The impact of pharyngeal fat tissue on the pathogenesis of obstructive sleep apnea

Pahkala, Riitta; Seppä, Juha; Ikonen, Aki; Смирнов, Г. А.; Tuomilehto, Henri

doi:10.1007/s11325-013-0878-4

Cited by 68 publications

(46 citation statements)

References 36 publications

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“…However, based on clinical series, mostly conducted in men, NC and WC seem to be more sensitive parameters than BMI for the prediction of OSA (Martinez-Rivera et al, 2008;Seidell, 2010). Furthermore, the amounts of adipose tissue adjacent to the pharyngeal airway and in the intraperitoneal space are directly associated with AHI but not with BMI (Liu et al, 2014;Pahkala, Seppä, Ikonen, Smirnov, & Tuomilehto, 2014;Shelton, Woodson, Gay, & Suratt, 1993). Despite this strong evidence, there is still wide discrepancy as to whether central obesity-related parameters better predict AHI variability in the general population and in clinical cohorts with a high suspicious of OSA.…”

Section: Discussionmentioning

confidence: 99%

Anthropometrical phenotypes are important when explaining obstructive sleep apnea in female bariatric cohorts

Gasa

López‐Padrós

Monasterio

et al. 2019

Journal of Sleep Research

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Central obesity is the main risk factor for obstructive sleep apnea (OSA). Whether there exists a central‐obesity anthropometric that better explains apnea–hypopnea index (AHI) variability in the general population and in sleep cohorts is unknown, and this is even less explored among increasing grades of obesity. The objective of the study is to investigate whether there is an anthropometric that better explains AHI variability in a sample of morbidly obese women awaiting bariatric surgery (BS). A prospective multicentre cross‐sectional study was conducted in consecutive women before BS. Demographic and anthropometric characteristics included age, body mass index (BMI), neck circumference (NC), waist circumference (WC), hip circumference (HC) and waist‐to‐hip ratio (WHR). OSA was diagnosed by polysomnography. The capacity of anthropometrics to explain AHI variance was investigated using regression linear models. A total of 115 women were evaluated: age, 44 ± 10 years; BMI, 46 ± 5 kg/m2; AHI, 35 ± 26 events/hr. AHI was associated with all anthropometrics except weight, height and HC. The best univariate predictor was WHR, which accounted for 15% of AHI variance. The simplest model (age + BMI) accounted for 9%, which increased to 20% when applying more complex measurements (age + BMI + NC + WC + HC). The explanatory capacity did not change significantly when applying a simpler model (age + WHR + NC, 19%). In this female morbidly obese cohort, anthropometrics explained one‐fifth of AHI variability. WHR is the best univariate parameter and models including waist and neck data provide more information than BMI when explaining AHI variability. Thus, even in young women with extreme obesity, OSA seems to be linked to a specific central‐obesity phenotype rather than to a whole‐obesity pattern.

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Section: Discussionmentioning

confidence: 99%

Anthropometrical phenotypes are important when explaining obstructive sleep apnea in female bariatric cohorts

Gasa

López‐Padrós

Monasterio

et al. 2019

Journal of Sleep Research

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“…Also, obesity may worsen OSA, because of fat deposition surrounding the upper airway. This appears to result in a smaller lumen and increased collapsibility of the upper airway, predisposing to apnea [35,36] . In 36 patients with OSA, Pahkala et al [36] demonstrated that in the early stages of OSA, the pharyngeal fat pad seems to play an important role in the development of disease in overweight patients.…”

Section: Weightmentioning

confidence: 99%

Predictive Success Factors in Selective Upper Airway Stimulation

Heiser

Hofauer²

2017

ORL

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Obstructive sleep apnea is one of the most common diseases in Western industrialized countries. A variety of conservative and surgical treatment options are available for its treatment. In recent years, selective upper airway stimulation (sUAS) has been shown to be effective and safe. Different biomarkers have been investigated as predictive clinical success factors in a number of clinical trials. Age does not matter in sUAS, as compared to its predictive role in other therapies. Weight seems to play a limited role, depending on drug-induced sleep endoscopy to rule out a complete concentric collapse with an increased body mass index. For surgical success and the related postoperative tongue motions, a nerve integrity monitoring methodology has been developed for predicting correct cuff placement. Postoperative sonography remains a promising method for the future assessment of predictive markers in sUAS.

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“…Because of increased fat deposition, overweight/obese individuals generally have a more collapsible airway than normal-weight individuals (4)(5)(6)(7)(8), yet the modest relationship between body mass index (BMI) and upper-airway collapsibility (3,9) indicates that some individuals gain weight without major upper-airway compromise.…”

mentioning

confidence: 99%

Enhanced Upper-Airway Muscle Responsiveness Is a Distinct Feature of Overweight/Obese Individuals without Sleep Apnea

Sands

Eckert

Jordan

et al. 2014

Am J Respir Crit Care Med

113

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Rationale: Body habitus is a major determinant of obstructive sleep apnea (OSA). However, many individuals do not have OSA despite being overweight/obese (body mass index . 25 kg/m 2 ) for reasons that are not fully elucidated.Objectives: To determine the key physiologic traits (upper-airway anatomy/collapsibility, upper-airway muscle responsiveness, chemoreflex control of ventilation, arousability from sleep) responsible for the absence of OSA in overweight/obese individuals.Methods: We compared key physiologic traits in 18 overweight/ obese subjects without apnea (apnea-hypopnea index , 15 events per hour) with 25 overweight/obese matched patients with OSA (apnea-hypopnea index > 15 events per hour) and 11 normal-weight nonapneic control subjects. Traits were measured by repeatedly lowering continuous positive airway pressure to subtherapeutic levels for 3 minutes during non-REM sleep.Measurements and Main Results: Overweight/obese subjects without apnea exhibited a less collapsible airway than overweight/ obese patients with apnea (critical closing pressure: 23.7 6 1.9 vs. 0.6 6 1.2 cm H 2 O; P = 0.003; mean 6 95% confidence interval), but a more collapsible airway relative to normal-weight control subjects (28.8 6 3.1 cm H 2 O; P , 0.001). Notably, overweight/obese subjects without apnea exhibited a threefold greater upper-airway muscle responsiveness than both overweight/obese patients with apnea (Dgenioglossus EMG/Depiglottic pressure: 20.49 [20.22 to 20.79] vs. 20.15 [20.09 to 20.22] %max/cm H 2 O; P = 0.008; mean [95% confidence interval]) and normal-weight control subjects (20.16 [20.04 to 20.30] %max/cm H 2 O; P = 0.02). Loop gain was elevated (more negative) in both overweight/obese groups and normal-weight control subjects (P = 0.02). Model-based analysis demonstrated that overweight/obese individuals without apnea rely on both more favorable anatomy and collapsibility and enhanced upper-airway dilator muscle responses to avoid OSA.Conclusions: Overweight/obese individuals without apnea have a moderately compromised upper-airway structure that is mitigated by highly responsive upper-airway dilator muscles to avoid OSA. Elucidating the mechanisms underlying enhanced muscle responses in this population may provide clues for novel OSA interventions.

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The impact of pharyngeal fat tissue on the pathogenesis of obstructive sleep apnea

Cited by 68 publications

References 36 publications

Anthropometrical phenotypes are important when explaining obstructive sleep apnea in female bariatric cohorts

Anthropometrical phenotypes are important when explaining obstructive sleep apnea in female bariatric cohorts

Predictive Success Factors in Selective Upper Airway Stimulation

Enhanced Upper-Airway Muscle Responsiveness Is a Distinct Feature of Overweight/Obese Individuals without Sleep Apnea

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