Pharyngeal Fat in Obstructive Sleep Apnea

Shelton, K.; Woodson, Harrell; Suratt, Paul M.

doi:10.1164/ajrccm/148.2.462

Cited by 393 publications

(253 citation statements)

References 16 publications

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“…Similar increased fat deposition in the neck may explain why, in our sample, men had larger neck circumferences than women at similar BMIs. Such fat deposition has been associated with the development of SAHS [20][21][22]. It is noteworthy that the differences in neck circumference between the sexes were similar at all body masses and that it was not merely that obese men had larger necks while thin men and women had similar neck sizes.…”

Section: Discussionmentioning

confidence: 99%

The effect of age, sex, obesity and posture on upper airway size

Martin¹,

Mathur²,

Marshall³

et al. 1997

Eur Respir J

282

166

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Most patients with sleep apnoea/hypopnoea syndrome (SAHS) are middle-aged men. As there are conflicting data on the effects of age and gender on upper airway calibre, we tested the hypothesis that increasing age and the male sex predispose to upper airway narrowing in normal subjects.We measured upper airway calibre using acoustic reflection in 60 men and 54 women (median 35, range 16-74 yrs) both seated and supine.All upper airway dimensions, except oropharyngeal junction (OPJ), decreased with increasing age in both men and women (r>-0.24, p≤0.05) while supine (r 2 >0.06). Men had greater changes in airway area at OPJ on lying down (mean (SEM) 0.5 (0.1), 0.2 (0.1) cm 2 ; p<0.02). Men had greater body mass indices (mean (SD) 26 (4), 24 (4) kg·m -2 ; p=0.04), and larger neck circumferences (mean (SD) 38 (3), 33 (2) cm; p<0.0001) than women. For any body mass index, neck circumference was larger in men than women (p<0.001).This study shows that upper airway size decreases with increasing age in both men and women, and that men have greater upper airway collapsibility on lying down at oropharyngeal junction than women. Eur Respir J 1997; 10: 2087-2090 The effects of age and gender on upper airway calibre are unclear. Clarification of their influences is important because the clinical condition associated with upper airway narrowing, the sleep apnoea/hypopnoea syndrome (SAHS), is predominantly a condition of middle-aged men [1]. BROOKS and STROHL [2] reported men to have larger upper airway calibre than women when seated and awake. Studies performed in the sitting position have indicated that upper airways resistance increases, and pharyngeal area decreases [3] with age in men but not in women. In contrast, computed tomography (CT) scan studies in supine men have shown no age-related increase in upper airway collapsibility in men [4]. In order to clarify this, we tested the hypothesis that increasing age and the male sex predispose to upper airway narrowing in the normal population. Methods SubjectsWe aimed to select a cross section of the local population and therefore recruited 60 male and 54 female subjects from the hospital workforce using an advertisement that did not refer to sleep. Their height, weight and neck circumference at the cricothyroid membrane were measured (table 1). Subjects were asked whether they snored and in which position, and whether they suffered from uncontrollable daytime sleepiness. Responses were noted but no one was excluded from the analysis as this was a population-based study. However, subjects with gross retrognathia were assessed clinically and excluded from the analysis. The study was approved by the local Ethics Advisory Committee.

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Section: Discussionmentioning

confidence: 99%

The effect of age, sex, obesity and posture on upper airway size

Martin¹,

Mathur²,

Marshall³

et al. 1997

Eur Respir J

282

166

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“…Obese subjects with OSA have a narrowed upper airway during wakefulness and an enlargement of the upper airway structures (4)(5)(6)(7)(8). Why obesity leads to altered upper airway structure and upper airway compromise is currently unknown.…”

Section: Discussionmentioning

confidence: 99%

“…We anticipated that the volume of the parapharyngeal fat pads would be greater in NZO mice than in leaner NZW mice, as was previously shown in obese human patients with OSA (6,7,25). It has also been shown that obese humans have fat infiltration of their tongue, which increases with the degree of obesity (26).…”

mentioning

confidence: 82%

“…Fat has also been described as infiltrating the soft palate in obese humans (28,29). Moreover, increased volume of the lateral pharyngeal walls has also been described in patients with OSA when compared with matched controls (7,30); although the role of fat in this enlargement is unknown. Thus, in addition to measuring the dimensions of the upper airway, we examined the size of key upper airway structures among obese NZO and lean NZW mice, specifically the volume of the parapharyngeal fat pads, tongue, soft palate, and lateral pharyngeal walls.…”

mentioning

confidence: 99%

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Altered Upper Airway and Soft Tissue Structures in the New Zealand Obese Mouse

Brennick¹,

Pack²,

Ko³

et al. 2009

Am J Respir Crit Care Med

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Rationale: The effect of obesity on upper airway soft tissue structure and size was examined in the New Zealand Obese (NZO) mouse and in a control lean mouse, the New Zealand White (NZW). Objectives: We hypothesized that the NZO mouse has increased volume of neck fat and upper airway soft tissues and decreased pharyngeal airway caliber. Methods: Pharyngeal airway size, volume of the upper airway soft tissue structures, and distribution of fat in the neck and body were measured using magnetic resonance imaging (MRI). Dynamic MRI was used to examine the differences in upper airway caliber between inspiration and expiration in NZO versus NZW mice. Measurements and Main Results:The data support the hypothesis that, in obese NZO versus lean NZW mice, airway caliber was significantly smaller (P , 0.03), with greater parapharyngeal fat pad volumes (P , 0.0001) and a greater volume of other upper airway soft tissue structures (tongue, P 5 0.003; lateral pharyngeal walls, P 5 0.01; soft palate, P 5 0.02). Dynamic MRI showed that the airway of the obese NZO mouse dilated during inspiration, whereas in the lean NZW mouse, the upper airway was reduced in size during inspiration. Conclusions: In addition to the increased volume of pharyngeal soft tissue structures, direct fat deposits within the tongue may contribute to airway compromise in obesity. Pharyngeal airway dilation during inspiration in NZO mice compared with narrowing in NZW mice suggests that airway compromise in obese mice may lead to muscle activation to defend upper airway patency during inspiration.

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“…However a corresponding weight loss can result in 20% more improvement in severity of sleep apnoea. Fat deposition nearby upper inhalation route in the tissue appears to result in an enlarged collapsibility of the upper passage and smaller the size of lumen predisposing to apnoea [9]. When fat deposition surrounds the thorax (trance obesity) it reduce functional remaining capacity, chest obedience and may need higher oxygen demand [10].…”

Section: Obesity Induced Sleep Apnoeamentioning

confidence: 99%

A Review on Obstructive Sleep Apnoea in Men

Khan¹

2017

J Mol Imaging Dynam

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Sleep apnoea occurs by the blockage of airway/airline when throat muscles relax and soft tissue near the throat collapses during sleep, so due to collapsing of soft tissue the chest muscles and diaphragm work tougher as the pressure generated to open the blocked air route, breathing/inhalation typically continues with a loud-gasp and body-jerk. It supply the poor flow of oxygen in to vital organs in the body, and produce heart rhythm irregularities. Sleep apnoea is the most common sleep issue, common in general population which affect 40-45% of all men on a regular basis. Sleep apnoea may be strongly connected with obesity and hypertension in men, affecting an individual quality of life.

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Pharyngeal Fat in Obstructive Sleep Apnea

Cited by 393 publications

References 16 publications

The effect of age, sex, obesity and posture on upper airway size

The effect of age, sex, obesity and posture on upper airway size

Altered Upper Airway and Soft Tissue Structures in the New Zealand Obese Mouse

A Review on Obstructive Sleep Apnoea in Men

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