Obstructive Sleep Apnea

and Obesity

Luisito O. Llido, MD, FPCS

Head

Center for Obesity and Weight Management

St. Luke’s Medical Center

Objectives of the presentation

To present prevalence of sleep apnea in the

general population and obese patients

To show the prevalence of obesity in the local

setting

To present the approaches in the management

of obesity

To present outcome data on the outcome of

obesity management in the Philippines

(specifically St. Luke’s Medical Center)

Some practical suggestions

Prevalence of obstructive sleep

apnea in the population

2% of women and 4% of men in the general population Strollo PJ Jr, Rogers RM. Obstructive sleep apnea. N Engl J Med

1996; 334: 99-104.

70% in morbidly obeseFritscher LG, Mottin CC, Canani S, Chatkin JM Obes Surg. 2007

Jan;17(1):95 .

In the Philippines? in St. Luke’s ?– IDK, please ask the other speakers

Prevalence of obesity

Worldwide: BMI > 30: 1.7 billion

number of overweight is equal to the underweights

(Worldwatch Institute)

United States:

2/3 are overweight

Obese = 50 million

Philippines:

21% (PASOO)

Obesity prevalence snap shots

Hospital BMI < 18.5 BMI > 30

Marikina, Rizal 1 38% 15%

Lipa City, Batangas 2 48%

Quezon City 3 22% 20%

1. Amang Rodriguez Medical Center (n = 61)

2. Mary Mediatrix Medical Center (n = 2,345)

3. St. Luke’s Medical Center (n = 41,676)

Overweight and obesity

in St. Luke’s Medical Center

Obesity in pediatric patients of

St. Luke’s Medical Center

• Y2000, n = 4678

• Y2003, n = 3770

Obesity pattern per age group: y2000, 2003, 2005,2006 (slmc)

0%

5%

10%

15%

20%

25%

30%

35%

40%

1yr 2yr 3yr 4yr 5yr 6yr 7yr 8yr 9yr 10yr 11yr 12yr 13yr 14yr 15yr 16yr 17yr 18yr

age group

pe

rce

nt

of

tota

l

y2000_%

y2003_%

y2005_%

y2006_%

Log. (y2000_%)

Log. (y2003_%)

Log. (y2005_%)

Log. (y2006_%)

• 1 to 2 y/o = 33%

• 18 y/o = 12% to 15%

• Y2005, n = 4006

• Y2006, n = 2151

Stroke 1.6

Low mood poor self esteem

Hypertension 2.9

Coronary heart disease 2.5

Thromboembolism 1.5

Heart failure 1.5

Infertility

Pregnancy problems 2.0

Cancer of uterus 4.6

Menorrhagia 1.8

Diabetes mellitus 10

Dyslipidemias 1.5

Hyperinsulinemia

Gallstones 2.7

Cancer of colon 1.5

Cancer of pancreas 1.6

Kidney disease

Breast cancer 1.3

Hypoventilation

Sleep apnea

Breathlessness 3.5

Hirsutism 2

Sweating

Obesity complications, relative risk

Multidisciplinary:

nutrition support

endocrinologist

cardiac rehab

pulmonologist

psychiatrist

physiatrist

pediatrician

surgeon

physical therapist

nurse

dietitian

Management of obesity

SCREENING

NON-SURGICAL

• diet

• exercise

• drugs

• behavioral mx

SURGICAL

BMI > 30

Adult and pediatric: Failed

non-surgical programs

BMI 30 – 34.9 with

co-morbidity

Balloon?

Non-surgical program

Pediatric obese: outcomePatient Profile and baseline values

Total patients 46

Age Range 5 to 17 years; Median: 14 yrs

(95% LCL: 11 yrs, 95% UCL: 15 yrs)

Pre-adolescent (5-9 years) 9 (20%)

Early Adolescent (10-13 years) 14 (30%)

Mid Adolescent (14-16 years) 19 (41%)

Late Adolescent (17-18 years) 4 (9%)

Male to female ratio (29M : 17F) or 1.7 to 1

Tan-Ting A, Llido LO, Gepte AT. Outcome of Ambulatory Weight Management Program in Obese Children

Pediatric obese: outcome

Figure 1: Number of sessions versus outcome; * P < 0.05, One Way ANOVA;

** P < 0.05, Wilcoxon Rank Sum Test.

Tan-Ting A, Llido LO, Gepte AT. Outcome of Ambulatory Weight Management Program in Obese Children

Weight loss: bariatric surgery

Obesity Surgery in the Philippines: Experience in a Private Tertiary Care Hospital for Years

2002 to 2004. Dineros H, MD; Sinamban R, Siozon M, Llido L, Yumang E, Gregorio IV AE,

Cacas Jr R.. Obesity Surgery, 17, 82-87.

Weight Loss: comparison between non-surgical

and surgical programs

0

5

10

15

20

25

30

35

30d 60d 90d 120d 150d 180d 270d 360d >360d

Time interval

Wt

Lo

ss

(k

g)

Non_Surg

Surg

Experience of multidisciplinary approach to weight management,

St. Luke’s Medical Center; report for years 2003 to 2006

Non-surgical vs. surgical

Body composition changes: non surgical

weight loss program

*

Effect of weight loss on sleep apnea

Prospective, randomized, one year follow up study

(n=72)

Method of weight loss: (grp1) counselling alone vs.

(grp2) counselling + very low calorie diet

Result:

Weight loss: grp1 = -6.5 kg; grp2 = -10.7 kg

BMI change: grp1 = -2.1 units; grp2 = 3.5 units

Improvement in Apnea-Hypopnea Index (AHI): OR 0.24 (95%

CI 0.08-0.72, P=0.011) in group 2

Tuomilehto HP, Seppa JM, Partinen MM et al. Lifestyle Intervention with

Weight Reduction-First Line Treatment in Mild Obstructive Sleep Apnea.

Am J Respir Crit Care Med. 2008.

How to control your weight

Count your calories – if you don’t know

how, consult/ask our clinical dietitians or

clinical nutrition fellows

Exercise – don’t take the elevator, leave

this to the old and weak people

Check your family history – if there is a

diabetic or obese, the statistical chance of

you becoming one is highly significant

Physical activity and risks to obesity and

diabetes

24

14

5 7

-9-12

-24

-34-40

-30

-20

-10

0

10

20

30

Obesity Risk Diabetes Risk

pe

rce

nt

­ 2 hrs w atching TV

Sitting at w ork

2 hrs standing/

w alking (home)

1 hr brisk w alking

JAMA 2003; 289, 1785-1791

Conclusion

Obesity is on the rise from the pediatric to the

adult population

We can deal with it – for those who are far gone

into the problem, there are several ways of

dealing with it

Obesity management is best managed with a

multidisciplinary approach

Managing complications related to obesity is

expensive and difficult; prevention always gives

the best outcome for you