Obesity, particularly upper body obesity, is a risk factor for sleep apnea and has been shown to be related to its severity (19, 20). The major pathophysiologic consequences of severe sleep apnea include arterial hypoxemia, recurrent arousals from sleep, increased sympathetic tone, pulmonary and systemic hypertension, and cardiac arrhythmias (21). Most people with sleep apnea have a BMI > 30 (96, 97). Large neck girth in both men and women who snore is highly predictive of sleep apnea. In general, men whose neck circumference is 17 inches or greater and women whose neck circumference is 16 inches or greater are at higher risk for sleep apnea (98).