{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:48:18Z","timestamp":1792511298553,"version":"4.5.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2022,10,27]],"date-time":"2022-10-27T00:00:00Z","timestamp":1666828800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,10,27]],"date-time":"2022-10-27T00:00:00Z","timestamp":1666828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001774","name":"University of Sydney","doi-asserted-by":"publisher","award":["Kickstart grant"],"award-info":[{"award-number":["Kickstart grant"]}],"id":[{"id":"10.13039\/501100001774","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001774","name":"University of Sydney","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001774","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sleep Breath"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Obesity is a reversible risk factor for obstructive sleep apnoea (OSA). Weight loss can potentially improve OSA by reducing fat around and within tissues surrounding the upper airway, but imaging studies are limited. Our aim was to study the effects of large amounts of weight loss on the upper airway and volume and fat content of multiple surrounding soft tissues.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Participants undergoing bariatric surgery were recruited. Magnetic resonance imaging (MRI) was performed at baseline and six-months after surgery. Volumetric analysis of the airway space, tongue, pharyngeal lateral walls, and soft palate were performed as well as calculation of intra-tissue fat content from Dixon imaging sequences.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Among 18\u00a0participants\u00a0(89% women), the group experienced 27.4\u2009\u00b1\u20094.7% reduction in body weight. Velopharyngeal airway volume increased (large effect; Cohen\u2019s d [95% CI], 0.8 [0.1, 1.4]) and tongue (large effect; Cohen\u2019s d [95% CI],\u2009\u2212\u20091.4 [\u2212\u20092.1,\u2009\u2212\u20090.7]) and pharyngeal lateral wall (Cohen\u2019s d [95% CI],\u2009\u2212\u20090.7 [\u2212\u20091.2,\u2009\u2212\u20090.1]) volumes decreased. Intra-tissue fat decreased following weight loss in the tongue, tongue base, lateral walls, and soft palate. There was a greater effect of weight loss on intra-tissue fat than parapharyngeal fat pad volume (medium effect; Cohen\u2019s d [95% CI],\u2009\u2212\u20090.5 [\u2212\u20091.2, 0.1], <jats:italic>p<\/jats:italic>\u2009=\u20090.083).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The study showed an increase in velopharyngeal volume, reduction in tongue volume, and reduced intra-tissue fat in multiple upper airway soft tissues following weight loss in OSA. Further studies are needed to assess the effect of these anatomical changes on upper airway function and its relationship to OSA improvement.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11325-022-02734-8","type":"journal-article","created":{"date-parts":[[2022,10,27]],"date-time":"2022-10-27T14:06:20Z","timestamp":1666879580000},"page":"1333-1341","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["The effect of surgical weight loss on upper airway fat in obstructive sleep apnoea"],"prefix":"10.1007","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6106-7303","authenticated-orcid":false,"given":"Kate","family":"Sutherland","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garett","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimee B.","family":"Lowth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Sarkissian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Liebman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart M.","family":"Grieve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7920-4924","authenticated-orcid":false,"given":"Peter A.","family":"Cistulli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,10,27]]},"reference":[{"issue":"8","key":"2734_CR1","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/S2213-2600(19)30198-5","volume":"7","author":"AV Benjafield","year":"2019","unstructured":"Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ et al (2019) Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 7(8):687\u2013698. https:\/\/doi.org\/10.1016\/S2213-2600(19)30198-5","journal-title":"Lancet