Obesity and obstructive sleep apnea

Obesity is the most powerful risk factor for obstructive sleep apnea (OSA). Several pathophysiologic mechanisms relate obesity to the development of OSA. These mechanisms include anatomic and functional considerations of the pharyngeal airway, central nervous system activity, inspiratory control, central obesity, and the effects of leptin. Sleep deprivation, daytime somnolence, and metabolic dysregulation may also contribute to obesity in the setting of OSA. Recent data increasingly support a strong interaction between obesity, OSA, mechanisms of disease, and specific disease states. Although history and physical examination may help predict OSA in obese individuals, polysomnography is the gold standard for making the diagnosis of OSA and assessing effects of therapy. Weight loss is an important strategy for treating OSA; however, the cornerstone of current management is continuous positive airway pressure. This article reviews the influence of obesity on the epidemiology, pathophysiology, diagnosis, and treatment of OSA. Emphasis is placed on cardiovascular disease mechanisms and disease conditions that are particularly common to both OSA and obesity