MONDAY, Sept. 28 (HealthDay News) -- People with sleep apnea who are also obese may triple the chances of eliminating their sleep problems by losing weight, a new study suggests.

Losing about 10 percent of their body weight was enough to bring on total or near-total remission, said Gary Foster, head of the Center for Obesity Research and Education at Temple University in Philadelphia, and lead author of the study.

"It's been clear that obesity increases the risk of sleep apnea but less clear that if obese people or people with type 2 diabetes lost weight, it would result in significant improvements in their sleep apnea -- and it did," said Foster.

People who are overweight or obese are much more likely to have obstructive sleep apnea, a condition in which a person's breathing stops or becomes very shallow, sometimes several hundred times a night and sometimes for as long as a minute, according to the American Sleep Apnea Association.

"The soft palate in the back of mouth falls down and blocks the airway," said Dr. Mitchell Roslin, chief of bariatric surgery at Lenox Hill Hospital in New York City. "When you get to people with serious levels of obesity, it's virtually impossible to find those without [this type of] sleep apnea."

The condition can lead to cardiovascular problems, including stroke, and can raise the risk for dying prematurely.

"It really has tremendous detrimental effects on the cardiovascular system," Roslin said.

The study involved 264 obese men and women who also had type 2 diabetes and obstructive sleep apnea. They were randomly assigned to an intensive behavioral program intended to encourage weight loss or to a less intensive set of group sessions that mainly addressed the issue of diabetes management.

After a year, those in the intensive program had lost an average of about 24 pounds, compared with slightly more than a one-pound average weight loss for the others.

Those who lost the weight also saw a substantial reduction in the number of sleep apnea episodes they experienced, with more than three times as many people in the intensive group experiencing complete remission (13.6 percent versus 3.5 percent).

"The greatest benefit was seen in men and those with severe apnea," Foster said.

Any amount of weight loss brought on an improvement, but those who lost about 10 percent of their original body weight saw the greatest effect. "Any weight loss is good," Foster said.

Most experts recommend 10 percent as the weight loss needed to improve sleep apnea.

However, the study also found that people whose weight remained stable experienced a worsening in their sleep apnea. Just why that occurred remains unclear.

"This is one of the first and certainly the largest study ever conducted so we're at the point in the field, unfortunately, where we're just describing the effect," Foster said.

The study, published Sept. 28 in the Archives of Internal Medicine, does seem to confirm what common sense and experience have shown.

"We've seen that when patients gain five to 10 pounds, their sleep apnea is much worse. If they lose five to 10 pounds, the sleep apnea is much better," said Dr. Hormoz Ashtyani, director of pulmonary critical care and sleep medicine at Hackensack University Medical Center in New Jersey. "It's usually not a resolution, but it's a significant improvement."

More information

The U.S. National Heart, Lung and Blood Institute has more on sleep apnea.

SOURCES: Gary Foster, Ph.D., director, Center for Obesity Research and Education, and professor, medicine and public health, Temple University, Philadelphia; Hormoz Ashtyani, M.D., director, pulmonary critical care and sleep medicine, Hackensack University Medical Center, Hackensack, N.J.; Mitchell Roslin, M.D., chief, bariatric surgery, Lenox Hill Hospital, New York City; Sept. 28, 2009, Archives of Internal Medicine

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TUESDAY, Aug. 18 (HealthDay News) -- The classic manifestations of sleep apnea -- loud snoring, interrupted breathing and sleep disruption -- nearly double the risk for chronic disease and premature death among middle-aged and elderly men, according to major new research.

Even patients with moderate sleep apnea face an increased death risk, as much as 17 percent, compared with those who do not have sleep-disordered breathing problems, the decade-long U.S. study finds.

"The primary finding of our study is that sleep apnea can increase the risk of death by about 40 percent, even after other factors have been accounted for," said study lead author Dr. Naresh Punjabi, an associate professor of medicine at the Johns Hopkins University School of Medicine in Baltimore.

