Sleep Apnea, Sleep Deprivation, and Obesity

Sleep Apnea, Sleep Deprivation, and Obesity


– Hi I’m Ananth Karumanchi, a nephrologist at Beth Israel Deaconess Medical Center and a professor of medicine
at Harvard Medical School. – I’m Virend Somers a cardiologist
and professor of medicine at Mayo Clinic in Rochester. – Dr. Somers, why should the hypertension community care about sleep? – So, sleep and blood pressure are very closely linked. Basically, in a physiologic sense, when people fall asleep
the blood pressure falls. What we know is if your
blood pressure doesn’t fall at night when you’re sleeping you fall into the non-dipper category and that puts you at an increased risk of cardiovascular imports. We also know that if you
have problems during sleep, if you develop obstructive sleep apnea, it will raise your blood pressure at night and raise your blood pressure
even during the day time. And the third compelling reason to care is that people who are sleep deprived don’t get enough sleep at night, whether it’s by choice or whether it’s by some external course, these people chronically will tend to have higher blood pressures than those who sleep normally. – So, in your opinion, do all patients with hypertension would you recommend them to get a screen for some sort of sleep abnormalities. – No, no I wouldn’t because
the number of people with hypertension is so huge that logistically and
economically wouldn’t be feasible to study all these people. So we need to be very
selective on who we study and some of the points to
think about who we study would be people who have witnesses apneas, meaning the wife or husband says I see him or her stop
breathing during sleep. That’s called a witnessed apnea and a great sign of obstructive apnea. The other is if you hypertensive and you have day time somnolence. If you fall asleep during
the day time very easily, then you quite likely have sleep apnea. If you have significant obesity, especially central
obesity and hypertension, chances are you have
obstructive sleep apnea. Now of course, if you
have disruptive snoring if you snore so loudly
that your wife wakes up. Another clue that physicians
need to be aware of is resistant hypertension. Patients with a resistant hypertension have a very high prevalence
of obstructive sleep apnea. And there are some data suggesting if we diagnose and treat sleep apnea, their hypertension becomes
much easier to control. – That’s terrific. The
next question I had, I found this point that
you made in your talk quite fascinating on the relationship between weight gain and sleep deprivation. Could you tell us a bit
about that relationship and why that’s important for
the hypertension community. – Sure, so what we know
from the literature and from the punologic data is that people who are obese don’t sleep well. That could be various reason cause and effect is not clear. What is emerging from studies from a number of groups both in Europe and in North American is that if you take healthy people
and sleep deprive them, if you give them only four or five hours of sleep a night, and you do this for several
nights, maybe a week, what you’ll find is these people tend to start eating more. And in some studies you can actually find and identifiable weight gain after about a week of sleep deprivation. So there’s data suggesting then that not sleeping enough makes
you want to eat more. Whether you eat more carbohydrates or fat or protein, we don’t know. But certainly your total calorie intake increases significantly
thereby predisposing you to weight gain in the future. And then the obvious follow up question is would this epidemic of sleep
deprivation that we are facing, with the use of smart
phones and other devices that emit light and
keep up awake at night, is this population wide sleep deprivation setting up for a larger
increase in the prevalence of hypertension, diabetes,
cardiovascular disease. – Well thank you. That was fascinating. Just a follow up question on that, you said the major risk
for sleep deprivation are all these enviornmental risk factors, but are there, is there
a genetic component to sleep deprivation as well? – Not that I’m aware of
that is well established. – Okay – What we know is that some
people need less sleep, some people need more sleep. And people who just get
away with less sleep and do fine, never have a problem, live til they’re 90, totally healthy. So clearly there seems to
be a genetic determination of how much sleep we need. Whether our genes define how we will respond to deprivation, less than what we need,
I think it is likely, but I don’t know the specifics. – Okay, thank you very much. – Thanks very much. (dramatic music)

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