Obesity and Sleep Disorders

Carol Kavanaugh, D.O.
March 2009

Greetings Css’ers! In this months installment I want to discuss something that may be more common in the population with CSS that in the general population. But first let’s review the basics.

Sixty seven percent of the U.S. population is either overweight or obese. The number of obese adults ( those with a BMI/body mass index of greater than 30) has jumped from 15 % in 1980 to 27 % in 1999 to approximately 32 % now in 2008. More than 15 % of children 6- 19 years of age are overweight in 200. This is a three fold increase over 1980.

Why is this happening you may ask? The basic reasons are the following:

Physical expenditure of energy ( activity levels) which have declined while calorie consumption has stayed the same or increased. ( generally it has increased)The ready availability of calorie dense fast foods have played a big role here.

But getting less sleep also plays a role. All of these entities together have created the perfect storm.

But let’s talk a bit about what happens with sleep when a person becomes obese. As a person gains weight, especially in the trunk and neck area, respiratory function starts to become compromised. During sleep as the neck and upper airway muscles relax it become increasing difficult to hold the airway open. The airway may then temporarily collapse. The oxygen saturation then falls leading to decreased oxygen levels to the heart, brain, muscles and all the major organs of the body. Eventually this becomes so severe the person will ’wake up’ briefly to get more oxygen. This is called an arousal. A person can have hundred of these arousals an hour interrupting the normal sleep pattern. No wonder these people are so tired!

Most people with sleep apnea or obstructive sleep apnea as it is called have symptoms of severe daytime sleepiness, or fatigue, morning headaches and sometimes refractory high blood pressure.

Not only does obesity contribute to sleep problems but the reverse is also true. Poor sleep caused hormone imbalances that contribute to further weight gain. It contributes to high insulin levels and glucose intolerance ( a pre diabetic state). Obese patients also have a mismatch of leptin and gerhlin the hormones that stimulate and depress appetite which worsen the situation.

One can almost guess that obese and sleepy patients do not much feel like exercising and moving around a lot, worsening the situation and many are downright depressed. Prednisone which is a mainstay drug for many, promotes weight gain especially around the thorax and neck; vulnerable placed for breathing and sleep apnea.

So If you are having symptoms or concerns-see your doctor and get a referral to a good sleep center and get these things checked out. Sleep apnea may contribute to cardiovascular disease and can be a cause for sudden death if severe.

Take care of all of you fellow CSS’rs and God bless.

Carol Kavanaugh D.O.

Sub-Investigator: Kimberly Yaung, RN

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