The effect of surgical weight loss on upper airway fat in obstructive sleep apnoea

Abstract

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.

Association between obstructive sleep apnea and visceral adiposity index and lipid accumulation product: NHANES 2015–2018

“…This bidirectional relationship between OSA and obesity creates a vicious cycle where one condition exacerbates the other. Both conditions share common risk factors, including a sedentary lifestyle, poor dietary habits, and genetic predisposition, which further complicates their relationship [ 34 ].…”

Obstructive sleep apnoea in obesity: A review

“…44,53 Excess weight results in fat deposition and obstruction on multiple airway levels, likely reducing efficacy of mechanical and surgical therapies. 54 Hence, weight loss is also an important adjunct to enhance efficacy of other OSA treatments.…”

“…Obesity also predicts treatment failure with mandibular advancement splints and most studies on upper airway surgery excluded patients with BMI >40 44,53 . Excess weight results in fat deposition and obstruction on multiple airway levels, likely reducing efficacy of mechanical and surgical therapies 54 . Hence, weight loss is also an important adjunct to enhance efficacy of other OSA treatments.…”

Obstructive sleep apnea heterogeneity and autonomic function: a role for heart rate variability in therapy selection and efficacy monitoring

“…BMI is an independent predictor for OSA and AHI severity. Body fat distribution is also a critical component for obesity assessment of OSA (Sutherland, Smith, et al, 2023; Zhu et al, 2023). It has been noted that the degree of weight loss reduces respiratory events, with < 5% weight loss achieving this.…”