ORIGINAL RESEARCH article
Front. Physiol.
Sec. Respiratory Physiology and Pathophysiology
Volume 16 - 2025 | doi: 10.3389/fphys.2025.1648767
This article is part of the Research TopicThe Promise of Sleep TechnologyView all 8 articles
The impact of obesity on upper airway anatomy as assessed by magnetic resonance imaging and obstructive sleep apnea endotypic traits
Provisionally accepted
Brandon Nokes1,2*
Aaron Schueler1
Chantal Darquenne1
Christopher Schmickl1Brian Wojeck3Stacie Moore1Pamela Deyoung1
Lana Mcginnis1Rebecca J Theilmann1
Eli Gruenberg1
Eduardo Grunvald1Breanna M Holloway1
Raichel Mary Alex4Scott Sands4Peter Colvonen1,2Robert L Owens1Atul Malhotra1- 1University of California, San Diego, La Jolla, United States
- 2VA San Diego Healthcare System, San Diego, United States
- 3Yale School of Medicine, New Haven, United States
- 4Brigham and Women's Hospital Department of Medicine, Boston, United States
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Introduction Obesity is an important risk factor for obstructive sleep apnea (OSA) development. Likewise, obesity management is an important component of OSA treatment. We sought to evaluate the OSA endotypes as well as upper airway anatomy, using magnetic resonance imaging (MRI) in patients referred from a bariatric surgery clinic. Methods The SLIM-OSA trial (NCT04793334; IRB#191948) seeks to elucidate the mechanisms for why weight loss improves OSA in some but not all individuals. Participants underwent baseline research polysomnography. Six months following sleeve gastrectomy for those who underwent surgery, polysomnography was repeated. A subset of these individuals also completed upper airway magnetic resonance imaging (MRI). We evaluated relationships between upper airway anatomy and endotypic traits. Results Of 55 individuals undergoing baseline studies, 22 completed upper airway MRI and polysomnography at baseline, with 5 individuals returning for MRI and polysomnography after sleeve gastrectomy. The study population was 86.4% female, with a mean age of 41.7 (11) years and median AHI of 11/h [IQR 2, 33]. Upper airway length was strongly associated with apnea hypopnea index (AHI), hypoxic burden, and ventilatory burden; somewhat surprisingly, tongue fat percentage was not associated with AHI. Conclusion The relationship between obesity and OSA is complex and likely evolves through multiple mechanistic avenues. These findings may help inform future mechanistic studies aimed at understanding the heterogeneous impact of weight loss on OSA outcomes.
Keywords: osa, Obesity, MRI, Endotype, Endotypes, upper airway
Received: 25 Jun 2025; Accepted: 28 Aug 2025.
Copyright: © 2025 Nokes, Schueler, Darquenne, Schmickl, Wojeck, Moore, Deyoung, Mcginnis, Theilmann, Gruenberg, Grunvald, Holloway, Alex, Sands, Colvonen, Owens and Malhotra. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Brandon Nokes, University of California, San Diego, La Jolla, United States
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