A 42-year-old, Mumbai-based business man, weighing 140 kg, walked into the CODS clinic for a weight loss consultation. Not only was he diabetic and hypertensive, but also suffered from severe Obstructive Sleep Apnea (OSA). It was not only affecting his personal life but also had a detrimental effect on his business. So severe was his sleep apnea that he would doze off during important official meetings. The family was constantly under stress when he was out alone, driving. For the last 5 years the CPAP machine (to help him breathe) had been his constant companion and saviour.
He is only one, of the 90 % patients who suffer from this fatal condition. Though sleep apnea is mostly prevalent in males, obese females are prone to be affected by this condition too.
In another instance, a 56-year-old, Mumbai-based housewife, weighing 115 kg, was also diagnosed with sleep apnea about 2 years ago. She was prescribed a CPAP machine, but no matter how much she tried, she wasn’t able to get used to it. Her sleep apnea was so severe that she would fall asleep mid–sentence. She also had a couple of bad accidents as she dozed off while sitting or standing. As a result of these, her family had to hire a full time nurse to look after her and avoid such episodes in the future.
Obstructive Sleep Apnea (OSA) is a chronic condition in which the airway of the body collapses or gets blocked during sleep. This causes shallow breathing or breathing pauses. The breathing pauses could last from a few seconds to a few minutes. This condition most commonly affects obese individuals. Though OSA generally goes undiagnosed; it is a serious life threatening condition. The higher the weight, the greater is the risk of developing OSA.
The most common symptoms of OSA are snoring, excessive day time sleepiness, extreme fatigue, and lethargy after waking up. Individuals suffering from OSA are also at a greater risk of high blood pressure, cardiac arrhythmias, and heart failure; which when coupled with obesity, is an almost fatal concoction. Motor vehicle accidents and sudden death during sleep are the most dreaded consequences of OSA. The severity of OSA is determined by the parameters measured through a nocturnal polysomnography (sleep study test).
The CPAP machine is the initial treatment for OSA. However, compliance is low, with only about 50% of patients actually using the devices regularly. Weight loss of more than 10% of body weight is required for the remission of OSA. Realistically speaking, this kind of weight loss is sustainable only by very few patients. The most effective and sustainable treatment for weight loss is bariatric surgery. Post bariatric surgery, most patients are able to wean themselves off the CPAP machine within1-3 months of surgery. Two years after bariatric surgery the remission rate of OSA is 90–95 %.
One year post bariatric obesity surgery done by Dr. Lakdawala, at CODS; and 45 kg lighter, our business man is free of his CPAP machine, is more alert and efficient, and happily indulging in his new hobby – taking long drives on the weekends!
Six months post her operation, and 35 kg down, our housewife no longer needs a caregiver to accompany her all the time. She is quite capable of independently managing herself and all her household chores.
OSA is one of the many morbid conditions associated with obesity, which adds to the complications of this growing epidemic. All obese patients should necessarily be evaluated and screened for OSA; as bariatric surgery is by far the most effective solution for remission of OSA. Obese patients with OSA should consider obesity weight loss surgery as a viable treatment option and take their second chance at a better life!