Obstructive Sleep Apnoea and Obesity

ABSTRACT

The global obesity epidemic continues to gain momentum; and South Africa is one of those countries with an extremely high prevalence of obesity. The reported association between obstructive sleep apnoea (OSA) and obesity has resulted in a parallel increase in the incidence of OSA. Obesity and OSA interact by inducing systemic inflammation; metabolic aberrations and endocrine abnormalities; all of which predispose patients to atherosclerosis and cardiovascular disease. OSA is associated with a pro-inflammatory state; and increased serum C-reactive protein concentrations. Cardiovascular complications of OSA include myocardial infarction; stroke; congestive heart failure; hypertension and cardiac arrhythmias. The complications of OSA and obesity result in reduced quality of life; significant morbidity; and increased mortality; for untreated patients. OSA causes symptoms such as snoring; apnoea; excessive daytime sleepiness; and morning headaches; but 80-90 of patients are never diagnosed; or treated for their condition. Recognition of these symptoms; and referral of patients for a polysomnogram (home- or laboratory-based); expedites the diagnosis and therapy of OSA. While continuous positive airway pressure (CPAP) remains the mainstay of therapy; dietary measures are important; and should be implemented. Loss of weight can lead to significant reductions in the apnoea-hypopnoea index (AHI) of patients with OSA; and obese patients with OSA should aim for a 10 reduction in body weight