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A Reflection on Sleep Apnea
Volume One / Number One
by Dr. George Fielding
Obesity, a disease in itself, is the cause of many other diseases that can lead to premature death. One of the most common of these is sleep apnea, in which breathing stops for brief periods of time during sleep. People with this condition have a great deal of trouble getting a restful night’s sleep, since the interruptions in breathing cause them to constantly wake up. Hence they are chronically sleepy. Sleep apnea can be lethal. It can cause death in three ways: by the nocturnal breathing difficulty itself, which deprives the body of necessary oxygen, by the strain the condition puts on the heart, and by accidents caused by falling asleep at the wheel due to daytime sleepiness.
Although people of normal weight can develop sleep apnea, being obese greatly increases the risk. Many studies have shown that obstructive sleep apnea (OSA) is extremely common in severely obese patients, meaning those with a body mass index (BMI) of more than 35. People who store fat in their necks appear to be particularly at risk. Patients with neck circumferences of more than 18 inches have been shown in a study conducted in Australia to have a high likelihood of developing OSA.(1) Another study conducted recently in Israel demonstrated an increased incidence of deaths in men with sleep apnea compared to men without this condition, especially among those 50 years old or younger.(2)
In America as in most of the developed world today, being slim is touted as necessary for achieving good looks and health. But for professional football players, the ideal is just the opposite. In fact, NFL players are regularly encouraged to beef up to weight levels that place them in danger of immediate and future health problems.
A recent article on the ESPN website discussed a study published in the Journal of the American Medical Association investigating overweight among NFL players. Following are some excerpts:
“It’s no secret that size matters in the National Football League, but a new study suggests that a whopping 56 percent of NFL players would be considered obese by some medical standards…The theory is that bigger men, especially linemen and defensive players, are better blockers and harder to move…In the study, University of North Carolina endocrinologist Joyce Harp and student Lindsay Hecht used statistics on the NFL Web site to calculate BMIs for 2,168 NFL players, nearly all those playing in the 2003-04 season. Almost all the players qualified as overweight, and 56 percent had BMIs and a small percentage were morbidly obese with a BMI of at least 40.
“These larger body sizes are generally associated with greater cardiovascular risks,” said Dr. Arthur Roberts, a former NFL quarterback and retired heart surgeon whose Living Heart Foundation works with the players union to evaluate heart-related health risks faced by current and retired players. Roberts said. The increasing emphasis on size may be a bad influence on “all the young kids that play football around the country…and are trying to be like their heroes,” Roberts said.(3) "There are serious complications awaiting these men, including sleep apnea. Just look at their necks. Forget diabetes for a minute – these football players are at enormous risk of early death. The NFL would do better to champion weight loss and health, rather than to encourage a state of overweight that is dangerous for its players and the kids who emulate them."
The medical treatment for sleep apnea is a continuous positive airflow pressure (CPAP) device. This is a machine that pushes oxygen past the blocked windpipe, allowing the brain to get oxygen and the patient to relax at night, no longer waking up continuously. It can be uncomfortable to use, however, and is far from an ideal solution. When overweight is the cause for someone’s sleep apnea, the only known cure is weight loss. For many people with morbid obesity, bariatric surgery has been shown to be the only effective long-term solution. Sleep apnea is therefore an absolute indication for obesity surgery. The objective is to enable the patient to lose weight, get a thinner neck, and come off the CPAP mask.
- 1.Chest. 2003 Apr;123(4):1134-41. Predicting sleep apnea and excessive day sleepiness in the severely obese: indicators for polysomnography. Dixon, J.B., Schachter, L.M., O’Brien, P.E. Monash University Department of Surgery, Alfred Hospital, Melbourne, Australia.
- 2.Eur Respir J. 2005 Mar;25(3):514-20. All-cause mortality in males with sleep apnea syndrome: declining mortality rates with age. Lavie, P., Lavie, L., Herer P. Lloyd Rigler Sleep Apnea Research Laboratory, B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
- 3.Journal of the American Medical Association
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