Mr BB, 48 years old gentleman, an IT professional, was always overweight but was doing well till last year except for his high BP and thyroid problem which were well controlled before lockdown struck and he had to work from home. He started having breathing trouble in December 2020 which progressed to a level that he was breathless in daily activities by the New Year. He also developed lethargy and started noticing that he was sleepy throughout the day in spite of having slept at night.
Fortunately, his family physician guided him rightly to meet a Pulmonologist. Probing about his personal history he admitted to have gained about 25 kgs since the lockdown in 2020 and has also developed a sedentary life style with excessive drinking, smoking and irregular sleep schedule. He also acknowledged to excessive laptop and television watching.
In clinic, he was breathing hard even at rest and he dosed off occasionally while conversing with the doctor. His BP was 150/100 and oxygen level was 85% at the clinic. A sleep study was ordered which showed that his breathing stopped 34 times per hour during whole night sleep and quality of his sleep was very poor. A diagnosis of Obstructive sleep apnea (OSA) with poor sleep hygiene was made with possible obesity hypoventilation syndrome (OHS). This has led to an accelerated BP, fluid retention and respiratory failure with carbon diaoxide retention. His tests also showed that he has developed fatty liver and diabetes also.
Obesity is well known to cause diabetes and heart problems, but these ill effects are seen in long run. Lesser known is the fact that obesity can lead to acute problems like obstructive sleep apneas and obesity hypoventilation syndrome which Mr BB was suffering from.
OSA is a disease caused due to obstruction of upper airway which leads to stoppage in breathing during sleep in some obese patients who have a thick neck and narrow upper airway by birth. Stoppage of breathing leads to intermittent awakenings from sleep in night causing poor sleep quality. Consequently, the individual with OSA feels sleepy throughout the day, which make one prone to accidents especially road traffic accidents if a sleepy person with OSA is driving. It also can cause increase in stress hormones levels which can take a toll on body systems causing high BP, can lead to sudden death in sleep if OSA is very severe. People with poor sleep (due to OSA) or due to poor sleep habits like irregular sleep schedule frequently have mood changes and irritability and have some hormonal imbalance which make them feel hungrier and they donot feel satiety after meals and this lead to weight gain further and worsening of OSA triggering a vicious cycle.
Obesity hypoventilation syndrome is frequently associated with obese OSA patients which leads to respiratory failure (breathlessness), low oxygen and high carbondiaoxide levels during day time, fluid retention in body and this can become fatal.
Even though it will take time to lose weight and reverse the long term ill effects of obesity but good news is that the acute ill effects of obesity leading to OSA and OHS can be reversed immediately with treatment which is mainly by means of mechanical therapy called positive airway pressure (PAP) which can be of two types either Bilevel (Bi-PAP) or continuous (C-PAP). A pulmonologist trained in sleep medicine can guide the patient which is best therapy for them.
Mr BB was given Bipap therapy along with some water pills which increased his urine and decreased fluid retention and he lost 5 kgs in first week itself and his BP got under control and he was feeling refreshed and a totally new person.
