| Summary: | Obstructive sleep apnea (OSA), a disorder characterized by intermittent cessation of
breathing during sleep, is most prevalent in obese middle-aged men and is associated with
considerable morbidity and mortality. The purpose of this study was to characterize newly
diagnosed obese men with OSA regarding several variables linked to body weight. Although the
association between OSA and obesity is clear, very little is known about factors influencing body
weight in OSA. Studies have failed to uncover a metabolic defect in obese individuals with the
disorder, raising speculation that obesity may be related to lifestyle or psychological factors.
Patients meeting study criteria were recruited following the overnight sleep study at
which the diagnosis of OSA was confirmed. Data were collected using chart reviews,
anthropometric measurements, food records, written questionnaires, and subject interviews.
Forty-nine men participated, about two-thirds of whom completed and returned useable written
questionnaires. All completed other study components.
Food record analysis showed that reported energy intake was highly variable, but the
mean intake reported was moderate, and should not have resulted in weight gain. However,
qualitative problems with subjects' diets were evident, including high intake of meats and
alternatives and fat, and low intakes of vegetables and fruits and milk products. Binge eating
scores were significantly correlated with BMI, indicating increasing eating behaviour
dysfunction with increasing relative weight. No subjects appeared to have the night eating
syndrome (NES); however, three described eating behaviour suggestive of nocturnal binge eating
(NBE). Physical activity questionnaire results indicated that many subjects were physically
inactive, and few participated in recreational sports. Similar to previous studies of psychological
variables in OSA, about one third of patients were found to have symptoms of depression, anxiety, or both. Many of the psychological and eating behaviour variables were significantly
correlated.
The interview component of the study revealed that the symptom profile of obese men
with OSA was variable, although fatigue, unrefreshing sleep, and snoring were common. In
most cases, it was a family member or friend who had prompted the subject's visit to the clinic.
The majority of subjects had experienced a substantial increase in body weight since onset of
OSA symptoms. Most felt their weight gain was attributable to identifiable lifestyle factors. The
amount of weight gain reported was significantly correlated with binge eating and depression
scores. As well, subjects who felt that fatigue or stressful life events had affected their food
intake had gained significantly more weight than those who had not had these perceptions.
Most subjects reported that they had not become obese until adulthood. More than twothirds
of subjects reported that weight loss attempts had been infrequent. Eating habit changes
were the most predominant weight loss strategy used. Most subjects reported some initial
success with weight loss efforts, but virtually all had regained weight following weight loss
attempts.
Overall, this study provides a profile of a patient population in which debilitating
symptoms, sub-optimal diets, low physical activity, symptoms of depression and anxiety, and
escalating weight are common. These patients appear to need weight gain prevention strategies,
qualitative dietary changes, regular physical activity, and psychological support. A
multidisciplinary and community-based approach may be necessary to assist them in making
desirable lifestyle changes.
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