Wittels E H
Med Clin North Am. 1985 Nov;69(6):1265-80. doi: 10.1016/s0025-7125(16)30986-5.
The presence of obesity, defined as weight 20 per cent or more above ideal body weight or increased body fat content, significantly increases risk of pulmonary, cardiovascular, metabolic, and gastrointestinal problems. Obesity is a major cause of shortened life expectancy. While obesity is not essential for the development of the obstructive sleep apnea syndrome, a significant percentage of patients with obstructive sleep apnea are obese. When evaluating these patients who have obstructive sleep apnea, it is important to search diligently for medical problems that are commonly found among the obese. While there is an increased incidence of obese patients among those who have obstructive sleep apnea, the exact reason for this is uncertain. The study of endorphins and enkephalins may expand our understanding of obesity, ventilatory regulation, and obstructive sleep apnea. This may, in fact, enable us to understand better the interrelationship between obesity and obstructive sleep apnea. The role that thyroid hormone, testosterone, and progesterone play in obstructive sleep apnea has also been reviewed. Patients who have obstructive sleep apnea should not be treated with testosterone. All patients given testosterone should be observed quite closely for the possible signs and symptoms of obstructive sleep apnea. Progesterone seems to be of some help in patients who have obesity hypoventilation syndrome. Its effectiveness in patients with obstructive sleep apnea is less clear. The obesity hypoventilation syndrome as described by Burwell is relatively uncommon. Many of the manifestations of the obesity hypoventilation syndrome, however, are found in patients with obstructive sleep apnea. The recognition that the symptoms stem from underlying obstructive sleep apnea offers great potential for therapy. Weight reduction is valuable therapy for patients with obesity and pulmonary dysfunction, obesity and obstructive sleep apnea, and obesity hypoventilation syndrome. Weight reduction and weight maintenance, while difficult, are essential in patients with obesity, obesity and obstructive sleep apnea, and the hypoventilation syndrome. Obesity should be viewed as a medical problem deserving medical attention and long-term medical follow-up.
肥胖的定义为体重比理想体重超出20%或更多，或体脂含量增加，其存在会显著增加肺部、心血管、代谢和胃肠道问题的风险。肥胖是预期寿命缩短的主要原因。虽然肥胖并非阻塞性睡眠呼吸暂停综合征发病的必要条件，但相当一部分阻塞性睡眠呼吸暂停患者是肥胖者。在评估这些患有阻塞性睡眠呼吸暂停的患者时，认真查找肥胖者中常见的医学问题很重要。虽然阻塞性睡眠呼吸暂停患者中肥胖者的发病率有所增加，但其确切原因尚不确定。对内啡肽和脑啡肽的研究可能会扩展我们对肥胖、通气调节和阻塞性睡眠呼吸暂停的理解。事实上，这可能使我们更好地理解肥胖与阻塞性睡眠呼吸暂停之间的相互关系。甲状腺激素、睾酮和孕酮在阻塞性睡眠呼吸暂停中所起的作用也已得到综述。患有阻塞性睡眠呼吸暂停的患者不应使用睾酮进行治疗。所有接受睾酮治疗的患者都应密切观察是否出现阻塞性睡眠呼吸暂停的可能体征和症状。孕酮似乎对肥胖低通气综合征患者有一定帮助。其对阻塞性睡眠呼吸暂停患者的有效性尚不太明确。Burwell所描述的肥胖低通气综合征相对不常见。然而，肥胖低通气综合征的许多表现见于阻塞性睡眠呼吸暂停患者。认识到症状源于潜在的阻塞性睡眠呼吸暂停为治疗提供了巨大潜力。减轻体重对肥胖与肺功能障碍、肥胖与阻塞性睡眠呼吸暂停以及肥胖低通气综合征患者而言是有价值的治疗方法。减轻体重并维持体重，虽然困难，但对肥胖、肥胖与阻塞性睡眠呼吸暂停以及低通气综合征患者至关重要。肥胖应被视为一个值得医学关注和长期医学随访的医学问题。
