Ask the Doctors October 2017 Issue

Ask the Doctors: October 2017

What is metabolic syndrome, and what are the implications of having it? How can it be prevented or treated?

Michael Rocco, MD

Michael Rocco, MD, medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic

Metabolic syndrome (METs; also known as syndrome X) is a clustering of risk factors in an individual, increasing the risk of heart disease, stroke, diabetes and health conditions such as fatty liver, sleep apnea and others. The underlying problem is typically due to insulin resistance (inability of cells to respond to insulin properly), and is frequently linked to being overweight and sedentary. There are five metabolic risk factors: increased abdominal weight/fat (defined by waist circumference >40 inches in men or >35 inches in women), elevated triglycerides (>150 mg/dL) or on therapy, low HDL (<40 mg/dL in men or <50 mg/dL in women), fasting blood sugar (>100 mg/dL) or on medicine for high blood sugar, and elevated blood pressure (>130/85 mmHg) or on treatment for hypertension. Having three or more of these five criteria define the presence of metabolic syndrome.

MetS is on the rise, currently reported in 32 percent of the U.S. population. The implications of having this syndrome are important. Individuals with MetS have up to a five- to 10-fold increase risk of developing diabetes and three- to four-fold increased risk of developing cardiovascular disease. It is possible to prevent or delay metabolic syndrome and reduce the risk for heart disease and stroke, but this requires long-term effort and a coordinated approach with your healthcare providers.

Treatment goals are to modify the underlying causes of the syndrome, with a focus on lifestyle changes including diet (such as the Mediterranean diet), weight loss (of between 7 percent and 10 percent of current weight), exercise (at least 150 minutes of moderate-intensity activity weekly), and smoking cessation. Medications, when needed to treat blood sugar, cholesterol and blood pressure, are often prescribed.

I tried CPAP for my obstructive sleep apnea more than a year ago, but I couldn’t get used to the mask and the noise. Is the equipment getting better? Are there any effective CPAP alternatives?

Obstructive sleep apnea is increasing in prevalence and may be as high as 25 percent for men and 10 percent for women. It is often undiagnosed and undertreated. Treatment is important since there is an increased risk of cardiovascular events and death, hypertension, congestive heart failure and heart arrhythmias in addition to the daytime fatigue and poor sleep quality in untreated OSA.

Nasal CPAP (continuous positive airway pressure) is the most effective treatment and the standard of care for moderate-to-severe OSA. All interventions to improve tolerance to CPAP therapy should be attempted first. A change in mask, pressure settings or the blower unit may help. BiPAP (bilevel positive airway pressure) should be tried next if there is intolerance to CPAP. Oral appliances may be used in individuals with mild-to-moderate sleep apnea if failure of response or intolerance to PAP devices. Mandibular advancement devices (MADs) have been studied as an alternative. The device advances the jaw forward, producing more space at the back of the throat. It is like wearing a brace and does not require a machine with its associated noise and tubes. Depending on the type and severity of OSA, behavioral measures such as restriction in certain body positions during sleep (sleeping on the side rather than the stomach or back), smoking cessation, weight reduction, avoiding alcohol and sedatives four to six hours before bedtime and avoiding sleep deprivation may help. As a last resort, surgical intervention on the uvula and palate may be recommended. No clinical useful drug therapy is currently available. As you can see, there are alternatives, and a referral to a sleep medicine specialist is the best way to determine which therapy is right for you.

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