Interesting finding..

DreamStalker wrote:Anyway, as is already known by many on this forum … nonetheless, being fat is more than just diet, or exercise, or OSA, or depression, or genetics, or some other factor. Furthermore, fatness and OSA is generally an inter-related and complex issue not easily reduced to a simple statistical correlation (IMHO).

Yep!

I also keep wondering how much OSA was brought on by lousy sleeping in our earlier years......late nights studying in school, long working hours, shift work, stress (from many factors), etc.

I've written before about how I feel this is a "chicken & egg" situation. Maybe some of us are predisposed to it and some of us "work at it".

Den

Wulfman... wrote:
Yep!

I also keep wondering how much OSA was brought on by lousy sleeping in our earlier years......late nights studying in school, long working hours, shift work, stress (from many factors), etc.

I've written before about how I feel this is a "chicken & egg" situation. Maybe some of us are predisposed to it and some of us "work at it".

Den

Well there you go, another OSA study to publish … the statistical correlation between OSA and being a long-term college student/party-animal/work-a-holic.

Wow, you actually had time for some lousy sleep during that phase of your life? ... during my early years -- my undergraduate studies, partying, working, partying, playing, (did I mention partying?), and working and then a little more work left no time for sleep (it just wasn't all that important to me back then). I was lucky to sleep 8 hours a week during my early 20’s

When I finally went back to grad school in my early 30’s I cut back a lot on the working and even more on the partying for some of that lousy sleep time.

But yea ... I think I probably worked a little too hard at it during my immortal years. Looking back I feel really lucky to just be alive. Perhaps that is why OSA treatment has actually been such a breeze for me.

I once did some research on smoking and lung cancer It turns out that smoking doesn't cause lung cancer. Statistically it appears to be so, but you have to take into consideration that people who don't have enough sex are nervous and more prone to smoke. ACTUALLY IT'S LACK OF SEX THAT CAUSES LUNG CANCER!

DreamStalker wrote: What was the sample size of the study?

6 males and 9 females. Age- and BMI-matched. A relatively small sample size, therefore it was interesting to see a significant relationship between WHR and AHI and not neck circumference and AHI.

DreamStalker wrote: Re: relationships -- North America has the highest incidence of tornados in the world and there is a strong correlation with the fact that the North American population drive their automobiles on the right side of the road (... or the wrong side, depending upon your perspective) … therefore driving on the right side of the road causes tornados. Spurious relationships have a way of appearing factual.

lol...nice relationship there, which certainly points out flaws in correlations. Multiple regression analyses are much better at picking out which factors really do contribute. Nevertheless, this is why it's best to undertake "cause-and-effect" type studies. Unfortunately, this cannot be undertaken in all cases.

I have been taught that "nothing can be proven, only disproven." Here's a crude example. We know that the sun rises in the east. Who's to say if you go out just before sunrise, stand facing the west, bend down and look between your legs towards the east, that it will rise then.

DreamStalker wrote:So what are the physiological mechanics of central obesity that has prompted you to hypothesize that belly fat is more closely related to OSA than neck fat?

Check out my "link between OSA and the "beer gut" thread. I pretty much explain my thoughts behind central obesity and OSA. In simple terms, our group believes that increase pressure insie the abdomen (due to increased abdominal obesity), pushes the diaphragm and airways up towards the head. We believe that this reduces the amount of tension/stretch on the airway, making it more floppy and therefore, easier to collapse.

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI

socknitster wrote:There is a thread going on here that discusses the genetics of apnea and obesity. It seems there may be codes next to each other on the same gene that predispose some toward apnea and obesity.

Whether one causes the other isn't as important as knowing they often coexist. Apnea patients are tired of being told they are fat--especially the ones who aren't. I for one, know FOR SURE that my abdominal fat was gained AFTER my symptoms of apnea began. Had my doctor known about split_cities research findings, perhaps he would have been more likely to diagnose me at a younger age, instead of 35. The idea here isn't to call apnea patients fat and say shame on them, the idea is to find ways to screen for and diagnose more people so that they don't suffer as long as many of us have. Am I right, split_city?

After all, how many of us say we suffered for 10-15 years or more? Science is trying to figure out how to better predict who has it and who doesn't by finding SOMETHING, no matter how imperfect--something is better than nothing!--OBJECTIVE TO MEASURE to predict who has this syndrome.

Personally, I think the best thing they could do is for every patient who comes in with fatigue and depression issues give them a sleepiness questionaire. What is that called, the epworth test or something. That would probably catch more people than measuring waist to hip ratio since many of us were thin when symptoms started.

