Very often the impact that Obstructive Sleep Apnoea (OSA) is having on people’s lives is underestimated. Research conducted by the Office of Health Economics for the British Lung Foundation (1) has revealed that investing more in awareness, diagnosis and treatment of obstructive sleep apnoea (OSA) could save the NHS up to £28m and prevent up to 40,000 road traffic accidents a year. Around 667,000 (45 per cent) of the 1.5 million people estimated to be living with OSA in the UK have the moderate to severe forms of the disorder.
However, fewer than half of these (c.330,000) are currently getting the treatment they need. It means the remainder are exposed to an increased risk of extreme daytime sleepiness and serious health conditions associated with Sleep Apnoea, including stroke, diabetes and cardiovascular disease.
The characteristics and symptoms associated with OSA are very similar to those associated with obesity, such as high blood pressure, insulin resistance and dyslipidaemia. For many people with OSA, use of a CPAP machine will be part of their treatment. This can have a significant impact on quality of life for the patient, and for their partner.
You can learn more about sleep apnoea by visiting one of the websites listed at the foot of this page. Their site contains a wealth of resources that will inform you about the condition, symptoms, treatment options and support.
Obstructive sleep apnoea (OSA) is very common and is closely related to excess weight. Some patients might have snoring, excessive sleepiness during the day, fatigue and headaches; while others may have no symptoms despite having severe OSA. Currently, the mainstay of treatment of OSA is CPAP (continuous positive airway pressure), which is a device attached to a mask that the patient wears overnight to prevent their airways from temporarily closing during sleep. However, weight loss plays an important role in the management of OSA. Weight loss of 10-15% of total body weight can have a significant favourable impact on OSA; and weight loss in patients with OSA can lead to a reduction in the risk of Type 2 diabetes and cardiovascular disease, which are benefits that are not achievable by CPAP alone.
The link between weight loss and improvement in obstructive sleep apnoea (OSA)
Research over many years has shown the close relationship between sleep apnoea and obesity. Put simply, if you are obese you are more likely to have it, and if you can achieve and sustain weight loss, you can expect an improvement in your OSA and the other health issues associated with it, e.g. reduced risk of heart disease, cancer, etc. An authoritative study of the published literature into this relationship was conducted by Abel Romero-Corral et al (2).
The link between weight loss and improvement in OSA symptoms has been established for decades but until recently it was of little practical benefit to OSA patients as achieving and sustaining weight loss for those who are defined as obese (body mass index of 30+) is extremely difficult. Several studies have shown short term improvements in patients’ oxygen desaturation index going hand in hand with baseline body weight, but these improvements reversing as weight is regained – Kajaste (3), Lam (4) and Tuomilehto (5).
Most studies show that long term weight loss results from diet and behavioural programmes alone deliver less than 5% weight loss and this is rarely enough to make a material difference and is unlikely to be sufficient to move people out of the obese category.
Weight loss surgery and sleep apnoea
The situation has changed in recent years however with the development of laparoscopic (keyhole) weight loss surgery. Surgery provides a safe and effective long term treatment for obesity and the results among patients who are experiencing both OSA and obesity are excellent.
For most patients with OSA and a body mass index above 40, we generally consider the gastric bypass to be the preferred bariatric surgery option.
The published data (6) suggests that 90% of OSA patients undergoing gastric bypass surgery can expect a complete resolution of their symptoms. The figure drops a little with the gastric sleeve but is still an impressive 80% (7).
If you have been diagnosed with OSA and want to explore weight loss surgery you can read more your weight loss surgery options here. Obesity is a risk factor for sleep apnoea, but there is something you can do about it.
Useful links
- Weight loss surgery
- Gastric band
- Gastric sleeve
- Gastric bypass
Additional sources of information on OSA:
- The Sleep Apnoea Trust – A charity that is supporting those living with Sleep Apnoea – http://www.sleep-apnoea-trust.org/
- Brake – The road safety charity – http://www.brake.org.uk
- The British Lung Foundation Charity – https://www.blf.org.uk
- The British Sleep Society – https://www.sleepsociety.org.uk/
References:
- OSA UK health economics report – https://www.blf.org.uk/support-for-you/obstructive-sleep-apnoea-osa/health-care-professionals/health-economics-report
- Interactions between obesity and obstructive sleep apnoea – Abel Romero-Corral et al CHEST 2010 Mar; 137(3):711-719
- Kajeste et al. A cognitive Behavioural Weight Reduction Programme in the treatment of OSA syndrome with or without initial nasal CPAP. Sleep Med 2004; 5(2):125-131 (Pubmed)
- Lam et al. Randomised study of three non-surgical treatments in mild to moderate sleep apnoea. Thorax 2007; 62 (4): 354-359 (PubMed)
- Tiomilehto et al. Kuopio Sleep Apnoea Group Lifestyle Intervention with weight reduction: first-line treatment in mild obstructive sleep apnoea. Am J Respir Crit Care Med. 2009;179(4):320-327 (PubMed)
- Buchwald et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724-37.
- Buchwald et al. Trends in mortality in bariatric surgery: A systematic review and meta-analysis Surgery. 2007 Oct;142(4):621-32; discussion 632-5.