Better sleep, better health: managing sleep apnoea when living with obesity

Obstructive Sleep Apnoea (OSA) is a common sleep disorder where a person's breathing repeatedly stops and starts during sleep. This happens because the muscles in the throat relax too much, leading to a temporary blockage of the airway. These interruptions in breathing can cause poor sleep quality, fatigue, and a range of other health issues. OSA affects approximately 3% to 7% of men and 2% to 5% of women, in the general population.

Obesity is one of the most significant risk factors for developing OSA. Excess weight (fat), especially around the neck and abdomen, can cause physical changes that contribute to airway obstruction during sleep. For example:

• Excess weight: Fatty tissue around the neck can narrow the airway, making it more likely to have trouble breathing during sleep.
• Abdominal Tissue: Large amounts of abdominal tissue can press against the diaphragm, reducing lung capacity and making it harder to breathe.
• Inflammation: Obesity-related inflammation can also affect the upper airway, which can increase the risk of OSA.

The connection between obesity and OSA creates a cycle: obesity contributes to OSA, and untreated OSA can lead to poor sleep, which may result in weight gain. Studies show that people with obesity often experience shorter and lower-quality sleep compared to those with a healthy weight. If you are interested in how sleep effects obesity, read here.

Different factors such as gender, ethnicity, and socioeconomic status can influence the risk of developing OSA and obesity.

• Gender differences: Men are more likely to develop OSA than women, though the risk in women increases after menopause due to hormonal changes.
• Ethnicity differences: Certain ethnic groups, such as African Americans and Hispanic populations, have higher rates of obesity and OSA compared to other groups. This is influenced by genetic, cultural, and socioeconomic factors.
• Age and socioeconomic status: Older adults and those from lower socioeconomic backgrounds are at greater risk due to factors like age-related changes in body composition and limited access to healthcare and healthy lifestyle options.

Addressing both obesity and OSA requires a multifaceted approach that includes lifestyle changes, medical interventions, and sometimes surgery. If you are worried that you, or someone you may know has OSA, please speak to your doctor. Managing OSA as a chronic condition can help to ensure long-term treatment success. Sustainable lifestyle changes, such as avoiding foods high in fructose corn syrup and reducing stress, are also important.

• Continuous Positive Airway Pressure (CPAP): The treatment for OSA typically given as a first option, CPAP involves wearing a mask that provides a steady stream of air to keep the airway open during sleep. While effective, long-term adherence can be challenging for some people.
• Surgical procedures: In some cases, surgery may be necessary to remove excess tissue or reposition the jaw to keep the airway open. However, surgery is usually a last resort when other options may have not worked.
• Behavioural therapies: Cognitive-behavioural therapy for insomnia (CBT-I) can help improve sleep patterns, which can indirectly support weight management.

The relationship between obesity and obstructive sleep apnoea is complex and involves multiple factors, including physical, hormonal, and demographic influences. Addressing this connection requires sustainable approaches that combine lifestyle changes with effective medical treatments. Taking steps to manage weight loss can have a positive impact on sleep apnoea as it can reduce the amount of tissue in the abdomen and tongue, as well as the size of soft tissues in the upper airway, therefore allowing for a peaceful, uninterrupted night's sleep. By understanding the impact of obesity on sleep apnoea and vice versa, we can understand our own bodies more and healthcare providers can develop more targeted interventions, ultimately improving the quality of life for those affected by these conditions.