By the way, I went back to the gym for the first time since my diagnosis and WOW! What a difference in what I was able to do--twice as far in half the time and have energy to spare. It is amazing the difference xpap has made in my life. I'm so grateful to have a chance to turn my life around. Wait til you see how fast the fat falls off!

jen

I understand the heartache that you and a lot of other OSA patients have. You are right, there are lots of "skinny" OSA patients. Unfortunately, there is NO ONE cause of OSA (unlike what Snoredog will try and make you believe). If flopping back of the tongue was the only cause of OSA, you would think that surgery to this area would cure OSA patients. This is why patients get frustrated because there hasn't been enough research conducted to look at all the aspects of OSA. A particular treatment for one person may not work for another.

Unfortunately, there are a lot of doctors out there, who don't conduct research and have limited knowledge about the causes of OSA. Simply saying "you have to lose weight" is an easy way to move patients along. This is why groups like mine are conducting reasearch to better our understanding about the causes of OSA. Nevertheless, there are loads of examples where overweight OSA patients have been cured following weight loss.

In terms of screening, I'll leave that to the clinical researchers. You are correct though. There are many mis- and undiagnosed OSA patients out there. You do have to understand though that OSA is now only starting to be recognised. OSA has only been studied for the last 20 odd years. The CPAP machine was invented back in the 80s. A lot of OSA patients may have been suffering from OSA in the 80s but doctors/researchers didn't know too much about the disease back then.

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine

DreamStalker wrote:
Anyway, as is already known by many on this forum and nonetheless, being fat is more than just diet, or exercise, or OSA, or depression, or genetics, or some other factor ... it is all connected. Furthermore, fatness and OSA is also an inter-related and complex issue not easily reduced to a simple statistical correlation between the two (IMHO).

I totally agree. Our group has been trying to understand why males are more susceptible to OSA compared to females. Most research points to fat around the neck but there are definately other causes. This is why we have been looking at abdominal obesity. I would never say that if you have a WHR >1, then you'll definately have OSA. That would be foolish of me. It's like saying that if you drink and drive, you will definately have a car crash. We just are trying to point out that your chances of developing OSA may increase if you put more fat around the abdomen, more so than if you put fat around your neck or chest. Who knows. It's still open for debate.

Anonymous wrote: split-city,

I think my own case indicates an unknown cause which contributes to both the OSAHS and abdominal obesity.

I am female with severe abdominal/stomach fat although my legs, thighs, buttocks, etc. have very little fat. Think of a ball with stick legs and no behind. My waist size is 40 inches. This pattern of deposition began long before puberty - sometime during early childhood.

You don't have non-insulin dependent diabetes do you?

Quantifying the 'appleness' or 'pearness' of the human body by subcutaneous adipose tissue distribution. Ann Hum Biol. 2000 Jan-Feb;27(1):47-55.

This study found that 80% of women with diabtes had the "apple shaped" fat distribution (in the 60-69 age bracket). 20% of healthy women aged 20-29 years also had this fat distribution.

Body fat distribution is determined by hormones. Perhaps you had an inbalance in certain hormones when younger?

Anonymous wrote: I believe that I have had some form of sleep-disordered breathing also since childhood, but that the sleep-symptoms came BEFORE any significant weight gain. I was a very tired child, especially upon waking up in the morning after having had a full nights sleep.

OSA in kids is generally attributed to increased size of the tonsils, adenoids etc. Removal of these is the predominant form of treatment.

Anonymous wrote: On a tangent: A psychiatrist at a well regarded university discussed with me the possibility that this distribution of fat was the expression of a secret desire to become pregnant. (And I paid thousands of dollars for this "professional" medical treatment). This was years ago, but even then I told him that was ridiculous.

Now that's an interesting spin. I have never heard that before! Perhaps someone could conduct a study on that?

Anonymous wrote: I was diagnosed finally at age 44 with OSAHS (moderate AHI of 17 in nonREM and severe AHI of 65 in REM - and what causes that difference?).

REM is a state during which muscle activity is at its lowest. Therefore, your muscles in the upper airway can't help to keep the airway open. Lung volume is also at it's lowest in REM. The lower your lung volume, the smaller your airway, the more collapsible your airway is. REM is also a time where your arousal threshold is high i.e. takes a lot of external "noise" to wake you up. Therefore, apneas are generally longer in REM and your O2 desaturations are more severe.

Anonymous wrote: My question is this: Is there any info about the cause of the fat being deposited so specifically in the abdomen/stomach? Why am I so different from normal pear-shaped women? Is there anything that is even theorized to help shift anyone from the "apple" to the "pear" shape?

Thanks.

This really is a question for epidemiologists. As mentioned previously, hormones play a major role in determining where the fat is distributed.

