# Presentation: 528947

## Relationship Between Sleep and Obesity

*Presented by*
- Emerson Robinson, DDS, MPH
- Region II and V Dental Consultant

## Why We Need Sleep!

- A good night sleep is very important to a person’s overall health and their ability to function in a normal capacity throughout the day. Snoring and obstructive sleep apnea are common respiratory obstructive sleep disorders that can significantly affect an individual’s quality of sleep as well as the sleep of others

## Obstructive Sleep Apnea Adolescents/Young Adults...

- Obstructive sleep apnea syndrome (OSAS) is the most common organic disorder causing excessive daytime somnolence in patients seen in sleep disorders’ clinics
- Obstructive sleep apneas are part of the complex of “heavy snorer’s disease”
- Heavy snoring (partial upper airway obstruction) even without apneas may influence pulmonary  arterial pressure, and it may cause daytime sleepiness
- The presence of repetitive sleep apneas  is a potential determinant of risk in the same way as high blood pressure

## Obstructive Sleep Adolescents/Young Adults...

- Epidemiological studies show that about 10% to 15% of “occasional or never snoozers” may have occasional OSA
- It is known from clinical practice that patients with manifests OSA are almost always heavy snorers, but may not be aware of their condition
- The prevalence of any type of sleep apnea (central or obstructive) increases with age
- The severity of sleep apnea is indicated by both number of events and minimum oxygen saturation

## Terminology...

**Snoring** is a partial airway obstruction that reduces airflow but does not cause arousal from sleep
**Upper Airway Resistance Syndrome** (UARS) is exaggerated breathing effort and snoring created by high resistance to airflow in the upper airway.  This causes fragmented sleep and significant daytime drowsiness (no evidence of apnea on testing)
**Hypopnea** is a decrease in airflow with oxygen desaturations greater than 4% and an arousal from sleep

## Terminology

**Obstructive Sleep Apnea Syndrome (OSAS)**
- Stoppage of breathing for 10 seconds or more at least 5 times per hour
- Oxygen saturation in the blood decreases more than 4%
- Apnea events and with an arousal from sleep
- Arousals lead to chronic daytime sleepiness and other symptoms

## Signs and Symptoms of OSA

- Snoring with intermittent pauses
- Excessive daytime sleepiness (EDS)
- Awakenings due to gasping and choking
- Fragmented, non-refreshing sleep
- Poor memory and clouded intellect
- Personality changes
- Decreased sex drive
- Morning headaches

## Physiologic Effects of OSA...

- 1.	Cessation of breathing leads to:
- Reduced oxygen levels in the blood
- Increased carbon dioxide levels in the blood
- Acidosis
- 2.	Sleep fragmentation during apnea
- Leads to constant arousals from sleep and EDS

## Physiologic Effects of OSA

- 3. Cardiovascular consequences of OSA
- 30-45% of patients with OSA have hypertension
- OSA patients have 5 times greater incidence of myocardia infarct (MI)
- Individuals with chronic snoring have 3 times greater risk of dying during sleep than non-snorers (most likely due to accompanying apnea)

## Obesity and OSA...

- Obesity is a growing problem in the United States
- Approximately two-thirds of the United States population is at least overweight and half are obese
- While 2% to 4% of the population is estimated to have OSA, the prevalence  increases to 20% to 40% in the obese population
- Patients diagnosed with OSA often report recently gained  weight

## Obesity and OSA...

- Current issues involving obesity and OSA include clinical predictors of OSA, physiological contributors to OSA and other factors that may be confounded by OSA that contribute to obesity
- Excessive daytime sleepiness and fatigue—which are primary symptoms of OSA are known to contribute to overeating and being sedentary
- Habitually, people eat as a pick-me up.  These habits overtime result in obesity which worsens sleep apnea and leading to a progression of severity for both conditions

## Obesity and OSA

- Tomographic scanned images have shown that obesity causes increased fatty deposits in the pharyngen area
- The deposits encroach on the airway and contribute to airway narrowing
- Also, in obese patients as compared to normal controls, fat deposits appear to alter the shape of the upper airway without necessarily reducing the cross-sectional area
- During sleep, especially REM sleep, support for the airway is compromised due to muscle atonia.  A narrowing in the upper airway due to fat deposits and/or decreased rigidity of the tissue due to the presence of adipose tissue may predispose patients to sleep apnea

## Role of Obesity as a RiskFactor for Snoring withSleep Apnea...

- Obesity is an important risk factor for snoring and sleep apnea
- Adults with a BMI of more than 27kg/m2 maybe considered obese
- Upper body obesity in particular is related to increased risk of cardiovascular disease
- It has been suggested that neck size is more closely related to severity of sleep apnea than is BMI

## Role of Obesity as a RiskFactor for Snoring withSleep Apnea

- Neck Size may be easily measured and it is a useful indicator of upper body obesity
- The frequency of snoring increasing with obesity in all published epidemiological reports on snoring
- Habitual snoring was found to occur in 7% men and 2.8% of women with a BMI of less than 27kg/m2 and in 13.9% and 6.1% respectively of those above this level

## Consequences of Sleep Deprivation

**Adolescents generally do not sleep enough & they are at risk for a number of serious consequences including:**
- 	Daytime sleepiness
- 	Poor performance at school
- 	Increased incidence of automobile accidents
- 	Increased moodiness
- 	Increased use of stimulants and alcohol
- 	Inattentiveness during the day

## Other Risk Factors for Snoring and Sleep Apnea

- Smoking-related to upper airway inflammation and edema by cigarette smoke
- Smoking cessation may eventually reduce snoring risk
- Alcohol tends to induce OSA in healthy asymptomatic men and in chronic snorers—which is probably due to the acute centrally depressing effects of alcohol
- An association also exist between hostility and habitual snoring.  This could be explained by disturbed  sleep of the snorers; disrupted sleep caused daytime sleepiness, which in turn is associated with hostility

## Comparison of Life Needs

- Can live without sex
- Can fast for 60 days
- Can do without water for 10 days
- Can only do without sleep for 48 hours