Dr. Krainin

Many people on the journey to a healthy weight first encounter the field of sleep medicine due to a requirement from their surgeon or health care insurance company to get tested for sleep apnea. Let's explore the origination of this rule. Obstructive sleep apnea is an extraordinarily common medical condition that is characterized by the repetitive closure of the upper airway during sleep. The cartoon below depicts what happens in the back of the throat when people have sleep apnea: The Sleep Apnea-Weight Relationship Being overweight or obese is a major risk factor for sleep apnea. In fact, a 1998 study found that 20-40% of people with a BMI ≥ 32 had sleep apnea. What's the connection? Fat accumulates everywhere in our bodies - even in the tongue! As the tissues in our mouths and throats get bigger, and our necks get thicker, there is less space available in the posterior airway to allow us to breathe. When our breathing goes on "autopilot" during sleep, muscle tone in our bodies goes down and our upper airways are more prone to collapse, creating a recipe for disaster. Additionally, obese patients are at risk for another form of sleep disordered breathing called "obsesity-hypoventilation syndrome." The basic mechanism of this condition is that, when patients carry excessive weight on their chest and abdomen region, the muscles that operate the lungs can tire out, leading to sustained low oxygen and high carbon dioxide levels, both of which are harmful for the body. Physiological Effects During each abnormal breathing episode, our body experiences many negative physiological effects. Oxygen levels can drop precipitously, blood pressure goes through the roof, stress hormones are secreted into our bloodstream leading to blood sugar elevation, pressure in the brain skyrockets. Over time, these effects take a toll on the body. Sleep apnea is associated with numerous medical conditions including heart attack, irregular heart rhythms, stroke, hypertension, type 2 diabetes, headaches and acid reflux, to name a few. The Surgery Connection Medical research clearly shows that patients with significant sleep apnea are at an increased risk for "perioperative morbidity." This means that patients with sleep apnea are more likely to experience a complication after surgery if they have untreated sleep apnea. Research studies show that these complications include increased risk of death, irregular heart rhythms, need to be transferred to ICU and difficulty with extubation (removal of the breathing tube after surgery). One study showed that patients with sleep apnea were 2.25 times more likely to have a complication that required a prolonged hospital stay after gastric bypass surgery than those without the disorder. For these reasons, bariatric surgery teams now take sleep apnea very seriously when planning surgical interventions. Next column: Sleep Apnea Testing & Treatment in the Bariatric Surgery Patient

In this series of articles Dr. Krainin will explore the complex relationship between weight, weight loss through bariatric surgery, and sleep disorders. Many people on the journey to a healthy weight first encounter the field of sleep medicine due to a requirement from their surgeon or health care insurance company to get tested for sleep apnea. Let's explore the origination of this rule. Obstructive sleep apnea is an extraordinarily common medical condition that is characterized by the repetitive closure of the upper airway during sleep. The cartoon below depicts what happens in the back of the throat when people have sleep apnea: The Sleep Apnea-Weight Relationship Being overweight or obese is a major risk factor for sleep apnea. In fact, a 1998 study found that 20-40% of people with a BMI ≥ 32 had sleep apnea. What's the connection? Fat accumulates everywhere in our bodies - even in the tongue! As the tissues in our mouths and throats get bigger, and our necks get thicker, there is less space available in the posterior airway to allow us to breathe. When our breathing goes on "autopilot" during sleep, muscle tone in our bodies goes down and our upper airways are more prone to collapse, creating a recipe for disaster. Additionally, obese patients are at risk for another form of sleep disordered breathing called "obsesity-hypoventilation syndrome." The basic mechanism of this condition is that, when patients carry excessive weight on their chest and abdomen region, the muscles that operate the lungs can tire out, leading to sustained low oxygen and high carbon dioxide levels, both of which are harmful for the body. Physiological Effects During each abnormal breathing episode, our body experiences many negative physiological effects. Oxygen levels can drop precipitously, blood pressure goes through the roof, stress hormones are secreted into our bloodstream leading to blood sugar elevation, pressure in the brain skyrockets. Over time, these effects take a toll on the body. Sleep apnea is associated with numerous medical conditions including heart attack, irregular heart rhythms, stroke, hypertension, type 2 diabetes, headaches and acid reflux, to name a few. The Surgery Connection Medical research clearly shows that patients with significant sleep apnea are at an increased risk for "perioperative morbidity." This means that patients with sleep apnea are more likely to experience a complication after surgery if they have untreated sleep apnea. Research studies show that these complications include increased risk of death, irregular heart rhythms, need to be transferred to ICU and difficulty with extubation (removal of the breathing tube after surgery). One study showed that patients with sleep apnea were 2.25 times more likely to have a complication that required a prolonged hospital stay after gastric bypass surgery than those without the disorder. For these reasons, bariatric surgery teams now take sleep apnea very seriously when planning surgical interventions. Next column: Sleep Apnea Testing & Treatment in the Bariatric Surgery Patient