The Veterans Affairs Western New York Healthcare System, Buffalo, NY, United States.
Eur J Intern Med. 2012 Apr;23(3):219-26. doi: 10.1016/j.ejim.2011.10.016. Epub 2011 Nov 21.
The increasing prevalence of obesity has lead to an increase in the prevalence of sleep disordered breathing in the general population. The disproportionate structural characteristics of the pharyngeal airway and the diminished neural regulation of the pharyngeal dilating muscles during sleep predispose the obese patients to pharyngeal airway collapsibility. A subgroup of obese apneic patients is unable to compensate for the added load of obesity on the respiratory system, with resultant daytime hypercapnia. Weight loss using dietary modification and life style changes is the safest approach to reducing the severity of sleep apnea, but its efficacy is limited on the long run. Although it has inherent risks, bariatric surgery provides the most immediate result in alleviating sleep apnea. Obesity has been linked also to narcolepsy. The loss of neuropeptides co-localized in hypocretin neurons is suggested as the potential mechanism. Poor sleep quality, which leads to overall sleep loss and excessive daytime sleepiness has also become a frequent complaint in this population. Identifying abnormal nocturnal eating is critically important for patient care. Both sleep related eating disorder and night eating syndrome are treatable and represent potentially reversible forms of obesity.
肥胖症的发病率不断上升，导致普通人群中睡眠呼吸紊乱的发病率也有所增加。咽气道的结构特征不成比例，以及睡眠期间咽扩张肌的神经调节功能下降，使肥胖患者易发生咽气道塌陷。肥胖性呼吸暂停患者亚组无法代偿肥胖对呼吸系统的额外负荷，导致白天高碳酸血症。通过饮食调整和生活方式改变来减轻体重是减轻睡眠呼吸暂停严重程度的最安全方法，但从长远来看，其效果有限。尽管存在内在风险，但减重手术在缓解睡眠呼吸暂停方面提供了最直接的效果。肥胖也与发作性睡病有关。神经肽在食欲肽神经元中的共定位缺失被认为是潜在的机制。睡眠质量差导致总睡眠时间不足和白天过度嗜睡，在这一人群中也成为常见的抱怨。识别夜间异常进食对于患者护理至关重要。睡眠相关进食障碍和夜间进食综合征都是可治疗的，且代表潜在可逆转的肥胖形式。
