here. Calling me a dumb doctor is really mature now isn't it?

If you click Search at the top and then type Snoredog in as the author (Display posts. It's easier to skim than topics), you'll see this is a common technique of his. He doesn't mean anything by it.

The reason for the cat picture was to try to get him off the pissing contest, but here we are. Oh well.

oh ok...it's hard to tell since I just began posting

Moby wrote:

split_city wrote:Hi all. This is my first post in this forum. I'm currently a PhD student working in the area of sleep apnoea.

Daniel

Welcome to the forum Daniel, and good luck with your research.
Please keep us posted!
regards
Di

Thanks Moby