Calling slim people with OSA

DreamStalker · Post by **DreamStalker** » Fri Jul 13, 2007 7:28 am

Anonymous wrote:Well here is my story about the BMI tables.

I was sent to the Sleep Dr. as a sortof "lets just cover the bases" sortof type of thing from my general Dr. when I went in for a physical. My symptoms were EXCESSIVE daytime sleepyness (Yes I would fall asleep at stop lights/signs while driving), snoring according to my wife, and then finally high blood pressure which manifested about 2 weeks before my physical.

I went in to see the sleep Dr., filled out his little forms and had my BP taken. Dr. came and got me and the first thing out of his mouth in his office was, when do you want to come in for a study? I looked at him dumbfounded and he said, based on your symptoms, answers to questions, high blood pressure (135/101 that day), and BMI of 31.4 (I was 5'11" 225 at the time), you are a perfect candidate for sleep apnea. He went on to say, based on your BMI alone I would give you a diagnostic study, you really need to try to loose some of that weight, even if you don't have sleep apnea being that overweight can cause you serious health problems in the future!!!

Me: I don't really consider myself overweight.
Dr: Well the numbers don't lie, you are clearly carrying too much body fat, which may be causing your high blood pressure, contributing to possible sleep apnea, and further health problems!!
Me: Honestly Dr. this is as slim as I get, I can't loose much more weight!!
Dr.: Well son you need to work harder on loosing that weight, it's causing you problems, I can recommend some very good diet counselors to you.
Me: But i'm already on a great diet, I watch what i eat and count my calories very carefully!
Dr.: Approx. how many calories do you consume daily?
Me: Well right now, about 6000-7000.
Dr.: <blink> <silence> <blink> No wonder you can't loose any weight, that's WAY to many calories to be consuming daily!!

At this point I decided to let him off the hook with the weight issue. I stood up and took off the sweatshirt and 2 shirts I had on under it (my standard lifting wear).
Me: So what did you say about the "numbers didn't lie"?

This all happened in the summer, during which time I am fairly lean. Like I said though I'm 5'11" 225 BMI 31.4, however I had around 12% body fat. I ate 6000-7000 calories to keep my mass, not loose it.

So like a previous poster said, BMI is a very poor way to gague a persons actual body and make assumptions about their health, without a detailed physical exam. I have skipped my lean months this summer in favor of putting on muscle mass, so right now my BMI is around 34-35 since i'm weighing around 250.

However with all that said, I did end up having a sleep study, which resulted in a diagnosis of severe sleep apnea (AHI 48), and CPAP. Like many of you I have resigned that I will be on this for the rest of my life, and believe that my quality of life has improved.

Maybe you have some body parts made out of lead

Just kidding 'ya.

I think the point of this thread is not whether BMI is an accurate measure of fitness/fatness but rather that fit/thin people also have OSA and that fatness is not a real good predictor/indicator for determining OSA.

Sure fatness makes OSA worse for people that have it but our friend Rooster is trying to point out that perhaps studying how OSA works in thin people may provide more useful answers into the physiology of OSA and why it occurs.

split_city · Post by **split_city** » Fri Jul 13, 2007 7:54 am

DreamStalker wrote:
I think the point of this thread is not whether BMI is an accurate measure of fitness/fatness but rather that fit/thin people also have OSA and that fatness is not a real good predictor/indicator for determining OSA.

BMI has been shown to be a "good" (I use the word lightly) predictor for OSA but it has been proposed that where the fat is stored is perhaps a "better" predictor. Several studies have shown that neck circumference is a better predictor than BMI. Again, these are only predictors and not everyone fit these criteria.

DreamStalker wrote: Sure fatness makes OSA worse for people that have it but our friend Rooster is trying to point out that perhaps studying how OSA works in thin people may provide more useful answers into the physiology of OSA and why it occurs.

Generally, the proposed mechanisms for OSA in healthy-weight individuals include abnormal upper airway anatomy, abnormal cranio-facial disorders or ventilatory instability.

