Did you know? It turns out that obesity is closely related to sleep, especially Sleep apnea is the invisible killer of obesity.
In the past, obesity and weight loss mostly focused on reducing caloric intake (diet) and increasing caloric expenditure (exercise), but the relationship and interaction between sleep diseases and obesity were often ignored. The world's obesity rate has more than doubled in the past few years. The average number of hours of sleep per person is getting shorter and shorter, and more and more people’s sleep quality is deteriorating. Research in recent years has shown that "sleep" is an important factor in regulating neuroendocrine and metabolism. Therefore, long-term sleep disorders (whether due to sleep diseases, external environment or behavioral factors) will affect the normal secretion of appetite-regulating hormones and insulin sensitivity, thereby increasing the chance of obesity.
Obstructive sleep apnea is a common sleep disease that causes sleep disorders. Patients suffer from repeated obstruction of the upper airway due to reduced airway muscle tension during sleep, resulting in intermittent sleep. Not only is sleep quality impaired, but also reduced sleep hours, snoring, daytime sleepiness, and poor sleep quality are the main symptoms. With the growth of obesity and the serious increase in obesity, the number of patients affected by sleep apnea is also increasing rapidly. Taking the United States as an example, the overall male population growth rate of obstructive sleep apnea is 25%, and the female population growth rate is 9%. However, among obese patients, the male population growth rate of this disease is as high as 93.6%, and the female growth rate is as high as 73.5%.
In the past, our understanding of sleep apnea was that "obesity is one of the main causes of obstructive sleep apnea", and the number of apneas will indeed improve after weight loss. However, there is growing evidence that obstructive sleep apnea may in turn cause patients to gain weight. Obstructive sleep apnea will reduce the proportion of deep sleep. When normal people's deep sleep is suppressed, their diet will prefer high calories and carbohydrates, which will lead to weight gain. In addition, abnormal secretion of appetite-regulating hormones caused by sleep apnea may also affect weight. According to a report by Ozturk et al., patients with obstructive sleep apnea have higher levels of leptin, and the leptin concentration is proportional to the severity of the apnea. This reflects that patients with obstructive sleep apnea have developed resistance to leptin. Because they are insensitive to leptin, these patients are less likely to feel full after eating. To make matters worse, patients with obstructive sleep apnea will overproduce the hormone ghrelin, making it difficult to control their appetite. Insufficient satiety and excessive hunger make patients eat more and unhealthily, resulting in weight gain, which worsens obstructive sleep apnea and further increases weight, making sleep apnea more severe and falling into such a vicious cycle.
If the patient is willing to use a positive pressure respirator to effectively treat obstructive sleep apnea, not only will ghrelin and leptin be relatively reduced, but it will also help with poor diet control caused by appetite-regulating hormone imbalance and also reduce the desire to eat high-calorie foods by normalizing the sleep structure.
The cause and effect of obesity is complex and varies from person to person. If the focus of treatment is generally limited to caloric intake and consumption, the road to healthy weight loss will be difficult and inefficient. What’s even more frightening is that the more you lose, the more fat you will lose! As we gain a deeper understanding of obesity medicine, effective and healthy obesity treatments must not only be diverse but also personalized. Many factors that affect weight are not directly related to calories, but they still involve the energy balance of the entire body. Adequate and good sleep is one of these factors. Obesity is a global problem and is getting worse. To completely and efficiently conquer obesity, sleep is an evaluation item that cannot be ignored!
