Obesity and OSA

The statistics are alarming: About 65% of Americans are now overweight or obese, according to the Centers for Disease Control and Prevention. The number of obese adults jumped from 15% in 1980 to 27% in 1999. More than 15% of children from 6 to 19 years were overweight in 2000, which is three times higher than in 1980.

An estimated 18 million Americans have sleep apnea, which is often associated with people who are overweight. “As the person gains weight, especially in the trunk and neck area, the risk of sleep-disordered breathing increases due to compromised respiratory function,” say Margaret Moline, PhD, and Lauren Broch, PhD, two sleep specialists at New York Weill Cornell Medical Center.


But the main reason is hormonal. Meet the culprits.


Leptin- It is known to suppress appetite and promote weight loss. Levels of leptin are elevated with sleep. Sleep deprivation is correlated with a decrease in leptin levels as much as 19%. No sleep, no appetite suppression.


Ghrelin- Sleep deprivation causes ghrelin levels to increase as well as hunger, particularly for foods rich in calories and carbs. Even a single night of sleep deprivation is sufficient enough to raise ghrelin levels and hunger the next day. Levels tend to be higher in patients with OSA, but are successfully reduced with OSA treatment.


Insulin- Produced by the pancreas, which is central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle. Basically, high insulin levels cause high fat storage.


Cortisol- is a glucocorticoid produced by the adrenal gland. Its primary function is to increase blood sugar through gluconeogenesis. Sleep deprivation leads to elevated cortisol levels in the afternoon and evening as sleep restriction or prolonged wakefulness represents stressors to the system. Insulin also acts in synergy with cortisol to regulate leptin production. When cortisol levels rise, leptin levels fall.


Growth hormone- Is a peptide hormone that stimulates growth, cell reproduction and regeneration and is secreted during Stage 3 sleep. Its release is pulsatile but is suppressed by sleep restriction. Reduced nocturnal growth hormone secretion evident in OSA patients is reversed by OAT/CPAP therapy before any sign of weight loss is evident.


Melatonin- It is secreted generally around 9 pm by the pineal gland in response to darkness and is one of the most potent antioxidants. Its main function is to induce sleep but it also functions to enhance the appetite-suppression of leptin.


(Sources: National Sleep Foundation, Obesity Reviews, Sleep and Metabolic Function)

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