Tongue Fat and its Relationship to Obstructive Sleep Apnea

Kim, Andrew M.; Keenan, Brendan T.; Jackson, Nicholas; Chan, Eugenia L.; Staley, Bethany; Poptani, Harish; Torigian, Drew A.; Pack, Allan I.; Schwab, Richard J.

doi:10.5665/sleep.4072

Cited by 285 publications

(231 citation statements)

References 42 publications

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“…Obesity can crowd the upper airway via deposition of adipose tissue in regions surrounding the airway. Recent evidence obtained using MRI suggests that many people with OSA have increased fat within their tongues compared to equally obese people without OSA [42][43][44]. Additionally, reduced tongue stiffness may contribute to increase upper airway collapsibility [45].…”

Section: Upper Airway Anatomymentioning

confidence: 99%

Personalised medicine in sleep respiratory disorders: focus on obstructive sleep apnoea diagnosis and treatment

et al. 2017

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In all fields of medicine, major efforts are currently dedicated to improve the clinical, physiological and therapeutic understanding of disease, and obstructive sleep apnoea (OSA) is no exception. The personalised medicine approach is relevant for OSA, given its complex pathophysiology and variable clinical presentation, the interactions with comorbid conditions and its possible contribution to poor outcomes. Treatment with continuous positive airway pressure (CPAP) is effective, but CPAP is poorly tolerated or not accepted in a considerable proportion of OSA patients. This review summarises the available studies on the physiological phenotypes of upper airway response to obstruction during sleep, and the clinical presentations of OSA ( phenotypes and clusters) with a special focus on our changing attitudes towards approaches to treatment. Such major efforts are likely to change and expand treatment options for OSA beyond the most common current choices (i.e. CPAP, mandibular advancement devices, positional treatment, lifestyle changes or upper airway surgery). More importantly, treatment for OSA may become more effective, being tailored to each patient's need.

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Section: Upper Airway Anatomymentioning

confidence: 99%

Personalised medicine in sleep respiratory disorders: focus on obstructive sleep apnoea diagnosis and treatment

et al. 2017

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“…ORIGINAL ARTICLE control subjects (5,45). One untested possibility is that adipose cells are deposited within lymphoid tissue in obese adolescents with OSAS.…”

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confidence: 99%

Understanding the Anatomic Basis for Obstructive Sleep Apnea Syndrome in Adolescents

Schwab

Kim

Bagchi

et al. 2015

Am J Respir Crit Care Med

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Rationale: Structural risk factors for obstructive sleep apnea syndrome (OSAS) in adolescents have not been well characterized. Because many adolescents with OSAS are obese, we hypothesized that the anatomic OSAS risk factors would be more similar to those in adults than those in children.Objectives: To investigate the anatomic risk factors in adolescents with OSAS compared with obese and lean control subjects using magnetic resonance imaging (MRI).Methods: Three groups of adolescents (age range: 12-16 yr) underwent MRI: obese individuals with OSAS (n = 49), obese control subjects (n = 38), and lean control subjects (n = 50). Measurements and Main Results:We studied 137 subjects and found that (1) obese adolescents with OSAS had increased adenotonsillar tissue compared with obese and lean control subjects; (2) obese OSAS adolescents had a smaller nasopharyngeal airway than control subjects; (3) the size of other upper airway soft tissue structures (volume of the tongue, parapharyngeal fat pads, lateral walls, and soft palate) was similar between subjects with OSAS and obese control subjects; (4) although there were no major craniofacial abnormalities in most of the adolescents with OSAS, the ratio of soft tissue to craniofacial space surrounding the airway was increased; and (5) there were sex differences in the pattern of lymphoid proliferation.Conclusions: Increased size of the pharyngeal lymphoid tissue, rather than enlargement of the upper airway soft tissue structures, is the primary anatomic risk factor for OSAS in obese adolescents. These results are important for clinical decision making and suggest that adenotonsillectomy should be considered as the initial treatment for OSAS in obese adolescents, a group that has poor continuous positive airway pressure adherence and difficulty in achieving weight loss.Keywords: adenoid; adolescents; MRI; obstructive sleep apnea syndrome; tonsils The obstructive sleep apnea syndrome (OSAS) is common in children and adults, but it has not been well studied in adolescents. In one study, researchers reported the prevalence of OSAS in adolescents to be 2% (1), but the prevalence is probably higher in the United States because of the adolescent obesity epidemic (2). OSAS in children is thought to be secondary to a combination of enlargement of the lymphoid tissue (tonsils and adenoid) (3) and, sometimes, obesity, as well as to reductions in neuromuscular tone (4). In adults, there are known anatomic risk factors for OSAS, including enlargement of the tongue, soft palate, parapharyngeal fat pads, and lateral pharyngeal walls (5) in conjunction with craniofacial restriction (retrognathia) (6). In addition to anatomic factors, physiologic mechanisms increase OSAS risk in both children and adults (7-12). Although these risk factors for OSAS have been well described in children and adults, few Supported by grants from the National Institutes of Health (R01 HL058585, R01 HL089447, and P01 HL094307).Author Contributions: Conception and design: R.J.S., R.M.B., S.H., and C.L...

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“…Supõe-se que o acúmulo de gordura intramuscular deve alterar a forma e reduzir a força de contração, alterando a maneira como a língua atua como dilatador da faringe. [33] 1.3.1 Imagens de Ressonância Magnética (RM)…”

Section: Anatomia Da Vasunclassified

“…Além disso, os mecanismos pelo qual essa nova terapêutica [22][25] atua não estão esclarecidos. A anatomia avaliada por meio de imagens de ressonância magnética (RM) demonstrou grande quantidade de gordura na língua [33] e especula-se modificações nas estruturas da via aérea superior (VAS) e provavelmente na quantidade de gordura da língua. Na fisiologia da VAS especificamente em relação a língua (força e fadiga) observa-se aumento da força e redução do tempo da fadiga nos sujeitos com AOS e espera-se um aumento do tempo de fadiga da musculatura após a TMO.…”

Section: Fatores Neuromuscularesunclassified

Efeitos da terapia miofuncional orofacial em pacientes com ronco primário e apneia obstrutiva do sono na anatomia e função da via aérea

Kayamori¹

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Tongue Fat and its Relationship to Obstructive Sleep Apnea

Abstract: There is increased tongue volume and deposition of fat at the base of tongue in apneics compared to controls. Increased tongue fat may begin to explain the relationship between obesity and obstructive sleep apnea.

Cited by 285 publications

References 42 publications

Personalised medicine in sleep respiratory disorders: focus on obstructive sleep apnoea diagnosis and treatment

Personalised medicine in sleep respiratory disorders: focus on obstructive sleep apnoea diagnosis and treatment

Understanding the Anatomic Basis for Obstructive Sleep Apnea Syndrome in Adolescents

Efeitos da terapia miofuncional orofacial em pacientes com ronco primário e apneia obstrutiva do sono na anatomia e função da via aérea

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