Effects of postmenopausal hormone replacement therapy on body fat composition. Gynecol Endocrinol. 2007 Feb;23(2):99-104

This study showed that:

"Overall, all three types of hormone replacement therapy (HRT) caused a significant decrease in both waist circumference (WC) and subcutaneous fat (p < 0.001), and also in waist-to-hip ratio (WHR) (p < 0.05). There was no significant difference in baseline (p > 0.05) and final values (p > 0.05) between HRT groups. In each group, all types of HRT significantly decreased WC and subcutaneous fat (transdermal group: p < 0.001 and p < 0.05; transdermal/oral group: p < 0.001 and p < 0.01; oral group: p < 0.001 and p < 0.001, respectively), while body weight, BMI and WHR changed only insignificantly (p > 0.05).

This indicates the effect of hormones on fat distribution.

split-city,

You said that you study the arousal threshhold. I am wondering if you might be able to help me understand a problem with spontaneous arousals.

I am compliant on autoPAP with an AHI < 5, however my symptoms of fatigue and brain fog have shown little improvement after 6 months of treatment.

My diagnosis sleep study (full night) showed few spontaneous arousals (SA), an index of < 4/hr. However the follow-up titration study *with PAP* showed an SA index of 30 during nonREM and 50 during REM! The AHI on PAP = 0. My titration pressure was determined to be 7cm. Although the AHI was greatly improved, the quality of my sleep was still terrible from the SAs and I had very little SWS and REM sleep.

Have you ever seen anything like this in the lab? If the PAP is causing the spontaneous arousals, then is it fruitless as far as expecting PAP treatment to improve the quality of my sleep?

Have discussed the situation with the sleep doc several times. His last resort was to prescribe Clonazepam (aka Klonopin aka Rivotril). This is a benzodiazepine used as an anti-convulsant and is used to treat RLS. BTW I do not have any PLMs during my sleep studies.

Thank you very much for any info.

I'm unsure of this as I haven't specifically looked at the arousal threshold. However, I have passed your message on to a few sleep physicians to get their opinions on the matter

Guestt, a member nicknamed "StillAnotherGuest" had a question for you in the other thread, where you posted as "GuestJuly2":

viewtopic/t21660/questions.html

If there's any way you can get the graphs from both your diagnostic and your titration studies and let him take a look at them, he can probably help figure that out better than anyone on this board. He's a sleep lab manager, an RPSGT, and RRT. But he needs to see the graphs, not just a summary report. Ask your sleep lab to give you copies of the full report that was given to the doctor. Should be ten or a dozen pages and should have quite a few graphs.

Anonymous wrote:I'm unsure of this as I haven't specifically looked at the arousal threshold. However, I have passed your message on to a few sleep physicians to get their opinions on the matter

And just to be totally clear on things. I joined this forum so that I could provide you all with some information in regards to projects which have been currently undertaken to look at the physiology behind OSA. I am by no means an expert in this field, but more importantly, I am not a clinician either. Subsequently, I must be very careful with any advice relating to the clinical side of OSA because I have had no formal clinical training. It would be naive for me to give you such advice without discussing it with clinicians. I apologise for this because I understand that a lot of you simply would like answers/advice about your condition. Any questions relating to the clinical side of OSA should be discussed with your doctor. However, I can provide some basic physiology behind OSA (where applicable of course).

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CPAPopedia Keywords Contained In This Post (Click For Definition): Arousal

RestedGal,

I can see that my posts were all over the place. Sorry about that and thanks for the directions.

Split-city,

Thanks for posting the info about the studies. I will look into all of them.

You made some pretty good guesses with the diabetes and hormones as follows: An endocrinologist told from me that "from just looking at me that I had hyperinsulinemia" and that I was probably "born with insulin resistance". I do not have diabetes because I do not have HIGH blood glucose (BG) levels. However at times I have LOW BG. The endocrinologist explained that the excess insulin is probably clearing all the glucose out of the blood stream. When my pancreas eventually "gives out" from this overexertion, I will then become type-2 diabetic. It is also my understanding that OSAHS has been shown in studies to disrupt the normal functions of insulin.

Neither the endo nor my PCP would prescribe any meds on the market to prevent diabetes for various reasons. Said that there was no really good treatment yet at the clinical level. I am trying to follow a diet that was developed in Australia by Dr. Jennie Brand-Miller which may decrease BG and insulin levels.

I understand that you are not a clinician and that none of the advice on this site is to be taken as professional medical advice. I would discuss such advice with a doctor before trying it. My sleep doctor has been quite good, however HE is referring me to another sleep doc for a second opinion, and I am quite concerned about the lack of improvement in my condition after 6months of autoPAP treatment.

If it's ever figured out what is wrong with my sleep or my PAP use, I will post it here.

Thanks again for your input.