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Obesity and Respiration 2016
The document discusses the relationship between obesity and respiratory disorders, particularly sleep apnea, highlighting its prevalence, risks if untreated, and the importance of awareness and treatment. It outlines the mechanisms of sleep apnea, its symptoms, and potential cardiovascular complications associated with obesity, as well as the necessity for early detection and intervention. Furthermore, it emphasizes the public health impact and the benefits of awareness in reducing morbidity and mortality rates related to obesity and sleep apnea.
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Obesity and Respiration 2016
- 1. Obesity and Respiration- Dr. Parthiv Mehta Obesity and RESPIRATION Dr. Parthiv MEHTA Central UNITED Hospital Ahmedabad
- 2. GOAL • Increase awarenesstowards Obesity • Understand Obesity related Respiratory Disorder - Sleep Apnoea – with reference to risks if untreated • Educate / Revise recognizing, preventing and treating Sleep Apnoea
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- 4. Obesity 100______________ 1.80 X 1.80 =30.7 • BMI over 25….. Kg/m2 • BMI Calculator… Weight in kg_____________________________ Height in meter X Height in meter
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- 6. • Scientists haveidentified SNP (single nucleotide polymorphism) named “rs12970134” to be mostly associated with waist circumference. • Over 2000 individuals of Indian origin participated and SNP “rs12970134” is found highly prevalent. • Internationally, a BMI over 25 kg/m2 is considered overweight. Due to genetic tendency of Indians towards abdominal obesity and its associated risk of related lifestyle diseases like Diabetes & Heart Disease, Ministry of Health & Family Welfare and ICMR released updated guidelines (in 2012) that BMI over 23 kg/m2 is considered overweight. Normal : 18.0-22.9 kg/m2 Overweight: 23.0-24.9 kg/m2 Obesity: >25 kg/m2 Obesity - INDIA
- 7. Obesity - INDIA •Obesity has reached epidemic proportions in India, with morbid obesity affecting 5% of the country's population. Male Female India Gujarat India Gujarat 12.1 15.4 16.0 17.7
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- 10. Human Lung… • 22-24generations • >1,00,000 bronchi, bronchioles • 2400 km of airways • 30-50 Cr alveoli • 0.3mm in diameter • Surface area 70m2 • Capillaries 992 km end to end
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- 14. Respiration: Air - Inand Out of Lungs
- 15. I’m Thin, MyLungs are Happy..
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- 18. Obesity and Respiration- Dr. Parthiv Mehta See the Difference…
- 19. Our Nose &Throat…
- 20. Our Nose &Throat…
- 21. Our Nose &Throat…
- 22. Our Nose &Throat…
- 23. Our Nose &Throat…
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- 32. Obesity and Respiration- Dr. Parthiv Mehta FLOW TIME Open Airway
- 33. Obesity and Respiration- Dr. Parthiv Mehta Flow Limitation TIME FLOW
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- 35. Obesity and Respiration- Dr. Parthiv Mehta Snore FLOW TIME
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- 37. Obesity and Respiration- Dr. Parthiv Mehta Apnea TIME FLOW
- 38. Sleep Apnoea -Mechanism • During sleep – When the muscles at the back of the airway relax and the upper airway partially or completely collapses – Leads to obstruction in breathing and restricts airflow. • Snoring is a common symptom of SA. Every Snorer may not be Apnoeic
- 39. Sleep Apnoea -Mechanism
- 40. Sleep Apnoea • SleepApnoea (SA) is disordered breathing during sleep. • The airway is mechanically obstructed causing a cessation of breathing - OSA. • An apnoea occurs when a person stops breathing for 10 seconds or more. • If untreated can lead to Cardiovascular and Cerebro-vascular disease and Injury from vehicular accidents because of sleepiness.
