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Query: UMLS:C0037315 (sleep apnea)
 8,000 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obesity is a main risk factor for sleep apnea syndrome (SAS). The prevalence of SAS is especially high in massive obesity and in visceral obesity. The mechanisms of obstructive apneas in obesity are poorly known, but an increase in upper airway collapsibility probably plays an important role. Several cardiorespiratory complications of SAS, especially systemic arterial hypertension, diurnal alveolar hypoventilation and pulmonary arterial hypertension, are more frequent and more severe in obese patients. An important weight loss resulting from surgical treatment of obesity is often associated with a dramatic decrease in apnea-hypopnea index in patients with massive obesity. In patients with moderate obesity, dietary weight loss is associated with varying degrees of improvement in SAS. Pharyngoplasty and anterior mandibular positioning devices have a low success rate in patients with massive obesity. Nasal continuous positive airway pressure is often the only effective treatment in obese SAS patients.
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PMID:[Sleep apnea syndrome and obesity]. 1208 47

Surgical treatment for retro-lingual obstruction in patients suffering from obstructive sleep apnea syndrome remains a problem for which there is no simple solution. The techniques most in use (tongue suspension, genioglossal advancement with hyoid suspension) are effective primarily as stabilization methods modifying neither tongue position, nor volume and only produce appreciable results when performed on non-overweight patients with respiratory disturbance index <40. For patients suffering from severe obstructive sleep apnoea syndrome in whom the most obvious morphological alteration is the presence of hypo-pharyngeal obstruction due to tongue base hypertrophy, who are overweight or suffering from moderate obesity, a surgical procedure aimed at reducing tongue volume and at repositioning the hyoid bone, even if invasive, leads to a favourable outcome. Herein, personal experience is described in a group of 8 patients presenting severe obstructive sleep apnoea syndrome incompatible with normal quality of life and normal life expectancy (mean respiratory disturbance index = 55.1) who underwent surgical resection of the tongue base with hyoepiglottoplasty. This technique, first described by Chabolle, differs radically from others inasmuch as it guarantees enlargement of the hypo-pharyngeal lumen and remodelling of the hyolingual complex. Using a suprahyoid cervical approach, it is possible to effect ample reduction of the tongue base with amplification of the hypo-pharyngeal airway without inducing problems as far as concerns either swallowing or speech.
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PMID:Tongue base reduction with hyoepiglottoplasty for the treatment of severe OSA. 1568 5

The effects of treatment of obstructive sleep apnoea (OSA) on glucose metabolism have been investigated previously with conflicting results. This study evaluated the impact of nasal continuous positive airway pressure (nCPAP) treatment of OSA on insulin sensitivity. Males with moderate/severe OSA and no significant comorbidity were randomised to a therapeutic or sham nCPAP treatment group for 1 week and then reassessed. Those who received therapeutic nCPAP were further evaluated at 12 weeks. Insulin sensitivity (K(itt)) was estimated by the short insulin tolerance test. Other evaluations included blood pressure, metabolic profile, urinary catecholamines and intra-abdominal fat. In total, 61 Chinese subjects were randomised. 31 subjects receiving therapeutic nCPAP showed an increase in K(itt) (6.6+/-2.9 to 7.6+/-3.2 % x min(-1); p = 0.017), while the 30 patients on sham CPAP had no significant change, and the changes in K(itt) were different between the two groups (p = 0.022). At 12 weeks, improvement in K(itt) was seen in 20 subjects with BMI >or=25 kg x m(-2) (median (interquartile range) 28.3 (26.6-31.5); p = 0.044), but not in the nine subjects with BMI<25 kg x m(-2), or the entire group. The findings indicate that therapeutic nCPAP treatment of OSA for 1 week improved insulin sensitivity in nondiabetic males, and the improvement appeared to be maintained after 12 weeks of treatment in those with moderate obesity.
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PMID:A randomised controlled trial of nasal continuous positive airway pressure on insulin sensitivity in obstructive sleep apnoea. 1960 89

With increasing modernization and urbanization of Asia, much of the future focus of the obesity epidemic will be in the Asian region. Low testosterone levels are frequently encountered in obese men who do not otherwise have a recognizable hypothalamic-pituitary-testicular (HPT) axis pathology. Moderate obesity predominantly decreases total testosterone due to insulin resistance-associated reductions in sex hormone binding globulin. More severe obesity is additionally associated with reductions in free testosterone levels due to suppression of the HPT axis. Low testosterone by itself leads to increasing adiposity, creating a self-perpetuating cycle of metabolic complications. Obesity-associated hypotestosteronemia is a functional, non-permanent state, which can be reversible, but this requires substantial weight loss. While testosterone treatment can lead to moderate reductions in fat mass, obesity by itself, in the absence of symptomatic androgen defi ciency, is not an established indication for testosterone therapy. Testosterone therapy may lead to a worsening of untreated sleep apnea and compromise fertility. Whether testosterone therapy augments diet- and exercise-induced weight loss requires evaluation in adequately designed randomized controlled clinical trials.
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PMID:Lowered testosterone in male obesity: mechanisms, morbidity and management. 2440 87