The reciprocal interaction between obesity and obstructive sleep apnoea

Obesity is a significant risk factor in the pathogenesis of obstructive sleep apnoea (OSA) altering airway anatomy and collapsibility, and respiratory control. The association between obesity and USA has led to an increasing focus on the role of weight loss as a potential treatment for OSA. To date, most discussion of obesity and USA assumes a one-way cause and effect relationship, with obesity contributing to the pathogenesis of USA. However, OSA itself may contribute to the development of obesity. OSA has a potential role in the development and reinforcement of obesity via changes to energy expenditure during sleep and wake periods, dietary habits, the neurohormonal mechanisms that control satiety and hunger, and sleep duration arising from fragmented sleep. Thus, there is emerging evidence that OSA itself feeds back into a complex mechanism that leads either to the development or reinforcement of the obese state. Whilst current evidence does not confirm that treatment of OSA directly influences weight loss, it does suggest that the potential role USA plays in obesity and weight loss deserves further research. (C) 2012 Elsevier Ltd. All rights reserved.