Internal Medicine

0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43

Obesity Obstructive Sleep Apnea 1075

follow-up

During Treatment

■Weekly weight documentation

■Regular reinforcement/supportive encouragement to maintain

calorie and

■activity changes

Long-Term Maintenance

■Regular physical activity crucial

■Individualized lifestyle changes

■Maintain energy equilibrium (calorie intake≤energy output)

complications and prognosis

■Diabetes Mellitus: two-fold in mild obesity

➣five-fold in moderate obesity

➣ten-fold in morbid besity

■Hypertension: two-fold

➣10% weight gain=6.5 mm Hg increased blood pressure

■Coronary artery disease: 1.8–3.9 times relative risk

➣10% weight loss can=20% reduction CAD risk

■Osteoarthritis: 0.4–1.45% risk

■Gallstones: 18–35% risk

■Hyperlipidemia: 22 mg increase cholesterol synthesis/day with

excess weight

■Sleep apnea: increased risk closely associated, no specific data

■Long-term weight loss maintenance extremely difficult

➣Inactive lifestyles

➣Overabundant foods

■Require lifelong commitment

OBSTRUCTIVE SLEEP APNEA

DAVID CLAMAN, MD

history & physical

History

■Focused history key to diagnosis

■Pts often don’t recognize symptoms

■Men affected more than women (4% vs 2% prevalence)

■Associated w/ obesity (esp BMI >27–30) & hypertension