Impact of tongue fat volume on obstructive sleep apnea in non-obese patients

Evidence suggests excess head and neck adipose tissue contributes to OSA, particularly in obese patients. Surgical treatments are often ineffective in this subset of the population. We sought to investigate the role of tongue fat in the normal and overweight populations. In this prospective cohort study, patients underwent overnight polysomnography and MRI using a Dixon sequence. Volumetric reconstruction evaluated the size and distribution of tongue fat deposits in subjects with and without sleep apnea. The study included 86 patients; mean age of 42.2 (SD 11.2) years, 16% female. Average BMI 27.5 kg/m² (SD 2.9), with 18.6% (n = 16) normal BMI, 61.6% (n = 53) overweight, 19.8% (n = 17) obese. Logistic regression lines showed positive associations for BMI and age with AHI. No significant correlation was found between tongue fat volume or fraction and increased AHI nor presence of OSA. Although tongue volume and fat fraction were higher in patients with AHI ≥ 5 events per hour, the difference was not statistically significant. This study suggests that tongue fat does not play a significant role in the pathophysiology of OSA in the non-obese (BMI < 30) patient population. Therefore, selective treatments targeting tongue fat should focus on obese and morbidly obese patients.