The Indian Practitioner

Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Obesity, Obstructive Sleep Apnoea, and Metabolic Syndrome: The Fatal Association


Affiliations
1 Professor of Pulmonary Medicine, DM Wayanad Institute of Medical Sciences, Wayanad, Kerala, India
     

   Subscribe/Renew Journal


Obesity is the most common health risk for individuals of all age groups across the globe. Obstructive sleep apnoea (OSA) is now recognized as a major health problem in developed countries. The prevalence of OSA is undoubtedly rising given the epidemic of obesity. Recent data also suggest that OSA is associated with metabolic syndrome. Pathophysiological triggers of intermittent hypoxia and sleep fragmentation in OSA is responsible for cardiometabolic dysfunction. The potential mechanisms of OSA-obesity-metabolic syndrome interaction involve sympathetic activation, oxidative stress, inflammation and neurohumoral changes. In spite of support for an independent role of OSA in the contribution towards metabolic dysfunction, obesity plays a determinant role in initiating both these conditions.

Keywords

obesity, cardiometabolic dysfunction, metabolic syndrome
Subscription Login to verify subscription
User
Notifications
Font Size


  • Harilakshmanan P, Arun P, Sethu Babu, Ravindran C. Syndrome Z- A case report. Pulmon 2006;8:3: 91-94.

  • DS Hui, KW To, FW Ko, JP Fok, MC Chan, JC Ngai, AH Tung, CW Ho, MW Tong, C-C Szeto, CM Yu. Nasal CPAP reduces systemic blood pressure in patients with OSA and mild sleepiness. Thorax 2006; 61:1083-1090

  • Jensen MK, Chiuve SE, Rimm EB, et al. Obesity, behavioral lifestyle factors, and risk of acute coronary events. Circulation 2008; 117: 3062–3069. Google Scholar

  • Jackson-Leach R, Lobstein T. Estimated burden of paediatric obesity and co-morbidities in Europe. Part 1. The increase in the prevalence of child obesity in Europe is itself increasing. Int J Pediatr Obes 2006; 1: 26–32. CrossRefPubMedGoogle Scholar

  • Cali AM, Caprio S. Obesity in children and adolescents. J Clin Endocrinol Metab 2008; 93: Suppl. 1, s31–s36. CrossRefPubMedGoogle Scholar

  • Trayhurn P, Wood S. Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br J Nutr 2004; 92: 347–355.CrossRefPubMedWeb of ScienceGoogle Scholar

  • Hotamisligil GS. Inflammation and metabolic disorders. Nature 2006; 444: 860–867.CrossRefPubMedGoogle Scholar

  • Grunstein RR, Wilcox I, Yang TS, et al. Snoring and sleep apnoea in men: association with central obesity and hypertension. Int J Obes Relat Metab Disord 1993; 17: 533–540. PubMedGoogle Scholar

  • Katsuki A, Sumida Y, Urakawa H, et al. Increased visceral fat and serum levels of triglyceride are associated with

  • insulin resistance in Japanese metabolically obese, normal weight subjects with normal glucose tolerance. Diabetes Care 2003; 26: 2341–2344. Google Scholar

  • Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the United States. JAMA. 1999 Oct 27. 282(16):1530-8. [Medline].

  • Bays HE, Gonzales-Campoy JM, Bray GA, et al. Pathogenic potential of adipose tissue and metabolic consequences of adipocyte hypertrophy and increased visceral adiposity. Expert Rev Cardiovasc Ther 2008; 6: 343–368.CrossRefPubMedGoogle Scholar

  • Martin SE, Engleman HM, Deary IJ, Douglas NJ. The effect of sleep fragmentation on daytime function. Am J Respir Crit Care Med 1996; 153:1328–32.

  • Young T, Blustein J, Finn L, Palta M. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep 1997; 20:608–613.

