Sleep apnea is a common disorder with significant morbidity that affects at least 4% of middle-aged males and 2% of middle-aged females. Obesity is thought to be the most important risk factor for obstructive sleep apnea yet we do not understand how obesity predisposes to sleep apnea. Not all obese subjects have sleep apnea. The focus of this proposal is directed towards understanding the relationship between obesity and obstructive sleep apnea by examining tissue properties and the biologic behavior of the tongue. In particular we will examine tongue fat with high definition volumetric spin echo MRI, Dixon imaging for fat and water and MR spectroscopy and the metabolic function of the tongue with PET imaging in patients with sleep apnea and weight matched controls before and after weight loss. Weight loss will be achieved medically in half the subjects and surgically in half of the subjects. It is critical to understand exactly how obesity affects upper airway function in order for us to determine better treatment options and preventive strategies for patients with sleep apnea. This proposal is based on the overall hypotheses that patients with sleep apnea will have more fat in the tongue and increased metabolic activity of the tongue as compared to weight matched controls.
Our specific aims are: 1) To compare the tissue properties and metabolic function of the tongue and other upper airway soft tissue structures in apneics and weight-matched controls without apnea; and 2) to determine the differences in the tissue properties and metabolic function of the these structures after weight loss. Our resources, which include advanced static and dynamic MR imaging techniques, novel volumetric computer graphics image analysis paradigms, a world renown PET imaging center and expertise in sleep apnea biostatistics, polysomnography, imaging the upper airway, weight loss studies, Pcrit and tongue force measurements will allow us to achieve our specific aims. ? ?

Public Health Relevance

Obesity is reaching epidemic proportions in this country. Obesity is the biggest risk factor for obstructive sleep apnea, a condition characterized by snoring, daytime sleepiness and airway closure during sleep. This grant is designed to understand the relationship between obesity and sleep apnea so that we can determine optimal treatment strategies for this disorder. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
1R01HL089447-01A1
Application #
7527568
Study Section
Respiratory Integrative Biology and Translational Research Study Section (RIBT)
Program Officer
Twery, Michael
Project Start
2008-09-20
Project End
2012-05-31
Budget Start
2008-09-20
Budget End
2009-05-31
Support Year
1
Fiscal Year
2008
Total Cost
$622,758
Indirect Cost
Name
University of Pennsylvania
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Feng, Yuan; Keenan, Brendan T; Wang, Stephen et al. (2018) Dynamic Upper Airway Imaging during Wakefulness in Obese Subjects with and without Sleep Apnea. Am J Respir Crit Care Med 198:1435-1443
Schwab, Richard J; Leinwand, Sarah E; Bearn, Cary B et al. (2017) Digital Morphometrics: A New Upper Airway Phenotyping Paradigm in OSA. Chest 152:330-342
Loro, Emanuele; Wang, Stephen H; Schwab, Richard J et al. (2017) In Vivo Evaluation of the Mechanical and Viscoelastic Properties of the Rat Tongue. J Vis Exp :
Schwab, Richard J; Kim, Christopher; Bagchi, Sheila et al. (2015) Understanding the anatomic basis for obstructive sleep apnea syndrome in adolescents. Am J Respir Crit Care Med 191:1295-309
Chi, Luqi; Comyn, Francois-Louis; Keenan, Brendan T et al. (2014) Heritability of craniofacial structures in normal subjects and patients with sleep apnea. Sleep 37:1689-98
Schwab, Richard J; Kim, C; Siegel, Lawrence et al. (2014) Examining the mechanism of action of a new device using oral pressure therapy for the treatment of obstructive sleep apnea. Sleep 37:1237-47
Kim, Andrew M; Keenan, Brendan T; Jackson, Nicholas et al. (2014) Tongue fat and its relationship to obstructive sleep apnea. Sleep 37:1639-48
Yuan, Haibo; Schwab, Richard J; Kim, Christopher et al. (2013) Relationship between body fat distribution and upper airway dynamic function during sleep in adolescents. Sleep 36:1199-207