M.D.Hosehead wrote:SleepingUgly wrote:
IN GENERAL, why do the members here refuse to acknowledge the role of weight in OSA and any other possible solutions to OSA other than CPAP? Is it that CPAP is so hard to embrace, that once having changed ones attitudes so much as to tolerate living with it, there is too much cognitive dissonance to allow room in one's brain for any other possible solution? That can't be the whole explanation
I don’t think your premiss is a fair characterization. Though the direction and magnitude of causality is unclear, I don’t think anyone has denied a correlation--“risk factor” in jargon--between obesity and OSA.
Well, my friend, I beg to differ. Many times it's been stated on this forum that OSA leads to weight gain, and not the other way around (I probably have that quoted nearly verbatim). The reality is that the relationship between obesity and OSA is bidirectional (i.e., obesity --> OSA and OSA--> obesity).
Quoting from the Stanford powerpoint presentation that I linked to above:
• Obesity is the most powerful risk factor for obstructive sleep apnea (OSA)
• Obesity is essentially the only reversible risk factor
• Potentially modifiable risk factors for OSA also include alcohol, smoking, nasal congestion, and estrogen depletion in menopause.
• Data suggest that obstructive sleep apnea is associated with all these factors, but at present the only intervention strategy supported with adequate evidence is weight loss. ( Young et al. 2002)
• About 70% of those with OSA are obese (Malhotra et al 2002)
• Prevalence of OSA in obese men and women is about 40% (Young et al 2002)
• Higher BMI associated with higher prevalence
• BMI>30: 26% with AHI>15, 60% with AHI>5
• BMI>40: 33% with AHI>15, 98% with AHI>5
(Valencia-flores 2000)
• Total body weight, BMI, and fat distribution all correlate with odds of having OSA
– Every 10 kg increase in weight increases risk by 2X
– Every increase in BMI by 6 increases risk by 4X
– Every increase in waist or hip circumference by 13 to 15 cm increases risk by 4X (Young et al 1993)
• Airway obstruction occurs when the nasopharynx and oropharynx are occluded by posterior movement of the tongue and palate against the posterior pharyngeal wall
• Narrower airways are more easily collapsible and prone to airway occlusion
• Obese people have extrinsic narrowing of the area surrounding collapsible region of the pharynx and regional soft tissue enlargement (Fleetham 1992)
• Increased fat deposits posteriolateral to oropharyngeal airspace at level of soft palate, in the soft palate, and in submental area (Horner et al 1989)
• Distribution of fat is an important correlate
• Fat accumulation in the central, android (apple shape), and upper body correlate with metabolic syndrome, atherosclerosis, and OSA
• Waist circumference more important than BMI, weight, or total fat content
• Increased waist circumference predicts OSA even in non-obese (Grunstein 1993)
• Anatomic respiratory effects: reduced upper airway size secondary to mass effect of the large abdomen on the chest wall and tracheal traction (Pillar, Shehadeh 2008)
• Endocrine effects: The concept of leptin and ghrelin
Regarding treatment, though it’s been debated here whether weight loss is effective or sufficient, certainly there have been threads on that topic.
Yes, there seem to be those that believe that IF weight gain causes OSA, then losing weight must always cure OSA. For which I offer my usual analogy: Pregnancy caused my stretch marks. I am no longer pregnant, but I still have stretch marks. That's a bit of a simplification of the multifactorial causes of OSA (albeit there are multifactorial causes to stretch marks, as well, including individual variability in skin elasticity, etc.). But just because something is caused by an entity, either alone or in conjunction with other variables, doesn't mean that removing the entity will 100% cure the problem in 100% of cases. Look at the rest of the presentation for some support that losing weight is helpful in OSA, particularly in those whose BMI is especially high.
I doubt there's even one overweight member here who hasn't been the rounds with a number of obesity "treatments" (don't get me started on that one). Repeated weight-loss failures, denial, resentment at being patronized by professionals, humiliation, and resignation may explain the paucity of discussions about obesity here. That's just a guess, though.
I agree. I just find it interesting that the 2x4 approach taken to CPAP use is not taken to weight loss, given the high degree of similarity to the risk factors of OSA and the risk factors for obesity. (Keep in mind that I'm not a fan of the 2x4 approach for CPAP use, so I'm certainly not advocating it's use for other things.) I also think that the many misrepresentations on this board about how OSA-->obesity and NOT the other way around discourages people from trying to lose weight when that is the primary modifiable risk factor.
or any other possible solutions to OSA other than CPAP
Well, you must admit the digiridoo has been mentioned repeatedly. Why more people aren't trying
that is indeed curious.
The response to the article, however poorly summarized by the reporter, was to disparage the notion of there being a solution to OSA other than CPAP and to disparage the researchers who are likely "psychologists" engaged in psychobabble. I'm not a big believer that there will be a pill that will cure OSA, certainly not severe OSA. Still, I'm happy that this type of research is being done. I think the fact that they have found an association between better breathing and the release of noradrenaline dovetails nicely with some literature showing increased upper airway patency with antidepressants that block reuptake of norepinephrine.
Though I am a little chafed at not winning the research prize. (Just kidding)
You won! Didn't you get the certificate in the mail?
Never put your fate entirely in the hands of someone who cares less about it than you do. --Sleeping Ugly
