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A reader writes:

Here's one example of someone who is a lean, muscular, fit apnea patient: Percy Harvin of the Minnesota Vikings.  Mr. Harvin apparently was suffering from severe migraines that affected his ability to perform on the field.  He's listed at 5-11, 184 lbs. and is one of the fastest players in the NFL. I have no doubt that weight can contribute to sleep apnea.  However, as Mr. Harvin's experience demonstrates, there are plenty of other causes.

Another writes:

One reader commented that surely diet and exercise would be the most effective way to treat sleep apnea, since it is so often caused by obesity. Not true on several counts.

A fairly overweight aquaintance of mine was diagnosed with sleep apnea after she put on even more weight. Her lack of sleep caused her not only to gain weight, but her perpetual exhaustion prompted more eating, in the hopes that food would give her more energy to get through the day. Such a recursive loop of exhausting/eating/weight gain/exhaustion would not be effectively treated by "losing weight." And anyway, when has losing weight through diet and exercise ever been easy? I would posit that a CPAP would potentially make it easier.

Another:

A reader asserted: DSC00610

Ok, I'm thinking sleep apnea is another self inflicted wound of fat America. If readers differ, please send pictures of skinny apnea patients wearing masks.

You dissented.

Just to back you up, here I am.  I have a 22.4 BMI, a normal-width neck, large-ish tonsils (not near large enough for it to be the cause), and no diabetes.  Of course those things (and age) are risk factors.  Sometimes it just happens!

Another:

I don't have a photo of myself with the mask on, but I'm 5' 10" and weigh 160 lb. I'm in my late twenties, eat a low-fat diet, and get 40-60 minutes of exercise 5-6 times each week. I also have sleep apnea and a CPAP. The most important benefit of my CPAP is that I have the energy to work out regularly and cook healthy food at home, which creates a virtuous cycle making it easier for me to stay fit and sleep well.

When I send my CPAP through the airport scanner, the TSA usually asks someone in front of me or behind me who is older or heavier if my machine can be swabbed for explosives. And they sometimes look surprised when I tell them it's my device. So not everybody with sleep apnea is fat or old, but enough people are that the TSA engages in a little profiling to speed things along.

I agree with your reader that America is too fat. But if I had not gotten the CPAP at 23, I might have gotten fat in middle age and been diagnosed at 53. It would have been fat caused by the *lack of* treatment, and not treatment necessitated by fat. Data is not the plural of anecdote, but correlation isn't causation, either.

Another:

I'm really finding this thread interesting. Part of the reason it took me so long to get checked out for a CPAP was that I, like your reader, thought apnea was mainly an affliction of the overweight. I'm 5-11, 190 lbs, and although that puts me at sort of a high BMI, I run 40-50 miles a week and just finished my third marathon in about a year. My body fat is somewhere around 15%. So I wouldn't send in a photo of myself as a skinny CPAP user, but I'm not a fat one, either.

(Photo: Percy Harvin #12 of the Minnesota Vikings hangs his head during a break in NFL game action against the Pittsburgh Steelers at Heinz Field on October 25, 2009 in Pittsburgh, Pennsylvania. By Rick Stewart/Getty Images)

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