  • Leung RS, Bradley DT. Sleep apnea and cardiovascular disease. Am J Respir Crit Care Med 2001; 164:2147–2165.

  • Lavie P, Hoffstein V. Sleep apnea syndrome: a possible contributing factor to resistant hypertension. Sleep 2001; 24(6):721–725.

  • Apoor S. Gami, Virend K. Somers. Obstructive sleep apnea, metabolic syndrome and cardiovascular outcomes. European Heart Journal 2004; 25:709–711.

  • Coughlin S. Mawdsley, L., Mugarza, JA et al. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 2004; 25:735– 41.

  • Wilcox I, McNamara SG, Collins FL et al. “Syndrome Z”: the interaction of sleep apnoea, vascular risk factors and heart disease. Thorax 1998; 53(Suppl 3):25–28.

  • Bonsignore MR, Eckel J. Metabolic aspects of obstructive sleep apnoea syndrome. Eur Respir Rev 2009; 18: 113–124. Google Scholar

  • Yin J, Gao Z, He Q, et al. Role of hypoxia in obesity-induced disorders of glucose and lipid metabolism in adipose tissue. Am J Physiol Endocrinol Metab 2009; 296: E333–E342. Google Scholar

  • Myers MGJ, Leibel RL, Seeley RJ, et al. Obesity and leptin resistance: distinguishing cause from effect. Trends Endocrinol Met 2010; 21: 643–651.CrossRefPubMedGoogle Scholar

  • Ambrosini G, Nath AK, Sierra-Honigmann MR, et al. Transcriptional activation of the human leptin gene in response to hypoxia. J Biol Chem 2002; 277: 34601–34609. Google Scholar

  • Koh KK, Park SM, Quon MJ. Leptin and cardiovascular disease: response to therapeutic interventions. Circulation 2008; 117: 3238–3249. Google Scholar

  • Nawrocki AR, Rajala MW, Tomas E, et al. Mice lacking adiponectin show decreased hepatic insulin sensitivity and reduced responsiveness to peroxisome proliferator-activated receptor gamma agonists. J Biol Chem 2006; 281: 2654–2660. Google Scholar

  • Han SH, Sakuma I, Shin EK, et al. Antiatherosclerotic and anti-insulin resistance effects of adiponectin: basic and clinical studies. Prog Cardiovasc Dis 2009; 52: 126–140. CrossRefPubMedGoogle Scholar

  • Shoelson SE, Lee J, Goldfine AB. Inflammation and insulin resistance. J Clin Invest 2006; 116: 1793–1801. CrossRefPubMedGoogle Scholar

  • Varlamov O, Somwar R, Cornea A, et al. Single-cell analysis of insulin-regulated fatty acid uptake in adipocytes. Am J Physiol Endocrinol Metab 2010; 299: E486–E496. Google Scholar

  • Coughlin SR, Mawdsley L, Mugarza JA, et al. Obstructive sleep apnea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 2004; 25:735– 41.

  • Lam JCM, Lam B, Lam CL, et al. Obstructive sleep apnea and the metabolic syndrome in community-based Chinese subjects in Hong Kong. Resp Med 2006; 100(6):980–87

  • Schwartz AR, Patil SP, Laffan AM, Polotsky VY, Schneider H, Smith PL. Obesity and obstructive sleep apnea: pathogenic mechanism and therapeutic approaches. Proc Am Thorac Soc 2008; 5(2):185–92.

  • Alberti KG, Zimmet P, Shaw J. The metabolic syndrome: a new worldwide definition. Lancet 2005; 366:1059–1062.

  • Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2008; 5:136–43.

  • de Sousa AGP, Cercato C, Mancini MC, Halpern A. Obesity and obstructive sleep apnea. Obes Rev 2008; 9:340–54.

  • Peppard PE, Young T, Palta M, Dempsey J, Skareyd J. Longitudinal study of moderate weight change and sleep disordered breathing. JAMA 2000; 284:3015–21.

