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Obesity and Breathing Related Sleep Disorders

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Obesity

Abstract

The increasing prevalence of obesity has lead to an increase in the prevalence of sleep disordered breathing in the general population. Obesity is a serious disorder resulting in significant health impairment. Obese adults are at increased risk of morbidity and mortality from acute and chronic medical conditions. Obesity is associated with anatomic alterations that predispose to upper airway obstruction during sleep. Obesity and sleep related breathing disorders occur to a particular subgroup that includes obese patients with hypoventilation correlated with Hypercapnic-OSA (obstructive sleep apnea), Hypercapnic-OSA with OHS (hypoventilation syndrome) and OHS without OSA.

OHS is a disease entity distinct from simple obesity and OSA. OSA is a common disorder. Sleep apnea is due to recurrent episodes of upper airway obstruction during sleep that are caused by elevations in upper airway collapsibility during sleep. Collapsibility can be increased by underlying anatomic alterations and/or disturbances in upper airway neuromuscular control, both of which play key roles in the pathogenesis of OSA. Obesity and particularly central adiposity are potent risk factors for sleep apnea. They can increase pharyngeal collapsibility through mechanical effects on pharyngeal soft tissues and lung volume, and through central nervous system–acting signaling proteins (adipokines) that may affect airway neuromuscular control. Specific molecular signaling pathways encode differences in the distribution and metabolic activity of adipose tissue.

The OHS is characterized by the combination of obesity (BMI >30 kg/m2), daytime awake hypercapnia and hypoxemia, in the presence of sleep-disordered breathing without other known causes of hypoventilation, such as severe obstructive or restrictive parenchymal lung disease, kyphoscoliosis, severe hypothyroidism, neuromuscular disease, and congenital central hypoventilation syndrome. It is estimated that 90 % of patients with OHS also have OSA. Patients with OSA typically have normal control of breathing and obesity is not a necessary condition; patients with OHS are morbidly obese, have hypoventilation during wakefulness with increased arterial PCO2 and decreased arterial PO2, as well as nocturnal hypoventilation. The gold standard for the diagnosis is monitored polysomnography during sleep. In stable hypercapnic patients therapeutic choice will depend on two factors: underlying diagnosis (presence or absence of OSA) and severity of hypercapnia.

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Author information

Authors and Affiliations

  1. Department of Respiratory Diseases Unit, Hospital of Sestri Levante, via Terzi 43, Sestri Levante, 16039, Italy

    Antonello Nicolini MD & Ines M. G. Piroddi

  2. Department of Medicine, Hospital of Sestri Levante, Sestri Levante, Italy

    Elena Barbagelata

  3. Department of Health Medicine, Hospital of Sestri Levante, Sestri Levante, Italy

    Cornelius Barlascini

Authors
  1. Antonello Nicolini MD
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  2. Ines M. G. Piroddi
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  3. Elena Barbagelata
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  4. Cornelius Barlascini
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Corresponding author

Correspondence to Antonello Nicolini MD .

Editor information

Editors and Affiliations

  1. School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom

    Shamim I. Ahmad

  2. Al Mouwasat Hospital, Jubail, Saudi Arabia

    Syed Khalid Imam

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© 2016 Springer International Publishing Switzerland

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Nicolini, A., Piroddi, I.M.G., Barbagelata, E., Barlascini, C. (2016). Obesity and Breathing Related Sleep Disorders. In: Ahmad, S., Imam, S. (eds) Obesity. Springer, Cham. https://doi.org/10.1007/978-3-319-19821-7_10

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  • DOI: https://doi.org/10.1007/978-3-319-19821-7_10

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-19820-0

  • Online ISBN: 978-3-319-19821-7

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