- 41. Sleep Apnoea Symptoms Snoring Night time gasping or pauses in breathing Morning headaches Daytime fatigue Excessive drowsiness at Day Body ache – Leg cramps Difficulty in concentration Forgetfulness Overweight & obesity High Blood Pressure Towards the End of Day
- 42. Sleep Apnoea –Reasons… Mechanical obstruction of the airway BMI (body mass index) of 25 or above - Obesity Short neck or Excessive tissue in neck area Aging process which causes the neck muscles to loose tone and collapse when lying supine Crowded teeth and narrow palate in children
- 43. Sleep Apnoea –Existence..
- 44. Sleep Apnoea –Existence.. OSA – “Pickwickian Syndromme”: 1836 • Joe – “The Fat Boy” who was described by Charles Dickens in “The Pickwick Papers” had typical features with snoring, obesity and sleepiness.
- 45. W. H. Broadbent:Lancet (1877) • “When a person, especially advanced in years, is lying on his back in heavy sleep and snoring loudly, • it very commonly happens that every now and then inspiration fails to overcome the resistance in the pharynx - of which stridor or snoring is the audible sign, • and there will be perfect silence through two, three, or four respiratory periods, in which there are ineffectual chest movements; • finally, air enters with a loud snort, after which there are several compensatory deep inspirations before the breathing settles down to its usual rhythm..” Sleep Apnoea – Existence..
- 46. Why Don’t AnimalGet it??
- 47. Why Don’t AnimalGet it??
- 48. Why Don’t AnimalGet it??
- 49. Sleep Apnoea -Burden • 42 million Americans suffer from OSA – Found across all age groups, both sexes, all socioeconomic classes and ethnic groups – Most common in obese middle-aged men and obese postmenopausal women • 4-9% of Population in INDIA fall in High Risk group Young et al. Sleep 2008
- 50. Sleep Apnoea –Effect on Body During an apnoea At the end of an apnoea Oxygen levels begin to decrease Oxygen “recovers” upon arousal (though this may take several minutes) Heart rate slows Dramatic rise in heart rate Blood pressure drops Dramatic rise in blood pressure
- 51. Sleep Apnoea –ACommon Companion Diabetes Obesity All Hypertension Atrial Fibrillation Congestive Heart Failure Drug-Resistant Hypertension Coronary Artery Disease Pacemakers 80% 50% 35% 50% Sjostrom et al, Thorax, 2002 Logan et al, J. Hypertension, 2001 Javaheri et al, Circulation, 1999 O'Keeffe & Patterson, Obes Surgery, 2004 Einhorn et al. Endocrine Prac, 2007 50% Somers et al, Circulation, 2004 77% 30% 59% Garrigue et al. Circulation 2007 Schafer et al. Cardiology 1999
- 52. Sleep Apnoea –ACommon Companion Diabetes Obesity All Hypertension Atrial Fibrillation Congestive Heart Failure Drug-Resistant Hypertension Coronary Artery Disease Pacemakers 80% 50% 35% 50% Sjostrom et al, Thorax, 2002 Logan et al, J. Hypertension, 2001 Javaheri et al, Circulation, 1999 O'Keeffe & Patterson, Obes Surgery, 2004 Einhorn et al. Endocrine Prac, 2007 50% Somers et al, Circulation, 2004 77% 30% 59% Garrigue et al. Circulation 2007 Schafer et al. Cardiology 1999
- 53. Sleep Apnoea –Impact on Heart Postgrad Med J 2008; 84:15-22
- 54. Sleep Apnoea –Impact on Heart High Blood Pressure – All cause Hypertension • 3 times higher risk to develop High Blood pressure • ~40% of people with OSA have high blood pressure while awake Heart Attack – Ischaemia / Infarction • 36% of patients with OSA had Fatal or Non fatal event. • Sudden death from cardiac causes (between midnight and 6 am) occurred in 46% of pts with OSA v/s 16% of general population Sleep Apnea is an identifiable cause of hypertension according to the National Institute of Health (NIH)
