Sleep Apnea ⇒ Obesity and ⇒ Sleep Apnea Again - A Vicious Circle!

As the number of apnea attacks in sleep increases, obesity becomes easier and obstructive sleep apnea syndrome is exacerbated as obesity increases!

Obstructive Sleep Apnea Syndrome

Sleep apnea is defined as an attack of respiratory arrest for more than 10 seconds. If the number of sleep apnea is more than 5 hours per hour, this is defined as "Obstructive Sleep Apnea Syndrome".

An increase in obesity and neck circumference facilitates sleep apnea. Unfortunately, sleep apnea syndrome is a predisposition to obesity, which facilitates the emergence of the disease.

In other words, as sleep apnea increases, obesity becomes easier and sleep apnea syndrome is exacerbated as obesity increases.

So how can this be explained?

During the apnea episodes during sleep, a situation near our body suffocates. Stress hormones, which increase the blood sugar, are secreted by showing anti-insulin action during respiratory arrest. In this case, blood pressure increases, there is sudden increase in blood sugar, and insulin is released simultaneously from insulin stores in our body. In other words, blood sugar and blood pressure, sharp edged increases and depressions occur. As the number of apnea attacks increases, this biochemical war is over.

With the action of these anti-insulin hormones in patients with sleep apnea, insulin resistance increases over time. For example, patients may be hungry more quickly or they may want to eat something. However, blood oxygen levels are reduced and metabolism decreases during apnea attacks.

So patients with sleep apnea may not lose weight easily.

Sleeping Endoscopy Video of a Snoring and Obese Patient:

Above is a video of a patient with snoring and sleep apnea who cannot lose weight, during the airway evaluation with a flexible endoscope during sleep. The patient's soft palate and collapse in the small tongue area are observed.

Patients with sleep apnea should be treated as soon as possible, with contraction and loosening of the resulting airway. Especially, alcohol, cigarettes, antidepressant drugs and muscle relaxant drugs that accelerate the slack and sagging in the airways, increasing sports activities such as walking, jogging or swimming and mediterranean style nutrition can be useful.

During the sleep endoscopy performed on the patient on the side, it is seen that tongue tonsils close the airway completely. The yellow arrow shows "epiglottis", which serves as the flap of the larynx, the blue arrows indicate the "tongue tonsils", the red arrow tongue base.

The most effective treatment in patients with tonsil growth, soft palate sagging and small tongue dilation is classic UPPP (Uvulopalatopharyngoplasty) surgery.

In this surgical technique described many years ago, tonsils are removed, the small tongue is completely or partially removed, and the soft palate is stretched.

Especially in patients who have problems in the nose and airway stenosis in the throat region, when combined with nasal surgeries, UPPP surgery, the patient may experience increased metabolism, decrease in insulin resistance, decrease in weight loss and a decrease in the symptoms of the disease.

Similarly, sleep-induced oxygen therapy (CPAP / BIPAP) applications which can partially reverse the negative biochemical effects of sleep apnea syndrome are also useful in the treatment of patients who are not suitable for surgery.

Early treatment of patients with symptoms of sleep apnea syndrome may lead to increased treatment success and negative biochemical effects.

You can read how sleep apnea syndrome can increase insulin resistance and increase susceptibility to diabetes.

How is obstructive sleep apnea treated? - Obstructive sleep apnea treatment - Obstructive Sleep Apnea (OSA) Treatment

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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