Obesity has reached epidemic proportions nationwide, and Kentucky’s ranking in the top 10 most obese states is a reason to be concerned about Obstructive Sleep Apnea and the relationship to obesity. Several studies have shown that obesity can be a dominant factor in as many as 50% of the people with Obstructive Sleep Apnea (OSA). The circumference of a person’s neck is a predictive marker for obesity. Men with neck circumferences over 17” and women greater that 16”are more likely to be obese which in turn increases the risk of having OSA. With OSA, the sleep cycle is interrupted several times throughout the night, which can have a definite affect on the endocrine system. Many hormones associated with obesity, appetite, and metabolism are affected, which in turn can possibly link obesity and OSA.
Insulin is a hormone produced by the pancreas, which is vital in regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the muscle, liver and fat tissue to take up glucose from the blood storing it as glycogen in the muscle and liver. Quite simply, high insulin levels cause fat storage. Frequently patients with OSA have what is called insulin resistance that can cause increased waist size, elevated blood pressure and a host of other features. It has been suspected that OSA may be an important factor in diabetes.
Growth Hormone stimulates growth, cell reproduction and regeneration. This hormone is secreted only when someone is in the deeper stages of sleep. Patients with OSA have fragmented or multiple interruptions in the sleep cycle and frequently do not get to the deeper stages of sleep required to have the growth hormone secreted.
Melatonin is secreted by the pineal gland in response to darkness and is a very potent antioxidant. Its main function is to induce sleep but it also functions to enhance the affects of Leptin in the body, which suppresses appetite and promotes weight loss.
Prolactin produced in the pituitary gland is an important regulator of the immune system. It is secreted 3-4 hours after the release of melatonin. Late nights which mean later melatonin secretion results in later prolactin secretion, which in turn upsets the entire cycle. This can lead to increased carbohydrate cravings and an increase in the level of insulin. When you wake up with high insulin levels you frequently have a tendency to skip the important meal of breakfast.
Cortisol (hydrocortisone) is a steroid hormone that is released in response to stress and a low level of blood sugar. The primary function of Cortisol is to increase blood sugar. Patients with sleep deprivation frequently have elevated cortisol levels and therefore can trigger a series of negative events in the sleep cycle to happen.
Dentists practicing dental sleep medicine are committed to proper screening with specialized equipment such as a rhinometer and pharyngometer, diagnosis by a board certified sleep specialist M.D, and a commitment to helping patients manage their OSA.
Encouraging patients to go to bed by 10 p.m. in a room that is cool, dark and quiet could possibly be one of the best suggestions to improve health of an individual. The understanding of the roles of the hormones and sleep can help achieve a better level of health. Weight loss may be recommended as a treatment for OSA, but OSA treatment may well be a very important component of weight loss as well. Providing this level of service to our patients, we play a vital role in both directions of the obesity epidemic.