Obstructive sleep apnea has deadly consequences

Sleep apnea is a deadly disease. Several studies have demonstrated that patients with sleep apnea have a mortality rate six to seven times higher than patients without.

As many as 18 million Americans have sleep apnea, approximately one in every 15 or 6.62 percent of the population. People with sleep apnea are six times more likely to be part of a traffic accident. A bedmate of a person with untreated obstructive sleep apnea can lose one to two hours sleep per night.

According to the National Commission on Sleep Disorders Research, about 38,000 deaths occur annually that relate to cardiovascular problems caused or worsened by sleep apnea. These problems include high blood pressure, hypertension, stroke and heart failure.

Obstructive sleep apnea is caused by repetitive upper airway obstruction during sleep as a result of narrowing of the respiratory passages. Patients with the disorder are most often overweight, with associated throat infiltration of fat and/or increased size of the soft palate and tongue.

These anatomic abnormalities decrease the cross-sectional area of the upper airway. Initially, partial obstruction may occur and lead to snoring. As tissues collapse further or the patient rolls over on his or her back, the airway may become completely obstructed. The patient struggles to breathe and is aroused from sleep. Often, arousals are only partial and are unrecognized by the patient, even if they occur hundreds of times a night. The obstructive episodes often are associated with a reduction in oxygen saturation. Cycles of sleep, snoring, obstruction, arousal and sleep occur throughout the night. Patients with severe apnea may have episodes of upper airway obstruction 100 or more times in one hour. Patients often complain of restless sleep and may awake with intense headaches. Symptoms also may include falling asleep during daily activities such as eating or watching television.

The physiologic impact of decreased oxygen levels and increased carbon dioxide levels are what cause the deadly side effects of sleep apnea. Chronic oxygen deprivation and increased carbon dioxide levels cause high blood pressure to develop. High blood pressure subsequently increases the risk of stroke or heart attack. Decreased oxygen also causes right heart strain that can lead to right heart failure and liver congestion or failure.

The No. 1 cause of sleep apnea is morbid obesity. As weight increases, the fatty deposition occurs in the neck and throat, which leads to the obstructive episodes. External devices known as CPAP machines actively blow air into the mouth and upper airways and hold the airways open to prevent the sleep apnea. In patients who tolerate the devices, the effects are noticed almost immediately with more restful sleep and better daytime energy levels. Unfortunately, around 30 percent of the patients can't tolerate wearing the tight mask necessary for blowing air, or they develop dry mouth. Surgical procedures performed in the mouth or on the jaw are limited to patients who fit certain criteria and only have success rates of 50-70 percent at two years post procedure with success rates decreasing further after two years.

The most effective treatment for patients with obesity and sleep apnea is bariatric weight loss surgery. Patients undergoing weight loss surgery can expect an 85 percent chance of cure for sleep apnea. As weight decreases, the fatty tissue around the neck and in the throat diminish, opening up the airway and completely eliminating the disease. In addition to alleviating sleep apnea, patients undergoing weight loss surgery also will see: 90 percent chance of cure of diabetes; 80 percent chance of cure of high blood pressure; 90 percent cure of heartburn; 90 percent cure of hypercholesterolemia; 50 percent decreased chance of most cancers as well as marked improvement in chronic joint and back problems.

While bariatric surgery is a major surgery that has risks and requires significant work up and careful planning prior to surgery, the benefits are dramatic and lasting.

Weight-loss surgery an effective treatment for type 2 diabetes

Diabetes is a disease caused by either lack of insulin or the body's resistance to insulin. The end result is a lack of ability to control one's blood sugar.

The effects of a chronically elevated blood sugar are devastating. Diabetes causes early development of blood vessel blockages leading to heart attacks, strokes, kidney failure and loss of limbs of the lower extremity. Diabetics also suffer from early development of cataracts and loss of sensation in the feet and hands. Kidney failure frequently results in a need for dialysis.

Weight-loss surgery is emerging as one of the most effective tools we have to send type 2 diabetes into complete remission.

Childhood onset diabetes is referred to as type 1 and is caused by failure of the body to produce insulin. Type 2 diabetes is referred to as adult onset diabetes and develops when a person develops resistance to insulin produced at normal levels.

About 90 percent of type 2 diabetes is related to obesity. The development of adult type 2 diabetes has been increasing in children in the past decade with significant increases in childhood obesity. In most type 2 diabetics, the development of the diabetes mirrors the increase in body weight.

Patients are initially treated with medicines to increase the body's sensitivity to insulin and frequently progress to needing large doses of insulin. While the extra insulin helps control blood sugar, it also promotes further weight gain which produces further resistance to the insulin.

Even with medical treatment, life expectancy is dramatically decreased in patients with type 2 diabetics. On average, a patient diagnosed with diabetes will have their remaining average life expectancy cut by 30-40 percent. For a 40-year-old, this means dying 11 to 15 years earlier than nondiabetics. A recent report released by United Health Center estimates that by 2050, half of Americans will have either pre-diabetes or type 2 diabetes.

The average annual health care costs in 2009 for a person with known diabetes were about $11,700 compared with about $4,400 for the nondiabetic public, according to a report drawn from 10 million United Healthcare members. The average annual cost nearly doubles to $20,700 with complications related to diabetes.

Because 90 percent of type 2 diabetes is caused by obesity, controlling weight is the key to eliminating diabetes. Once a patient begins taking insulin, weight loss becomes more difficult. The most effective treatment in a patient with obesity is weight-loss surgery. About 85 to 90 percent of gastric bypass patients achieve complete remission of diabetes. Patients undergoing lap band surgery see a 73 percent incidence of complete remission. While diet and exercise are important treatments, these measures alone only achieve a 13 percent incidence of remission.

Gastric bypass cures diabetes by helping patients control their weight as well as producing metabolic changes that improve the interaction of insulin and diabetes. Lap-band patients achieve remission of diabetes through weight control. Gastric bypass patients routinely leave the hospital 48 hours after surgery with their diabetes in complete remission or with their insulin requirements cut in half and the need for insulin quickly eliminated.

With the diabetes in remission, a patient's risk of dying related to diabetes complications returns to that of the nondiabetic patient population. Lifelong diabetes remission is maintained through weight control with routine follow up. While surgery does carry risks, the risks of complications from weight loss surgery are far less than the risk of continuing to remain diabetic and morbidly obese.

Remission of diabetes means adding years to a patient's life expectancy. Remission means a dramatic improvement in quality of life and dramatic decreases in health care cost. The personal cost of eliminating diabetes typically results in thousands of dollars in savings each year.