Respir Med"},{"issue":"1","key":"2734_CR2","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1093\/sleep\/24.1.96","volume":"24","author":"CM Baldwin","year":"2001","unstructured":"Baldwin CM, Griffith KA, Nieto FJ, O\u2019Connor GT, Walsleben JA, Redline S (2001) The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. Sleep 24(1):96\u2013105. https:\/\/doi.org\/10.1093\/sleep\/24.1.96","journal-title":"Sleep"},{"issue":"6","key":"2734_CR3","doi-asserted-by":"publisher","first-page":"573","DOI":"10.5664\/jcsm.27662","volume":"5","author":"S Tregear","year":"2009","unstructured":"Tregear S, Reston J, Schoelles K, Phillips B (2009) Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis. J Clin Sleep Med 5(6):573\u2013581","journal-title":"J Clin Sleep Med"},{"issue":"12","key":"2734_CR4","doi-asserted-by":"publisher","first-page":"e013983","DOI":"10.1136\/bmjopen-2016-013983","volume":"7","author":"C Xie","year":"2017","unstructured":"Xie C, Zhu R, Tian Y, Wang K (2017) Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality: a meta-analysis. BMJ Open 7(12):e013983. https:\/\/doi.org\/10.1136\/bmjopen-2016-013983","journal-title":"BMJ Open"},{"key":"2734_CR5","doi-asserted-by":"publisher","unstructured":"Hudgel DW, Patel SR, Ahasic AM, Bartlett SJ, Bessesen DH, Coaker MA et al. (2018) The role of weight management in the treatment of adult obstructive sleep apnea. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 198(6):e70-e87. https:\/\/doi.org\/10.1164\/rccm.201807-1326ST","DOI":"10.1164\/rccm.201807-1326ST"},{"issue":"6","key":"2734_CR6","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1016\/j.amjmed.2008.10.037","volume":"122","author":"DL Greenburg","year":"2009","unstructured":"Greenburg DL, Lettieri CJ, Eliasson AH (2009) Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. Am J Med 122(6):535\u2013542. https:\/\/doi.org\/10.1016\/j.amjmed.2008.10.037","journal-title":"Am J Med"},{"key":"2734_CR7","doi-asserted-by":"crossref","unstructured":"Sutherland K, Chapman JL, Cayanan EA, A.B. L, Hoyos CM, Wong KKH et al. (2020) Does craniofacial morphology relate to sleep apnea severity reduction following weight loss intervention? A patient level meta-analysis. Sleep","DOI":"10.1093\/sleep\/zsaa207"},{"issue":"1","key":"2734_CR8","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1111\/j.1440-1843.2011.02093.x","volume":"17","author":"S Isono","year":"2012","unstructured":"Isono S (2012) Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway. Respirology 17(1):32\u201342. https:\/\/doi.org\/10.1111\/j.1440-1843.2011.02093.x","journal-title":"Respirology"},{"key":"2734_CR9","doi-asserted-by":"publisher","unstructured":"Schwartz AR, Patil SP, Squier S, Schneider H, Kirkness JP, Smith PL. (2010) Obesity and upper airway control during sleep. J Appl Physiol (1985) 108(2):430\u20135. https:\/\/doi.org\/10.1152\/japplphysiol.00919.2009","DOI":"10.1152\/japplphysiol.00919.2009"},{"key":"2734_CR10","doi-asserted-by":"publisher","unstructured":"Kairaitis K, Howitt L, Wheatley JR, Amis TC (2009) Mass loading of the upper airway extraluminal tissue space in rabbits: effects on tissue pressure and pharyngeal airway lumen geometry. J Appl Physiol (1985) 106(3):887\u201392. https:\/\/doi.org\/10.1152\/japplphysiol.91236.2008","DOI":"10.1152\/japplphysiol.91236.2008"},{"issue":"9","key":"2734_CR11","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1136\/thx.2010.151613","volume":"66","author":"K Sutherland","year":"2011","unstructured":"Sutherland K, Lee RW, Phillips CL, Dungan G, Yee BJ, Magnussen JS et al (2011) Effect of weight loss on upper airway size and facial fat in men with obstructive sleep apnoea. Thorax 66(9):797\u2013803. https:\/\/doi.org\/10.1136\/thx.2010.151613","journal-title":"Thorax"},{"key":"2734_CR12","doi-asserted-by":"publisher","unstructured":"Wang SH, Keenan BT, Wiemken A, Zang Y, Staley B, Sarwer DB et al. (2020) Effect of weight loss on upper airway anatomy and the apnea-hypopnea index. The Importance of Tongue Fat. Am J Respir Crit Care Med 201(6):718\u201327. https:\/\/doi.org\/10.1164\/rccm.201903-0692OC","DOI":"10.1164\/rccm.201903-0692OC"},{"issue":"8","key":"2734_CR13","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1136\/thx.2009.131094","volume":"65","author":"AS