My website and this blog provide what I hope is an useful educational resource for my patients and others, but I know that many patients with snoring and obstructive sleep apnea will never reach it. As such, I have contributed to two online resources that reach larger audiences. I am a content author for sleep surgery at About.com, writing the pages for the Pillar Procedure, palate surgery, tongue region (aka hypopharyngeal) surgery, and jaw advancement surgery (maxillomandibular advancement). In addition, the American Academy of Sleep Medicine recently updated their pages at SleepEducation.com related to surgical treatment of snoring and obstructive sleep apnea. The edits I provided on the Surgery Overview and Procedures pages were an attempt to indicate that surgery, although far from perfect, is a treatment option and that a wide variety of surgical options have been developed over the past 10-20 years.
CPAP treatment of sleep apnea may lead to weight gain, not weight loss
The October 2013 issue of the Journal of Clinical Sleep Medicine included a study and editorial relating to a common problem faced by patients with obstructive sleep apnea who may be overweight. Weight gain is a major risk factor for sleep apnea, and so too does sleep apnea contribute to weight gain. Many patients with sleep apnea find that they experience fatigue or sleepiness, making it extremely difficult for them to exercise and burn calories. In addition, obstructive sleep apnea may affect various hormones, such as leptin and ghrelin, that are involved in food intake. The detailed explanation is more complicated, but on a basic level the increase in calorie intake and decrease in calorie burning can make weight loss challenging. It has commonly been felt that treatment of sleep apnea, for example with positive airway pressure therapy, will restore energy levels and normalize hormone levels, enabling weight loss to occur.
The study published in the journal comes from the APPLES study, a randomized trial of 6 months of positive airway pressure (CPAP) therapy to treat obstructive sleep apnea. What this study showed was that those patients who received sham (fake) positive airway pressure had no change in their weight. In contrast, those who received real CPAP actually had a weight gain. The amount of weight gain, on average, was low (0.35 kg), but the striking finding was that the more the patients used CPAP, the more weigh they gained–for every increase of 1 hour in usage per night, the additional weight gain was 0.42 kg. It turns out that other studies (although not all studies) have shown similar findings, but the strength of this study was that it was a large, randomized trial and that it demonstrated such a strong relationship between more CPAP use and more weight gain. Although this has never been studied for surgery, but my experience is that surgery does not have the same weight gain. Some patients, for reasons that are not clear, will lose weight right after surgery due to pain in their throat and then can have additional weight loss over time. I wonder if there is some sort of cycle between sleep apnea and weight gain that is broken, enabling them to lose weight. Clearly, we need to learn more about the relationship between sleep apnea and body weight.
Patients need accurate information about treatments for snoring and obstructive sleep apnea. In many cases, relying on our own knowledge base and expectations are sufficient, but everyone–patients and physicians alike–should seek out information and conduct studies to check these expectations against reality. Challenging accepted wisdom is the reason that I perform research, and I encourage patients and colleagues (surgeons and non-surgeons) to do the same with me.