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Contemporary Reviews in Sleep Medicine |

Impact of Weight Loss Management in OSA FREE TO VIEW

Simon A. Joosten, MBBS, PhD; Garun S. Hamilton, MBBS, PhD; Matthew T. Naughton, MD
Author and Funding Information

Conflict of interest statement: GSH has received equipment to support research from Resmed, Philips Respironics and Air Liquide Healthcare. SAJ, MTN have no conflict of interest to declare.

1Department of Lung and Sleep Medicine, Monash Health

2Alfred Hospital

3Monash University

4School of Clinical Sciences, Monash University

Correspondence to Professor Matthew T. Naughton Department of Respiratory Medicine Alfred Hospital and Central Clinical School, Monash University, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.01.027
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Abstract

The interaction between obesity and obstructive sleep apnea (OSA) is complex. Whilst it is often assumed that obesity is the major cause of OSA, and that treatment of the OSA might mitigate further weight gain, new evidence is emerging that suggest these statements may not be the case. Obesity explains about 60% of the variance of the apnea hypopnea index definition of OSA, mainly in those < 50 years and less so in the elderly. Moreover, long term treatment of OSA with continuous positive airway pressure is associated with small but significant weight gain. This weight gain effect may result from abolition of the increased work of breathing associated with OSA. Weight loss, by either medical or surgical techniques, which often cures type 2 diabetes, has a beneficial effect upon sleep apnoea unfortunately in a minority of patients. A short jaw length may be predictive of a better outcome. The slight fall in the overall apnea hypopnea index with weight loss, however may be associated with a larger drop in the non-supine apnea hypopnea index, thus converting some patients from non-positional to positional (ie supine only) OSA. Importantly, patients undergoing surgical weight loss need close monitoring to prevent complications. Finally, in patients with moderate to severe obesity related OSA, the combination of weight loss with CPAP appears more beneficial than either treatment in isolation.


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