Chan","year":"2010","unstructured":"Chan AS, Sutherland K, Schwab RJ, Zeng B, Petocz P, Lee RW et al (2010) The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax 65(8):726\u2013732. https:\/\/doi.org\/10.1136\/thx.2009.131094","journal-title":"Thorax"},{"issue":"3","key":"2734_CR14","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1002\/jmri.21492","volume":"28","author":"J Ma","year":"2008","unstructured":"Ma J (2008) Dixon techniques for water and fat imaging. J Magn Reson Imaging 28(3):543\u2013558. https:\/\/doi.org\/10.1002\/jmri.21492","journal-title":"J Magn Reson Imaging"},{"issue":"9","key":"2734_CR15","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1016\/j.mri.2012.05.001","volume":"30","author":"A Fedorov","year":"2012","unstructured":"Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin JC, Pujol S et al (2012) 3D Slicer as an image computing platform for the Quantitative Imaging Network. Magn Reson Imaging 30(9):1323\u20131341. https:\/\/doi.org\/10.1016\/j.mri.2012.05.001","journal-title":"Magn Reson Imaging"},{"key":"2734_CR16","doi-asserted-by":"publisher","first-page":"613","DOI":"10.3389\/fbioe.2020.00613","volume":"8","author":"A D'Souza","year":"2020","unstructured":"D\u2019Souza A, Bolsterlee B, Herbert RD (2020) Intramuscular fat in the medial gastrocnemius muscle of people who have had a stroke. Front Bioeng Biotechnol 8:613. https:\/\/doi.org\/10.3389\/fbioe.2020.00613","journal-title":"Front Bioeng Biotechnol"},{"issue":"1036","key":"2734_CR17","doi-asserted-by":"publisher","first-page":"20130761","DOI":"10.1259\/bjr.20130761","volume":"87","author":"JJ Noble","year":"2014","unstructured":"Noble JJ, Keevil SF, Totman J, Charles-Edwards GD (2014) In vitro and in vivo comparison of two-, three- and four-point Dixon techniques for clinical intramuscular fat quantification at 3 T. Br J Radiol 87(1036):20130761. https:\/\/doi.org\/10.1259\/bjr.20130761","journal-title":"Br J Radiol"},{"key":"2734_CR18","unstructured":"Lenhard W, Lenhard A (2016) Berechnung von Effektst\u00e4rken [Calculation of effect sizes]. Dettelbach: Psychometrica Available online at: https:\/\/wwwpsychometrica.de\/effektstaerke.html (accessed February 15, 2020)"},{"issue":"7","key":"2734_CR19","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.4187\/respcare.00929","volume":"57","author":"Y Li","year":"2012","unstructured":"Li Y, Lin N, Ye J, Chang Q, Han D, Sperry A (2012) Upper airway fat tissue distribution in subjects with obstructive sleep apnea and its effect on retropalatal mechanical loads. Respir Care 57(7):1098\u20131105. https:\/\/doi.org\/10.4187\/respcare.00929","journal-title":"Respir Care"},{"issue":"1","key":"2734_CR20","doi-asserted-by":"publisher","first-page":"17722","DOI":"10.1038\/s41598-019-53515-5","volume":"9","author":"HC Chen","year":"2019","unstructured":"Chen HC, Wang CJ, Lo YL, Hsu HC, Huang CG, Kuo IC et al (2019) Parapharyngeal fat pad area at the subglosso-supraglottic level is associated with corresponding lateral wall collapse and apnea-hypopnea index in patients with obstructive sleep apnea: a pilot study. Sci Rep 9(1):17722. https:\/\/doi.org\/10.1038\/s41598-019-53515-5","journal-title":"Sci Rep"},{"issue":"2","key":"2734_CR21","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1007\/s11325-013-0878-4","volume":"18","author":"R Pahkala","year":"2014","unstructured":"Pahkala R, Seppa J, Ikonen A, Smirnov G, Tuomilehto H (2014) The impact of pharyngeal fat tissue on the pathogenesis of obstructive sleep apnea. Sleep Breath 18(2):275\u2013282. https:\/\/doi.org\/10.1007\/s11325-013-0878-4","journal-title":"Sleep Breath"},{"issue":"11","key":"2734_CR22","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1164\/rccm.201408-1498LE","volume":"190","author":"MS Jang","year":"2014","unstructured":"Jang MS, Kim HY, Dhong HJ, Chung SK, Hong SD, Cho HJ et al (2014) Effect of parapharyngeal fat on dynamic obstruction of the upper airway in patients with obstructive sleep apnea. Am J Respir Crit Care Med 190(11):1318\u20131321. https:\/\/doi.org\/10.1164\/rccm.201408-1498LE","journal-title":"Am J Respir Crit Care Med"},{"issue":"8","key":"2734_CR23","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1096\/fasebj.10.8.8666167","volume":"10","author":"F