Managing weight loss and sleep apnea: better together?

Submitted by Jerry on Mon, 11/03/2008 - 22:38

Chronic conditions tend to travel together; the same person can have two or more conditions. How to manage them together?

This places a burden not only on the person trying to manage multiple lifestyle and medical interventions, it becomes a challenge for the health care system. Connected health can offer benefits for the individual and the system. For instance, I can see various ways to apply the consumer and medical models of connected health to the metabolic syndrome and sleep apnea.

Among the most common chronic conditions are obesity and the metabolic syndrome. Metabolic syndrome comprises a group of conditions that seem to show up together in individuals who are also prone to diabetes, cardiovascular disease, stroke, and heart attack. The same individuals are often living with sleep apnea.

Metabolic syndrome is defined by a person having several abnormalities (including abnormal insulin/sugar, abdominal obesity, high cholesterol and high blood pressure). Metabolic syndrome is associated with increased risk for the development of type 2 diabetes, heart disease, and stroke. In addition, people with the metabolic syndrome often have sleep apnea, which has many serious consequences.

Metabolic syndrome can be treated through weight loss, diet, and exercise. Sleep apnea can be treated using Continuous Positive Airway Pressure (CPAP), in which a device blows air through a mask to prevent airway collapse during sleep. People who have both metabolic syndrome and sleep apnea may be a population that would benefit from a coordinated medical model and consumer support system. Physicians would identify and advise on dealing with metabolic syndrome. Specialists in sleep disorders would identify and prescribe CPAP or another treatment for sleep apnea.

However, since adherence to treatment for sleep apnea is a major problem, (just like adherence to lifestyle changes for metabolic syndrome including weight loss, diet change, and exercise is also difficult to achieve) some form of consumer support might have a positive impact if properly coordinated with medical advice. Education, say in the form a detailed patient handbook combining a patient perspective with authoritative information: like Sleep Apnea--the Phantom of the Night, can be an important tool for someone living with sleep apnea to manage their own care. That care involves good communication and partnership with a qualified health care professional.

This information and support could be complemented by an interactive online or mobile companion along the lines of consumer support tools. A third level, enabling telemedicine connecting the patient with a physician or other qualified health professional for monitoring, problem solving, and changes in prescribed treatment would be needed for a comprehensive solution.

Apnea management is ripe for such a comprehensive solution. Already we have the ability to diagnose apnea and monitor treatment using remote sensors. A person can wear a collection of sensors at home during sleep, and obtain a diagnosis and prescription without having to go to a lab for an overnight study. Many CPAP treatment devices have the ability to record treatment progress and even transmit this information to a clinician. Although remote diagnosis and monitoring may be imperfect, and must be used with caution, they may offer the potential for reducing the numbers of undiagnosed people living with apnea, and helping those being treated to better manage and succeed in their treatment.