There was one study (I'll see if I can find it) which showed that even though BMI (healthy-weight BMI) was the same in two groups (OSA group versus non-OSA group), neck circumference was still bigger in the OSA group. So while BMI was classified as normal, this group perhaps still had more fat in the neck. Don't quote me on it until I find the study.

sharon1965 · Post by **sharon1965** » Fri Jul 13, 2007 8:09 am

I think the point of this thread is not whether BMI is an accurate measure of fitness/fatness but rather that fit/thin people also have OSA and that fatness is not a real good predictor/indicator for determining OSA.

i would like to know more about how OSA causes one to become overweight, as i believe this is what happened in my case...i was thin my whole life--so thin that people would ask me if i felt well and i think i was constantly on the verge of an intervention --i gained only 25lbs with my first pregnancy and only 17lbs with my second (preemie)...during the time that i was rapidly, inexplicably gaining weight out of the blue 3 years ago, i was, and still am, a very healthy eater; i was very active and took very good care of myself...still the weight packed on...i've come across some info about the effects of OSA on the hormones leptin and grehlin and how they become out of balance due to the effects of OSA, but i never seem to see this discussed here...i have to wonder how much of the time overweight people develop OSA and how much it's actually OSA causing people to become overweight

DreamStalker · Post by **DreamStalker** » Fri Jul 13, 2007 8:16 am

I think it is definitely an intertwined cycle of OSA feeding weight gain (for some but obviously not for all) and weight gain feeding OSA along with all of the interactions of related hormonal imbalances, blood pressure/hypoxia, and general stressing/inflamation of the body at the cellular level.

rested gal · Post by **rested gal** » Fri Jul 13, 2007 9:09 am

sharon1965 wrote:i've come across some info about the effects of OSA on the hormones leptin and grehlin and how they become out of balance due to the effects of OSA, but i never seem to see this discussed here...i have to wonder how much of the time overweight people develop OSA and how much it's actually OSA causing people to become overweight

ozij posted a good link in this thread:
viewtopic.php?t=21373

sharon1965 · Post by **sharon1965** » Fri Jul 13, 2007 11:05 am

general stressing/inflamation of the body at the cellular level.

dreamstalker,

are you referring to the release of stress hormomes while the body is in panic mode? also, the depletion of adrenals? i experienced an adrenal crash at the beginning of this most recent chapter in my health saga, which is when the sudden weight gain and muscle weakness became so pronounced...i've suffered from a chronic pain condition for 13 years or so but i was managing it quite well until this time 3 years ago

this is what actually scares me...i'm concerned that the damage is so extensive as it has been going on for so long, that my body no longer knows how it's supposed to work...

sharon1965 · Post by **sharon1965** » Fri Jul 13, 2007 11:20 am

thanks RG, for posting that link

i guess what isn't clear to me is how many people think that their being overweight was caused by OSA...there seems to be a lot of discussion about being overweight and developing OSA, but i'm curious as to how much of the time we just assume the weight came first without allowing for the possiblity that the OSA came first...chicken and egg?

this thread was originally meant to discuss the prevalence of OSA in thin/normal weight individuals --sorry for highjacking!

sharon1965

DreamStalker · Post by **DreamStalker** » Fri Jul 13, 2007 12:11 pm

sharon1965 wrote:
general stressing/inflamation of the body at the cellular level.
dreamstalker,

are you referring to the release of stress hormomes while the body is in panic mode? also, the depletion of adrenals? i experienced an adrenal crash at the beginning of this most recent chapter in my health saga, which is when the sudden weight gain and muscle weakness became so pronounced...i've suffered from a chronic pain condition for 13 years or so but i was managing it quite well until this time 3 years ago

this is what actually scares me...i'm concerned that the damage is so extensive as it has been going on for so long, that my body no longer knows how it's supposed to work...

Well what you are describing I think would fall under what I was referring to as hormonal imbalances … but yes I think it is all interrelated.

What I meant by stressing and inflammation was that whenever the body is injured (which causes inflammation at the cellular level), our immune system is called to duty and our white blood cells unfortunately do not have smart weapons technology and end up injuring adjacent healthy cells as well in their effort to keep infectious cells from developing a stronghold base of operation. Of course our immune system is tied to our hormones which in turn are tied to how we provide and use nutrients for our bodies.