"Our study also shows that it is the decrease in oxygen levels during sleep from sleep apnea that explains the increased risk of death," added Punjabi. Men with sleep apnea between the ages of 40 and 70 are particularly at risk of death from any source, but especially from cardiovascular disease, the researchers found.

Punjabi and his colleagues published their findings in the online Aug. 18 issue of the journal PLoS Medicine. The research effort is the largest ever to explore associations between sleep disturbances and illness, they said.

Sleep apnea is a common, chronic condition that affects about one in four men and about one in 10 women, the authors note. Left untreated, it can lead to excessive sleepiness, difficulties with daytime alertness and an increased risk for driving accidents.

For their study, the research team at Johns Hopkins Bayview Medical Center focused on more than 6,400 men and women between 40 and 70 years old who had mild to severe sleep apnea or had no such sleeping difficulties. Many participants described themselves as "snorers," a prime feature of sleep apnea.

During home monitoring of sleep patterns, the team amassed almost 10,000 in-depth recordings of breathing patterns, heart rhythms and brain activity during sleep.

After determining that about half the patients had moderate to severe sleep apnea, the researchers went on to track the incidence of sickness or death from high blood pressure, heart disease and/or stroke.

Over a tracking period of a little more than eight years, on average, the research team found that 587 men and 460 women died during the study.

Stacking the death tallies against the sleep pattern recordings, the team found that experiencing just 11 minutes of severe sleep apnea -- during which blood oxygen levels dipped to below 90 percent of normal -- appeared to roughly double the risk of death among men.

The small number of women with severe sleep apnea who died during the study ruled out similar conclusions about women.

Nonetheless, Punjabi and his colleagues stressed that the findings were alarming enough to warrant diligent physician attention to patient sleeping habits, in order to intervene quickly when appropriate.

"With such mounting evidence indicating the range of clinical effects of sleep apnea, awareness amongst health care professionals and the general community needs to increase," Punjabi said.

Losing weight sometimes reduces sleep apnea, and some sufferers get relief using a device that keeps them from rolling on their backs while they sleep. For serious cases, a current treatment is the "continuous positive airway pressure" (CPAP) device, which functions as a kind of oxygen mask worn over the nose to help force air into nasal passageways and prevent airways from collapsing.

People with clinical symptoms of sleep apnea, which include loud snoring, sleepiness during the day and fatigue, should discuss their symptoms with a physician, Punjabi advised. "Effective therapy for sleep apnea can improve such symptoms and lead to a better quality of life," he said.

Jim Cappuccino, a 49-year-old sleep apnea patient living in the Baltimore suburbs who was part of Punjabi's study, agreed.

Cappuccino, the owner of a surgical equipment and medical device sales company, knew he had high blood pressure, high cholesterol and type 2 diabetes before enrolling in the study.

Although he can trace the onset of sleep apnea difficulties, such as disruptive snoring and breathing pauses, back to his mid-30's, it was only when he enrolled in the study that he was finally diagnosed with sleep apnea, he said.

"When you're in that career mode, and you're on the go-go-go, you put your health issues on the back burner," he said. "But as I got older, I realized that this is probably something that I should have addressed years ago. I was shocked by the correlation between sleep apnea and heart disease and diabetes, and actually even death, but getting tested and diagnosed and treated has made all the difference. It's actually allowed me to wake up not feeling tired, which hasn't been the norm for me for a few years."

"So the only thing I can say," Cappucino added, "is people who feel that they are having trouble should get tested, because sleep apnea is going to deteriorate your system and lead to many other health problems."

Similar findings that linked severe sleep apnea with a greater risk of dying were reported last year in studies out of Australia and the University of Wisconsin.

More information

For additional information and resources on sleep apnea, visit the American Sleep Apnea Association.

SOURCES: Naresh Punjabi, M.D., Ph.D., associate professor of medicine, Johns Hopkins University School of Medicine; Jim Cappuccino, sleep apnea patient and study participant, Parkville, Md.; Aug. 18, 2009, online, PLoS Medicine

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