An estimated 22 million Americans suffer from sleep apnea with a large proportion of these going dangerously undiagnosed. Diseases associated with sleep apnea are diabetes, cardiovascular disease and stroke, even mental illness and death.

The premise has long been that obesity presented the strongest risk factor, with overweight and obese individuals accounting for over 70% of sleep apnea cases. As a result, interventions such as weight loss and CPAP machines (continuous positive airway pressure) have been regularly advocated.

Tongue Fat Reduction Corresponds to Improvement in Sleep Apnea

Recently, a 7-year study performed by sleep scientists at the University of Pennsylvania demonstrated that general weight loss reduced the volume of soft tissue around the throat and mouth (specifically the tongue), and this reduction of fat corresponded to an improvement in sleep apnea.

“The Penn study emphasizes an important issue that sleep surgeons have known for years,” says Dr. Donald M. Sesso, Philadelphia’s “sleep doctor” and the only triple board-certified sleep surgeon in the Tri-state area.  “If doctors don’t recognize or have the ability to treat tongue base obstruction, they may not be able to “cure” or alleviate sleep apnea with surgery. I have heard many times from patients and colleagues that sleep apnea surgery doesn’t work.  I would strongly challenge that assertion.  In my opinion, the reason that patients may still have persistent sleep apnea after throat and/or nasal surgery is a failure to recognize tongue base obstruction.   That is why we stress a complete anatomic examination of all sleep apnea patients. It’s rather simple and just takes a few minutes in the office.”

3 Reasons to Have Your Airway Evaluated

Dr. Sesso offers three reasons that patients should have their airways evaluated:

  1. If you’re planning surgery for sleep apnea, your surgeon should examine your airway with a fiberoptic laryngoscope (flexible camera) to determine which surgery would be the most appropriate.  The surgical plan should be customized and the only way to do that is to determine the location of the airway obstruction, i.e., tongue, soft palate, nose. Otherwise, your surgeon is guessing where the obstruction is occurring.
  2. Even if you aren’t considering surgery or are not a candidate for surgery, identifying the type of airway obstruction may assist you with choosing other non-surgical treatment options.  For example, a non-obese patient with mild tongue base obstruction is a much better candidate for oral appliance therapy as compared to a patient with mainly throat (palate) obstruction.  Also, if we note a large tongue (macroglossia), we may be more apt to recommend weight loss and tongue strengthening exercises as suggested in the Penn study.
  3. Many of my sleep apnea patients will need some type of surgical procedure during their lifetime unrelated to their apnea (colonoscopy, hernia repair, cataract surgery, oral surgery).  Our airway evaluation can be very valuable to the anesthesia team when determining the safest method to treat a patient as well as any special preoperative and post-operative precautions that should be considered.

Dr. Sesso says that “the idea of excess fat or soft tissue in the tongue is not new. In fact, my mentors at Stanford University pioneered radiofrequency surgery years ago to reduce the volume of the tongue.  In addition, I have seen many patients undergo weight loss surgery (bariatric surgery) which resolved their weight issue and sleep apnea.”

“I have always been an advocate of weight loss.  In fact, I instruct my patients that weight loss will only help their sleep apnea, and, in certain cases, alleviate it.  Conversely, weight gain can cause a progression or recurrence of sleep apnea.  Furthermore, there have been many studies to show that obese patients with severe sleep apnea can still have significant apneic episodes even after weight loss surgery.  I commend Penn on this finding.”

“I would also stress several take-home points for patients.  If you have sleep apnea, it is an important part of your treatment protocol to have your airway evaluated.  Weight loss is an important part of the treatment protocol.  Lastly, if you have sleep apnea and have experienced significant weight loss, you should consider repeat sleep testing/evaluation to make sure that the sleep apnea is truly resolved.”



Donald M. Sesso, D.O.Dr. Donald M. Sesso, D.O., board certified in Otolaryngology and Sleep Medicine, is the only fellowship-trained sleep surgeon in the Tri-state area. He is widely known as Philadelphia’s snoring doctor.

Treating both adults and children, Dr. Sesso is trained in all aspects of otolaryngology and specializes in sleep disorders, the surgical treatment of obstructive sleep apnea (OSA), and advanced endoscopic sinus surgery and allergies.

He is a member of the American Academy of Otolaryngology, American Osteopathic Association and American Academy of Sleep Medicine.