Obstructive sleep apnea (OSA) is a potential health risk for millions of Americans, and several studies point to one possible reason behind the disorder: a “fat” tongue. In one study, obese people with OSA were more likely to have an overweight base of the tongue.

“This is the first study to show that fat deposits are increased in the tongue of obese patients with obstructive sleep apnea,” study senior author Dr. Richard Schwab, co-director of the Sleep Center at the University of Pennsylvania Medical Center, said in a news release from Sleep, and published the findings last year.

Let’s remember, obstructive sleep apnea is a common sleep-related disorder where breathing is characterized by stops and starts in breathing, and these starts and stops may occur over 400 times in one night, causing the sufferer to wake up several times in one night. The hallmarks of this condition include chronic loud snoring, with periodic gasps or choking, along with daytime drowsiness because of poor sleep.

Should you see someone’s breathing stop and start continuously, throughout the night, you are likely observing some sort of sleep apnea. Apnea means “suspension in breathing.” Such stops and starts during sleep cause fatigue the next day. And the effects go beyond fatigue. Studies suggest those pauses in breathing stress the nervous system, boosting blood pressure and inflammation in the arteries.

Obese people tend to be at higher risk for obstructive sleep apnea because of the fat deposited in and around the breathing passageway, and Schwab’s team say the new findings may help explain the link between obesity and the breathing disorder.

The study included 90 obese adults with sleep apnea and 90 obese adults without the disorder.

The participants who had OSA had significantly larger tongues and a higher percentage of tongue fat than those without the disorder, the researchers found. Those with sleep apnea had fat concentrated at the base of the tongue. Too much fat at the base of a tongue may prevent muscles that attach the tongue to bone from positioning the tongue away from the breathing airway during sleep. While the study found an association between tongue fat content and sleep apnea, it could not prove cause and effect.

One answer to this condition is a common surgical procedure to reduce the large or over-sized tongue called base tongue reduction. But this may be avoided if the sufferer of OSA due to a large base tongue loses weight.

However, the researchers believe future studies should assess whether removing tongue fat through weight loss, upper airway exercises or surgery could help treat sleep apnea.

“Tongue size is one of the physical features that should be evaluated by a physician when screening obese patients to determine their risk for obstructive sleep apnea,” American Academy of Sleep Medicine President Dr. Timothy Morgenthaler added in the news release.

“Effective identification and treatment of sleep apnea is essential to optimally manage other conditions associated with this chronic disease, including high blood pressure, heart disease, type 2 diabetes, stroke and depression,” he said.

Nearly 35% of US adults, 78.6 million people, are obese, according to the Centers for Disease Control and Prevention.