Series","year":"1996","unstructured":"Series F, Cote C, Simoneau JA, St Pierre S, Marc I (1996) Upper airway collapsibility, and contractile and metabolic characteristics of musculus uvulae. FASEB J 10(8):897\u2013904. https:\/\/doi.org\/10.1096\/fasebj.10.8.8666167","journal-title":"FASEB J"},{"key":"2734_CR24","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.sleep.2016.01.022","volume":"21","author":"H Chen","year":"2016","unstructured":"Chen H, Aarab G, de Ruiter MH, de Lange J, Lobbezoo F, van der Stelt PF (2016) Three-dimensional imaging of the upper airway anatomy in obstructive sleep apnea: a systematic review. Sleep Med 21:19\u201327. https:\/\/doi.org\/10.1016\/j.sleep.2016.01.022","journal-title":"Sleep Med"},{"issue":"12","key":"2734_CR25","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1016\/j.ijom.2010.09.007","volume":"39","author":"SM Susarla","year":"2010","unstructured":"Susarla SM, Thomas RJ, Abramson ZR, Kaban LB (2010) Biomechanics of the upper airway: changing concepts in the pathogenesis of obstructive sleep apnea. Int J Oral Maxillofac Surg 39(12):1149\u20131159. https:\/\/doi.org\/10.1016\/j.ijom.2010.09.007","journal-title":"Int J Oral Maxillofac Surg"},{"issue":"10","key":"2734_CR26","doi-asserted-by":"publisher","first-page":"1388","DOI":"10.1164\/rccm.2112072","volume":"166","author":"A Malhotra","year":"2002","unstructured":"Malhotra A, Huang Y, Fogel RB, Pillar G, Edwards JK, Kikinis R et al (2002) The male predisposition to pharyngeal collapse: importance of airway length. Am J Respir Crit Care Med 166(10):1388\u20131395. https:\/\/doi.org\/10.1164\/rccm.2112072","journal-title":"Am J Respir Crit Care Med"},{"issue":"2","key":"2734_CR27","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1164\/ajrccm\/146.2.335","volume":"146","author":"CD Burger","year":"1992","unstructured":"Burger CD, Stanson AW, Daniels BK, Sheedy PF 2nd, Shepard JW Jr (1992) Fast-CT evaluation of the effect of lung volume on upper airway size and function in normal men. Am Rev Respir Dis 146(2):335\u2013339. https:\/\/doi.org\/10.1164\/ajrccm\/146.2.335","journal-title":"Am Rev Respir Dis"},{"key":"2734_CR28","doi-asserted-by":"publisher","unstructured":"Owens RL, Malhotra A, Eckert DJ, White DP, Jordan AS (2010) The influence of end-expiratory lung volume on measurements of pharyngeal collapsibility. J Appl Physiol (1985) 108(2):445\u201351. https:\/\/doi.org\/10.1152\/japplphysiol.00755.2009","DOI":"10.1152\/japplphysiol.00755.2009"},{"issue":"4","key":"2734_CR29","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1093\/sleep\/33.4.467","volume":"33","author":"L Simpson","year":"2010","unstructured":"Simpson L, Mukherjee S, Cooper MN, Ward KL, Lee JD, Fedson AC et al (2010) Sex differences in the association of regional fat distribution with the severity of obstructive sleep apnea. Sleep 33(4):467\u2013474. https:\/\/doi.org\/10.1093\/sleep\/33.4.467","journal-title":"Sleep"}],"container-title":["Sleep and Breathing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11325-022-02734-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11325-022-02734-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11325-022-02734-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T13:08:23Z","timestamp":1692104903000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11325-022-02734-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,27]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["2734"],"URL":"https:\/\/doi.org\/10.1007\/s11325-022-02734-8","relation":{},"ISSN":["1520-9512","1522-1709"],"issn-type":[{"value":"1520-9512","type":"print"},{"value":"1522-1709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,27]]},"assertion":[{"value":"22 June 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 September 2022","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 October 2022","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 October 2022","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed were in accordance with the ethical standards of the institutional research committee (Northern Sydney Local Health District Human Research Ethics Committee; protocol number HREC\/15\/HAWKE\/386) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}