- 55. Sleep Apnoea –Impact on Heart Heart Failure - CCF • 3 times more common in “mild-moderate OSA” then in “no OSA” Abnormal Heart Beats – Arrhythmia • 48% had cardiac arrhythmias at night - 2% sustained VT, 11% sinus arrest, 8% AV block, 19% VPC • 4 times increased risk of AF in pts with OSA (AHI>30) (Sleep Heart Health Study 2006) • Onset of >75% of persistent AF episodes in pts with OSA occur at night (8pm-8am) • AF recurrence after cardio-version twice as high in untreated OSA
- 56. Sleep Apnoea –Impact of Treatment High Blood Pressure: • Proven benefits from sleep apnoea therapy in lowering blood pressure – 4mm Hg to 10mm Hg reduction with CPAP therapy • Study showed a fall in systolic BP by 10 mm after 4 weeks of CPAP • Improvement in blood pressure correlated with improvement / reduction in sleepiness. Becker et al. Circulation 2003
- 57. Sleep Apnoea –Impact of Treatment Cardiac Failure: • Proven benefits from sleep apnoea therapy in improving cardiovascular health – Left ventricular ejection fraction, six-minute walk, VO2 max, after load, BNP Kaneko et al. NEJM 2003, Maisel et al. UCSD VA Hospital – Case Study Data (2002), Teschler et al. AJRCCM 2001 • 8 patients with dilated DCM and OSA: one month- increased EF 37% to 49%, improved dyspnea: improvement reversed one week after withdrawal • 24 patients with HF and OSA: randomized: 1 month: mean decrease in day time HR, BP, increased EF by 9% Postgrad Med J 2008; 84:15-22 Proc Am Thorac Soc 2008; 5:200-206
- 58. Sleep Apnoea –IMPACT of AWARENESS • Widespread public awareness resulted into an 80% increase of newly diagnosed cases of OSA over the next 24 months • With the initiation of early therapy, morbidity and mortality rates due to related cardiovascular disease in the at risk population reduced by 60% within the next 48 months. healthypeople.org. Healthy People 2010. Retrieved November 17, 2003, ProQuest
- 60. Let us Recap…..Obesity SLEEP,Vol. 30, No. 3, 2007
- 61. Sleep Apnoea –Wagon Wheel High Blood Pressure Cardiac Problems: CCF, Arrhythmia, Heart Attack Memory Problems: Inability to think correctly Insulin Resistance: Even in non- Diabetic Increased Accidents: Road Traffic Work place Stroke Obstructive Sleep Apnoea
- 62. Take Home Message… •There is a clear association between Obesity, OSA and cardiovascular disease • Higher incidence of adverse cardiovascular events in untreated patients with Obesity and OSA • Early Detection and Treatment helps to eliminate potential Cardio-Vascular Risks and reduces morbidity and mortality. Postgrad Med J 2008; 84:15-22 SLEEP 2007;30(3):291-304 CHEST 2008; 133:793-804 Proc Am Thorac Soc 2008; 5:200-206
- 63. If UNTREATED….. Take HomeMessage… Obesity with Sleep Apnoea can SINK LIFE..
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Editor's Notes
- #36 “breathing during sleep with hoarse or harsh sounds as caused by the vibration of the soft palate” Membranous parts (diffuse, soft palate, uvula, pharyngeal walls etc) of the upper airway which lack cartilage support may vibrate. Thus Rx difficult. Theory – effects of air wall compliance, gas density, and airway dimensions on the pressure flow relationship Eg: breathing a mix of O2 and helium reduces snoring b/c it decreases airflow turbulence and relationship on pressure-flow. Alcohol – reduces pharyngeal dilator muscle tone and increases air wall compliance = floppy Usually insp. sound but can occur on exp. Male dominance of snoring unexplained Presence of snoring implies upper airways resistance. Not all snorers have apneic episodes.