Zia H Shah MD FCCP Director of Sleep Lab Our Lady Of Lourdes Hospital, Binghamton
Obesity 70-80% of cases Alcohol use Hypognathism Marfan s syndrome Smoking ENT problems
OSA and DM epidemics have grown in tandem with obesity By 2025 there will be 300 million patients with DM world wide Obesity especially visceral obesity, sedentary life style and genetic predisposition are causes of type II DM We will examine what contribution OSA has in causation of DM Sleep Medicine Clinics. June 2007, Pages 237-250
OSA LIPID ISSUES Metabolic Syndrome x HT DM
Unattended polysomnography in 306 participants. Airflow by nasal pressure cannula and thermistor Over 86% of participants had OSA with AHI 5 mean 20.5 Greater the BMI greater the likelihood of OSA Almost a third had mild OSA A third had moderate OSA A third had severe OSA Given the similarities between the participants in Sleep AHEAD versus Look AHEAD, results do not appear to be secondary to a selection bias Diabetes Care June 2009 32:1017-1019
Nearly three-quarters (72.0%) had dyslipidemia, 82.6% had hypertension, and 93.4% had the metabolic syndrome Diabetes Care June 2009 32:1017-1019
CPAP: Pneumatic Splint
157 morbidly obese patients underwent SRGBP 18 of the 42 HT came off medication 17 of 34 asthma came off medication 18 of 19 NIDDM showed resolution 11 of 13 documented OSA resolved Obes Surg 10(5):428-35 Silastic ring gastric bypass, 121 females and 36 males The median weight loss of 49 kg at 2 years No deaths and only one serious complication
In bariatric surgery candidates the prevalence of OSA is 60-83% Approximately 70% of diagnosed OSA patients are obese Out of 554 consecutive bariatric surgery candidates a total of 197 patients (36%) agreed 132 (71%) of them fulfilled the diagnostic criteria for OSA The mean initial BMI of patients with OSA was 43.9 kg/m2
132 patients who had OSA in the baseline recording prior to the operation OSA was cured in 45% and cured or improved in 78% Moderate or severe OSA still persisted in 20% of the patients AHI decreased from 27.8 events/h to 9.9 events/h (p <0.001) Sleep Medicine 35 (2017) 85-90.
Laparoscopic Roux-en-Y gastric bypass, Amsterdam Netherlands 2008-2015 (LRYGB) BMI decreased from 46 to 34 and 134 kg to 98 kg Median AHI was 32; post op AHI < 15 in 152 26% still had moderate to severe OSA Higher AHI and HT were predictors of OSA after surgery Surgery for Obesity and Related Diseases 12 (2016) 1866 1872
N = 37 Baseline 2 year follow up P value Age 47 Gender 16 F 21 M Comorbid HT 18/37 49% Comorbid DM 14/37 38% Weight (kg) 131 113 <.0005 BMI 45.5 39.2 <.0005 Total AHI 52 27 <.0005 Supine AHI 61 36.002 Nonsupine AHI 45 24 <.0005 Percentage time supine 28 26.79 Percentage time on side 72 74.71 Supine predominant OSA 8/37 22% 17/37 46%.03 Supine only OSA 0/37 8/37 22%.003
Recurrent nocturnal awakenings Un-refreshing sleep Daytime fatigue Impaired concentration/memory loss Mood/behavioral changes Morning headaches Loss of sexual interest
Do you snore? Have you been told that you quit breathing or pauses in your breathing during sleep? Do you awaken from sleep choking, snorting or gasping for breath? How do you feel when you wake up?
Obstructive Sleep Apnea Diabetes Mellitus Hypertension Hypercholesterolemia Gout Atherosclerosis Low HDL Fatty Liver Polycystic ovarian disease Hypertriglyceridemia
Recruited 61 male subjects with OSA and 43 controls Subjects with OSA had high incidence of metabolic syndrome (87% vs. 35%, p < 0:0001) Metabolic syndrome was 9.1 (p < 0:0001) times more likely to be present in subjects with OSA Regression analysis adjusted for age, BMI, smoking, and alcohol consumption Patients had a metabolic syndrome if they had 3 or more of: Waist circumference >102 cm Triglycerides 1.7 mmol/l HDL cholesterol <1.04 mol/l Blood pressure > 130/ 85 Fasting glucose < 6.1 mmol/l European Heart Journal (2004) 25, 735 741