Purpose Obesity is a reversible risk factor for obstructive sleep apnoea (OSA). Weight loss can potentially improve OSA by reducing fat around and within tissues surrounding the upper airway, but imaging studies are limited. Our aim was to study the effects of large amounts of weight loss on the upper airway and volume and fat content of multiple surrounding soft tissues. Methods Participants undergoing bariatric surgery were recruited. Magnetic resonance imaging (MRI) was performed at baseline and six-months after surgery. Volumetric analysis of the airway space, tongue, pharyngeal lateral walls, and soft palate were performed as well as calculation of intra-tissue fat content from Dixon imaging sequences. Results Among 18 participants (89% women), the group experienced 27.4 ± 4.7% reduction in body weight. Velopharyngeal airway volume increased (large effect; Cohen’s d [95% CI], 0.8 [0.1, 1.4]) and tongue (large effect; Cohen’s d [95% CI], − 1.4 [− 2.1, − 0.7]) and pharyngeal lateral wall (Cohen’s d [95% CI], − 0.7 [− 1.2, − 0.1]) volumes decreased. Intra-tissue fat decreased following weight loss in the tongue, tongue base, lateral walls, and soft palate. There was a greater effect of weight loss on intra-tissue fat than parapharyngeal fat pad volume (medium effect; Cohen’s d [95% CI], − 0.5 [− 1.2, 0.1], p = 0.083). Conclusion The study showed an increase in velopharyngeal volume, reduction in tongue volume, and reduced intra-tissue fat in multiple upper airway soft tissues following weight loss in OSA. Further studies are needed to assess the effect of these anatomical changes on upper airway function and its relationship to OSA improvement.
BACKGROUND Sleepiness is the most common symptom of obstructive sleep apnoea (OSA). Despite this the Epworth Sleepiness Score (ESS) has not been shown to predict OSA severity. We present the preliminary results of a cross-sectional analysis in OSA patients to examine the relationship between sleepiness and physical activity. METHODS Participants aged >18, with an AHI >5, and no other sleep disorders were included. Sleepiness was defined as an Epworth Sleepiness Score (ESS) of >10. Physical activity was defined as quartiles of Metabolic Equivalent of Task (MET) minutes derived from the International Physical Activity Questionnaire (IPAQ). PROGRESS TO DATE 593 participants were included (mean age 53.7, SD 14.4 years; 70.7% male; mean BMI 32.7, SD 8.5 kg/m2). 24.3% had ESS>=10 in the lowest quartile of physical activity, 28.2% in the 2nd quartile, 35.3% in the 3rd quartile and 30.2% in those with most activity. Controlling for OSA severity, gender, age or BMI, logistic regression showed increased sleepiness among participants in the 3rd quartile (3,147–6,426 MET-min/week) compared to the 1st quartile (<924 MET-min/week) with an odds ratio of 1.75 (95%CI 1.04–2.97). There was no interaction between OSA severity and physical activity. INTENDED IMPACT AND OUTCOME Preliminary results suggest increased sleepiness among participants exerting 3,147–6,426 MET-min/week compared to <924 MET-min/week. Further analysis will consider frequency and type of physical activity (in addition to energy expenditure), additional confounding variables (e.g. sedating medication) and alternate measures of sleepiness (e.g. FOSQ-10).
Background Recent population level data has identified specific symptom and polysomnographic profiles associated with development of cardiovascular disease (CVD) in obstructive sleep apnoea (OSA). Our aims were to determine whether these profiles were present at diagnosis of OSA in pre-existing CVD and high cardiovascular risk. Methods Participants in the Sydney Sleep Biobank (SSB) database, aged 30-74 years, self-reported presence of CVD (coronary artery disease, cerebrovascular disease, or heart failure). In those without CVD, the Framingham Risk Score (FRS) was calculated to estimate 10-year absolute CVD risk, categorised as “low” (<10%), “intermediate” (10-20%), or “high” (>20%). Groups were compared on symptom and polysomnographic variables. Progress to Date 629 patients (68% male; mean age 54.3 years (SD 11.6); mean BMI 32.3 (SD 8.2)) were included. CVD was reported in 12.2%. Of the remainder, 27.7% had a low risk FRS, 25.4% had intermediate risk and 34.7% had high risk. Insomnia symptoms of waking too early and difficulty maintaining sleep were more prevalent in the high FRS group (p=0.003 and p=0.05, respectively). CVD and FRS groups differed on multiple polysomnographic variables, however none of these differences remained significant after adjusting for age, sex, and BMI. Intended Outcome and Impact CVD and high CVD risk are associated with OSA on insomnia symptoms and multiple polysomnographic variables, however these associations are most likely due to demographic differences. Our research adds to the growing body of evidence elucidating the association between OSA and CVD. Further research is needed to translate to personalised management strategies.
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