Enhanced Upper-Airway Muscle Responsiveness Is a Distinct Feature of Overweight/Obese Individuals without Sleep Apnea
Open accessAbstract
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/m2) 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: −3.7 ± 1.9 vs. 0.6 ± 1.2 cm H2O; P = 0.003; mean ± 95% confidence interval), but a more collapsible airway relative to normal-weight control subjects (−8.8 ± 3.1 cm H2O; P < 0.001). Notably, overweight/obese subjects without apnea exhibited a threefold greater upper-airway muscle responsiveness than both overweight/obese patients with apnea (Δgenioglossus EMG/Δepiglottic pressure: −0.49 [−0.22 to −0.79] vs. −0.15 [−0.09 to −0.22] %max/cm H2O; P = 0.008; mean [95% confidence interval]) and normal-weight control subjects (−0.16 [−0.04 to −0.30] %max/cm H2O; 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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Sands et al. showed that obese patients with OSA compared to those without OSA have worse pharyngeal collapsibility with less active pharyngeal muscle response.
“A study by Sands et al. showed that obese patients with OSA compared to those without OSA have worse pharyngeal collapsibility with less active pharyngeal muscle response.204”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [204]
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References 42 · Cited by 150
Research works printed but not linked: 2
- [7]7. Kim C, Jackson N, Marcus CL, Pien GW, Staley B, Sun Y, Wieland W, Schwab RJ. Relationship between upper airway collapsibility (pcrit) and pharyngeal structures [abstract]. Am J Respir Crit Care Med 2012;185:A2430.
- [37]37. Eckert DJ, Parikh S, White DP, Jordan AS, Merchia P, Malhotra A. Sleep deprivation impairs genioglossus muscle responsiveness [abstract]. Am J Respir Crit Care Med 2011;183:A6163.
- Authors
- Sands, S. A., Eckert, D. J., Jordan, A. S., Edwards, B. A., Owens, R. L., Butler, J. P., Schwab, R. J., Loring, S. H., Malhotra, A., White, D. P., & Wellman, A.
- Affiliations
- Brigham and Women's Hospital (US)
- University of Pennsylvania (US)
- Beth Israel Deaconess Medical Center (US)
- University of Southern California (US)
- Corresponding author
- Sands, Scott A.
- ORCID
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-10-01
- Volume
- 190
- Issue
- 8
- Pages
- 930-937
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- PMC
- PMC4299579
- OpenAlex
- W2049959832
- Semantic Scholar
- aa47255ab91c10a580670d344cabe56a5a97a577
- Cited by
- 150
- References
- 42
- Citations by year
- 2026: 15 · 2025: 10 · 2024: 16 · 2023: 12 · 2022: 18 · 2021: 8 · 2020: 8 · 2019: 11 · 2018: 12 · 2017: 12 · 2016: 16 · 2015: 10 · 2014: 1 · 2012: 1
- FWCI
- 8.64
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Monash University Research Portal (Monash University) (submittedVersion, other-oa)
- UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
- eScholarship (California Digital Library) (submittedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- Funders
- American Heart Association
- National Institutes of Health (7k24hl093218-06, 5r01hl090897-02)
- Medical Research Council
- National Health and Medical Research Council (1035115, 1053201, 1049814)
- National Heart, Lung, and Blood Institute (R01-HL090897, P01HL095491, K24 HL-093218, R01HL085188, 1R01HL090897-01A2, 1K24HL093218-01A1, R01HL048531, R01HL102321)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- obstructive sleep apnea, obesity, upper airway collapsibility, critical closing pressure, loop gain, arousability, body build, airway anatomy, sleep-disordered breathing, continuous positive airway pressure, NREM sleep
- MeSH terms
- Adult, Aged, Female, Humans, Male, Middle Aged, Models, Biological, Muscle, Smooth, Obesity, Pharynx, Respiratory Function Tests, Sleep Stages, Case-Control Studies, Polysomnography, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure, Overweight
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