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Sleep Apnea and Weight Loss

      To the Editor. In the June 2011 issue of Mayo Clinic Proceedings, Park et al
      • Park JG
      • Ramar K
      • Olson EJ
      Updates on definition, consequences, and management of obstructive sleep apnea.
      presented an excellent update on obstructive sleep apnea (OSA) and succinctly covered the latest information on this disorder, which seems to be encountered ever more frequently.
      I was surprised, however, that weight loss was mentioned almost as an afterthought in the last few words of the conclusion. Because obesity is the cause of many cases of OSA and is an important factor in all cases, weight loss can result in a cure for many patients and in an improvement in others. The importance of treating OSA as a causative factor in cardiovascular disease, hypertension, stroke, and other comorbidities as well as mortality is clearly pointed out in the body of the article. However, obesity alone is an independent and modifiable risk factor for these same complications.
      • O'Keefe JH
      • Carter MD
      • Lavie CJ
      Primary and secondary prevention of cardiovascular diseases. a practical evidence-based approach.
      Would it not be more appropriate to treat a cause of OSA and these comorbidities rather than acquiesce to the patient's lack of motivation to lose weight and simply initiate symptomatic treatment?
      • Woolf SH
      The power of prevention and what it requires.
      • Maciosek MV
      • Coffield AB
      • Flottemesch TJ
      • Edwards NM
      • Solberg LI
      Greater use of preventive services in U.S. health care could save lives at little or no cost.
      The current American Academy of Sleep Medicine guidelines by Epstein et al
      • Epstein LJ
      • Kristo D
      • Strollo Jr, PJ
      • Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine
      • et al.
      Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults.
      state that, after 10% body weight loss, patients should be retested to determine whether continuous positive airway pressure (CPAP) assistance is still necessary. In a nation in which obesity is an epidemic, we should consider primary prevention, rather than simply treating the symptoms. Is a CPAP machine or even bariatric surgery medically necessary for an obese patient with OSA before implementation of an aggressive and comprehensive weight loss program?
      • Ogrod E
      • American Medical Association (AMA)
      Report of the Council on Medical Service. Definition of “Medical Necessity.” Policy H.320.953(3). Published December 1999.
      In my experience, even in unusually well-controlled circumstances, CPAP machines are frequently disliked and used only intermittently.

      REFERENCES

        • Park JG
        • Ramar K
        • Olson EJ
        Updates on definition, consequences, and management of obstructive sleep apnea.
        Mayo Clin Proc. 2011; 86: 549-555
        • O'Keefe JH
        • Carter MD
        • Lavie CJ
        Primary and secondary prevention of cardiovascular diseases. a practical evidence-based approach.
        Mayo Clin Proc. 2009; 84: 741-757
        • Woolf SH
        The power of prevention and what it requires.
        JAMA. 2008; 299: 2437-2439
        • Maciosek MV
        • Coffield AB
        • Flottemesch TJ
        • Edwards NM
        • Solberg LI
        Greater use of preventive services in U.S. health care could save lives at little or no cost.
        Health Aff (Millwood). 2010; 29: 1656-1660
        • Epstein LJ
        • Kristo D
        • Strollo Jr, PJ
        • Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine
        • et al.
        Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults.
        J Clin Sleep Med. 2009; 5: 263-276
        • Ogrod E
        • American Medical Association (AMA)
        Report of the Council on Medical Service. Definition of “Medical Necessity.” Policy H.320.953(3). Published December 1999.
        (Accessed June 28, 2011.)