Obesity and obstructive sleep apnea: Pathogenic mechanisms and therapeutic approaches

Alan R. Schwartz, Susheel P. Patil, Alison M. Laffan, Vsevolod Polotsky, Hartmut Schneider, Philip L. Smith

Research output: Contribution to journalReview articlepeer-review

335 Scopus citations


Obstructive sleep apnea is a common disorder whose prevalence is linked to an epidemic of obesity in Western society. Sleep apnea is due to recurrent episodes of upper airway obstruction during sleep that are caused by elevations in upper airway collapsibility during sleep. Collapsibility can be increased by underlying anatomic alterations and/or disturbances in upper airway neuromuscular control, both of which play key roles in the pathogenesis of obstructive sleep apnea. Obesity and particularly central adiposity are potent risk factors for sleep apnea. They can increase pharyngeal collapsibility through mechanical effects on pharyngeal soft tissues and lung volume, and through central nervous system-acting signaling proteins (adipokines) that may affect airway neuromuscular control. Specific molecular signaling pathways encode differences in the distribution and metabolic activity of adipose tissue. These differences can produce alterations in the mechanical and neural control of upper airway collapsibility, which determine sleep apnea susceptibility. Although weight loss reduces upper airway collapsibility during sleep, it is not known whether its effects are mediated primarily by improvement in upper airway mechanical properties or neuromuscular control. A variety of behavioral, pharmacologic, and surgical approaches to weight loss may be of benefit to patients with sleep apnea, through distinct effects on the mass and activity of regional adipose stores. Examining responses to specific weight loss strategies will provide critical insight into mechanisms linking obesity and sleep apnea, and will help to elucidate the humoral and molecular predictors of weight loss responses.

Original languageEnglish (US)
Pages (from-to)185-192
Number of pages8
JournalProceedings of the American Thoracic Society
Issue number2
StatePublished - Feb 2008
Externally publishedYes


  • Obesity
  • Pharynx
  • Sleep apnea
  • Upper airway
  • Weight loss

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


Dive into the research topics of 'Obesity and obstructive sleep apnea: Pathogenic mechanisms and therapeutic approaches'. Together they form a unique fingerprint.

Cite this