The biggest snoozer
Best friends and "Biggest Loser" participants Danny and David, with their CPAP machines from Respironics.
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When the popular NBC reality weight-loss series "The Biggest Loser" launches its eighth season next month, representatives of a Pittsburgh-area company will be working behind the scenes.
It's almost a fluke that they're there at all.
For a second year, Philips Respironics in Murrysville is testing the show's participants for sleep problems, specifically a disorder known as obstructive sleep apnea (OSA), from which a person stops breathing for short periods during the night. Obesity is a common risk factor for OSA, and heavy snoring its most noticeable symptom.
The first time Respironics did this for the TV show, the company had about one week to prepare.
Ed Payne, a vice president for United Sleep Medicine sleep study centers in Charlotte, N.C., and a Respironics customer, had been watching "Biggest Loser" for years. He knew the participants had to be at risk for OSA and thought they should be screened. So he wrote a letter in March 2008 to Robert Huizenga, who oversees the participants' medical care.
Mr. Payne didn't hear back for months, and assumed the show wasn't interested. Then, 10 days before taping was to begin last year, a "Biggest Loser" staffer called to say the show wanted to do sleep studies for the 22 contestants.
"I said, 'Wow, how are we going to make this happen?' " recalled Mr. Payne.
His first call was to his Respironics regional manager, knowing the Murrysville company had the equipment and know-how to pull it off. The message got quickly passed on to headquarters where company officials enthusiastically agreed to participate.
At Respironics, the quick turnaround fell on the shoulders of respiratory therapist Pam Minkley, who pulled together a team of people, organized shipment of the needed medical equipment and headed off to Los Angeles. United Sleep sent six staff members, including Mr. Payne.
Because of the late notice, they had to set up a makeshift sleep laboratory using rooms at the Sheraton Universal Hotel, where the participants were staying.
"We built a 10-bed sleep center in about 24 hours," Mrs. Minkley said. They set up a control room, cameras to monitor the contestants, two-way communications and all the computers and medical equipment needed to record each person's sleep patterns, breathing and movement during the night.
Last season, contestants competed as couples so they were paired in rooms for the sleep study. Typically, sleep studies are done in single rooms for reasons that quickly became evident.
"On occasion, we'd hear snoring and we weren't sure who was making the noise," recalled Mrs. Minkley.
Everyone underwent one night's sleep study to determine if OSA was present and, if it was, a second study was done using Respironics' CPAP -- Continuous Positive Airway Pressure -- to learn if the treatment helped.
Respironics has been producing CPAP machines for nearly 25 years. The device includes a mask through which the wearer receives a steady flow of air, keeping the airway open during sleep. A related product, the BiPAP also provides airflow but in a manner that more closely resembles the natural inhale-exhale breathing cycle.
In all, said Mrs. Minkley, they performed about 53 sleep tests in six days.
Of the 22 Biggest Loser contestants, 16 were diagnosed with obstructive sleep apnea.
"I no longer will accept any contestant on the show without a sleep study," said Dr. Huizenga this week in an e-mail. "Even I, with a very high index of suspicion, would have missed multiple cases of OSA [without the sleep studies], putting contestants at risk for adverse health consequences and at a huge disadvantage for optimal fat loss."
At best, OSA means the person does not sleep well. As the base of the tongue and the uvula muscles relax during sleep, the airway can close and the person may stop breathing until his brain rouses him.
Affected individuals may never fully awaken, but they also never reach the most restful, deep sleep. They often wake up tired the next morning.
One contestant last season stopped breathing close to 140 times an hour. "He never had three minutes at one time that he had sleep," said Mrs. Minkley.
The same participant, in his early 30s, "was literally so tired that he would ask his wife to call him on the way to work, to keep him awake," she said. "They chalked that up to him being a hard worker. He didn't think it was normal, but he didn't think it was horrendous either."
At its worst, obstructive sleep apnea can be life-threatening. If for some reason, the person's startle response does not kick in -- whether due to severe fatigue or taking a sleep medication or having a couple of beers -- he or she may never wake up.
That's not counting the damage to the heart and other medical problems that might develop over time from lack of sleep.
Just this week, researchers at Johns Hopkins University linked sleep disorders with a significantly greater risk of death, particularly among men aged 40-70.
Once treated, either by a CPAP device or an oral appliance that moves the jaw forward during sleep, lots of good things can happen. Among Biggest Loser contestants using CPAP, said Dr. Huizenga, "We've seen fatigue and depression all the way to malignant hypertension or severe atrial fibrillation be instantly 'cured.'"
Mr. Payne said he'd noticed in the 25 years he'd been in the sleep business that once morbidly obese people with apnea get a good night's sleep, they seem to lose weight more quickly. That's why he was so eager to get involved in the study.
Both companies donated their services, to the tune of about $20,000 for Sleep Medicine Centers. Respironics officials would not disclose the value in equipment and salaries they provided.
"They see their ongoing relationship with the show as a unique opportunity to raise awareness and potentially reach millions of undiagnosed sufferers with an important message about OSA and the benefits of sleep therapy," said Respironics spokeswoman Tina Richardson.
The eighth season of "The Biggest Loser" premieres Sept. 15.
First Published August 20, 2009 12:00 am