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A total sample size of 52 participants (26 per arm) would yield 80% power to observe a large treatment effect (Cohens d 0.8)

Estrogen Exposure and Adipose-Driven Hormonal Modulation Because adipose tissue produces estrogen via aromatase, reductions in visceral fat can lower peripheral estrogen levels in some individuals

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p =0.004 and 0.13 mol/g, p =0.001)

The mechanisms include weight loss reducing upper airway fat deposition, improved respiratory muscle tone with reduced adiposity, and possible direct effects on central respiratory control through GLP-1R in the brainstem