I’m by no means an expert on any of this stuff and I cannot recall any references off the top of my head but it is a general idea I have been developing from my reading on nutrition over the past year or so.

I too have had chronic pain for over 20 years and I learned to just deal with it and accept it. I’m beginning to think that in addition, becoming less physically active starting about 20 years ago and practicing poor diet habits for most of that same time, I set myself up for a road trip on the fast lane to the grave. Having been told that I was a heavy snorer way back in my early 20’s, I probably have had OSA (for which I already had a likely genetic predisposition for from my dad) for about 25 years now and it most likely served to turbo-charge the road trip. When I finally took notice of my severe OSA symptoms about 5 years ago (not knowing it was due to OSA until last year), that was just a warning sign that the end of my road trip was fast approaching.

Fortunately, this newly found PAP treatment has offered me a switch to turn off the turbo-charger and knowledge has provided me with a detour onto a slower lane … I’m hoping that my body will adjust accordingly but I know what you mean … I too am a bit concerned about the damaging momentum. The faster you are going, the longer it takes to slow down … I hope my brakes are in good shape.

sharon1965 · Post by **sharon1965** » Fri Jul 13, 2007 1:02 pm

thanks, roberto, for clarifying for me

take good care

sharon

roster · Post by **roster** » Fri Jul 13, 2007 2:09 pm

[quote="Anonymous"]...............

So like a previous poster said, BMI is a very poor way to gague a persons actual body and make assumptions about their health, without a detailed physical exam. I have skipped my lean months this summer in favor of putting on muscle mass, so right now my BMI is around 34-35 since i'm weighing around 250.

However with all that said, I did end up having a sleep study, which resulted in a diagnosis of severe sleep apnea (AHI 48), and CPAP. Like many of you I have resigned that I will be on this for the rest of my life, and believe that my quality of life has improved.

Guest · Post by **Guest** » Fri Jul 13, 2007 7:43 pm

I was a at 23 BMI when I was diagnosed six years ago and am at 23 BMI now. In between I started lifting weights, lost no weight as a result but did lose two inches from my waist. (I'm a 5'10' 165 pound male.) Not much change in neck size.

From Medscape regarding alternatives to BMI:

Calls for replacement of BMI with a waist or hip circumference measurement or waist-to-hip ratio were led by the INTERHEART study investigators, who surveyed more than 27,000 participants worldwide and found that that waist-to-hip ratio showed a graded and highly significant association with risk of myocardial infarction (MI).[2] They and others have recommended that the definition of obesity for determination of CVD risk should be based on waist-to-hip ratio rather than BMI. Now more support for this proposal has come from recent studies from the United States and the United Kingdom.

As reported in The Lancet,[3] researchers at the Mayo Clinic of Medicine in Rochester, Minnesota, carried out a meta-analysis of studies in patients with established coronary artery disease (CAD). Remarkably, they found that patients with low BMI had an increased long-term mortality risk compared with patients with normal BMI. Equally remarkable, patients with very high BMI did not have increased total mortality risk, although they did have the highest CVD mortality risk compared with patients with normal BMI. Even after adjustment for potential confounding factors, the association between overweight and better outcomes remained. According to the investigators, these results did not suggest that obesity was not a health threat, but rather that BMI is not an effective measure of obesity in relation to cardiovascular risk.

Morpheus · Post by **Morpheus** » Fri Jul 13, 2007 7:44 pm

Yep, that was me.

Morpheus · Post by **Morpheus** » Fri Jul 13, 2007 7:48 pm

Get out your tape measures:

http://www.healthcalculators.org/calcul ... st_hip.asp

roster · Post by **roster** » Fri Jul 13, 2007 8:16 pm

Morpheus wrote:Get out your tape measures:

http://www.healthcalculators.org/calcul ... st_hip.asp

I never could figure out whether you are supposed to suck it in or let in hang out when you take the waist measurement.