  • Lam B, Sam K, Mok WY, et al. Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. Thorax 2007; 62(4):354–59.

  • Börntorp P. Metabolic implications of body fat distribution. Diabetes Care 1991; 14:1132–43.

  • Tasali E, Ip MS. Obstructive sleep apnea and metabolic syndrome: alterations in glucose metabolism and inflammation. Proc Am Thorac Soc 2008; 5(2):207–17.

  • Ip MS, Lam B, Ng MMT, Lam WK, Tsang KWT, Lam KSL. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 2002; 165:670– 76.

  • Reichmuth KJ, Austin D, Skatrud JB, Young T. Association of sleep apnea and Type II diabetes: a population-based study. Am J Respir Crit Care Med 2005; 172:1590–95.

  • Anderson AJ, Sobocinski KA, Freedman DS, et al. Body fat distribution, plasma lipids and lipoproteins. Arteriosclerosis 1998; 8:88–94.

  • Newman AB, Nieto FJ. Relationship of sleep-disordered breathing to cardiovascular risk factors. The Sleep Heart Health Study. Am J Epidemiol 2001; 154:50–59.

  • Somers VK, Dyken ME, Clary MP, et al. Sympathetic neural mechanisms in OSA. J Clin Invest 1995; 96:1897–1904.

  • Wolk R, Shamsuzzaman, Somers VK. Obesity, sleep apnea and hypertension. Hypertension 2003; 42:1067–74.

  • Pratt-Ubunama MN, Nichizaka MK, Boedefeld RL, et al. Plasma aldosterone is related to severity of obstructive sleep apnea subjects with resistant hypertension. Chest 2007; 131:453–59.

  • Yaggi HK, Araujo AB, McKinlay JB. Sleep duration as a risk factor for the development of Type 2 diabetes. Diabetes Care 2006; 29:657–61.

  • Ip MS, Mokhlesi B. Sleep and glucose intolerance/diabetes mellitus. Sleep Med Clin 2007; 2:19–29.

  • Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med 2004; 1(3):e62.

  • Trayhurn P, Wang B, Wood IS. Hypoxia in adipose tissue: Bases for the dysregulation of tissue function in obesity? Br J Nutr 2008; 100:227–35 . 49. Li J, Savransky V, Nanayakkara A, Smith PL, O’Donnell CP, Polotsky VY. Hyperlipidemia and lipid peroxidation are dependent on the severity of chronic intermittent hypoxia. J Appl Physiol 2007; 102:557–63.

  • Lam DCL, Xu A, Lam KSL, et al. Serum adipocyte-fatty acid binding protein (A-FABP) level is elevated in severe obstructive sleep apnea (OSA) and correlates with insulin resistance. Eur Respir J 2009; 33:346–51.


Abstract Views: 290

PDF Views: 0




  • Obesity, Obstructive Sleep Apnoea, and Metabolic Syndrome: The Fatal Association

Abstract Views: 290  |  PDF Views: 0

Authors

Ravindran Chetambath
Professor of Pulmonary Medicine, DM Wayanad Institute of Medical Sciences, Wayanad, Kerala, India

Abstract


Obesity is the most common health risk for individuals of all age groups across the globe. Obstructive sleep apnoea (OSA) is now recognized as a major health problem in developed countries. The prevalence of OSA is undoubtedly rising given the epidemic of obesity. Recent data also suggest that OSA is associated with metabolic syndrome. Pathophysiological triggers of intermittent hypoxia and sleep fragmentation in OSA is responsible for cardiometabolic dysfunction. The potential mechanisms of OSA-obesity-metabolic syndrome interaction involve sympathetic activation, oxidative stress, inflammation and neurohumoral changes. In spite of support for an independent role of OSA in the contribution towards metabolic dysfunction, obesity plays a determinant role in initiating both these conditions.

Keywords


obesity, cardiometabolic dysfunction, metabolic syndrome

References