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Obstructive sleep apnea (OSA) is a serious sleep-related breathing disorder that affects more than 22 million Americans. Patients with this condition report multiple cessations of breathing during the night, which can severely impact sleep quality. The most common symptom is snoring, and people with sleep apnea also experience daytime fatigue frequently. The condition is not to go lightly about since it can lead to increased blood pressure, heart problems, and stroke.

It has been known that obesity is one of the main risk factors for developing sleep apnea, and when you consider that more than 70% of adults in the US are overweight, the situation is alarming. Standard treatment options for sleep apnea include continuous positive air pressure (CPAP) treatment and weight loss. However, CPAP is not always effective, and weight loss only seems to work in some instances.

That is why scientists from the University of Pennsylvania’s School of Medicine looked into the mechanisms in which weight loss improved sleep apnea symptoms.

Their 2019 study used magnetic resonance imaging of upper airways to measure the effects of weight loss on OSA symptoms. They found out that weight loss leads to reduced tongue fat, which was the strongest impact on decreasing the severity of OSA.

The findings were published in the American Journal of Respiratory and Critical Care Medicine, and their results could have a significant impact on future treatment of sleep apnea. Since we now know what the primary reason for airway obstruction is, we can find ways to target it and lose tongue fat more efficiently.

One of the co-authors MD Richard Shwab led a previous study where he compared obese people with and without OSA. He already determined that patients who had OSA also had significantly larger tongues. The next logical step would be to assess how reducing tongue fat would affect OSA symptoms, which is precisely what this new study does.

The study included 67 obese participants with mild to severe sleep apnea. During a six month intervention, participants underwent diet adjustment or weight loss surgery which resulted in a 10% bodyweight reduction on average. Sleep study after the weight loss intervention showed that patients’ sleep apnea score improved by 31%.

And with MRI scans, researchers were able to locate the exact upper airway changes that led to this decrease of OSA symptoms. Tongue fat loss was the number one predictor of improvement, but also loss of soft tissue, reduced jaw muscles, as well as decreased muscle size on the sides of the airway all improved sleep apnea.

These findings could help us create an effective way of reducing tongue fat either through surgical procedures or possibly special diets that target fat loss in this area. These interventions are yet to be tested.

Shwab’s team is also interested in whether people who aren’t overweight but have fatty tongues could be predisposed to developing OSA. They think that because they have an average body mass index, they are less likely to get the right diagnosis, which poses a threat to their health. Their future research should shed some more light on this issue and help us get the most effective sleep apnea treatment.

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