Obstructive sleep apnoea/hypopnoea syndrome: relationship with obesity and management in obese patients

Abstract

Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is a disease characterised by upper airway obstruction during sleep, quite frequent in the general population, even if underestimated. Snoring, sleep apnoea and diurnal hypersomnia are common in these patients. Central obesity plays a key role: it reduces the size and changes the conformation of the upper airways, besides preventing lung expansion, with consequent reduction of lung volumes. Furthermore, obese people are also resistant to leptin, which physiologically stimulates ventilation; as a result, this causes scarce awakening during apnoea. OSAHS diagnosis is based on the combination of clinical parameters, such as apnoea/hypopnoea index (AHI), medical history, physical examination and Mallampati score. The first objective reference method to identify OSAHS is polysomnography followed by sleep endoscopy. Therapy provides in the first instance reduction of body weight, followed by continuous positive airway pressure (CPAP), which still remains the treatment of choice in most patients, mandibular advancement devices (MAD) and finally otolaryngology or maxillofacial surgery. Among surgical techniques, central is barbed reposition pharyngoplasty (BRP), used in the field of multilevel surgery.

Self-management behavior, associated factors and its relationship with social support and health literacy in patients with obstructive sleep apnea–hypopnea syndrome

“…For example, encouragement and support from partners are important for people with OSAHS to adhere to and implement health management plans (weight loss, smoking cessation, alcohol cessation) [ 38 ]. With the valuable advice and substantial help of others, people with OSAHS can receive more information and supervision, which will strengthen their resolve to overcome difficulties and solve problems, helping patients to better manage their disease [ 39 , 40 ]. In this study, health literacy was also a significant predictor of self-care behavior in patients with OSAHS.…”

Sperm DNA damage: The possible link between obesity and male infertility, an update of the current literature

“…142 Obesity predisposes to OSA through changes in airway mechanics because of increased adiposity, reduced lung volumes because of visceral fat deposition, loss of ventilation stimulation by leptin (leptin resistance) and somnogenic effects of pro-inflammatory cytokines. 143,144,145 No human studies have assessed sperm DNA damage in OSA; however, a rodent model of intermittent hypoxia mimicking OSA identified increased testicular oxidative stress, impairment in sperm motility and reduced pregnancy rates following intermittent hypoxia. 146 The exact mechanism is currently unknown; however, intermittent arterial hypoxia is associated with intermittent testicular hypoxia and likely downregulates anti-oxidant capacity of germ cells.…”

“…It is a significantly underdiagnosed condition affecting up to one in three men, with greater prevalence with increasing age and obesity 142 . Obesity predisposes to OSA through changes in airway mechanics because of increased adiposity, reduced lung volumes because of visceral fat deposition, loss of ventilation stimulation by leptin (leptin resistance) and somnogenic effects of pro‐inflammatory cytokines 143,144,145 …”

The Impact of Sleep-Disordered Breathing on Ghrelin, Obestatin, and Leptin Profiles in Patients with Obesity or Overweight

“…Increasing working hours, stress, work-related rush, widespread access to social media, and depressive disorders, particularly exacerbated in the era of the COVID-19 epidemic, adversely affect the quantity and the quality of sleep [ 4 ]. Sleep deprivation can promote obesity in two ways: on the one hand, it leads to hedonic eating and more frequent high-calorie meal choices, and on the other, it causes sleepiness during the day, which impedes physical activity [ 5 , 6 , 7 ].…”