title: Systematic Evaluation of the Upper Airway in a Sample Population: Factors Associated with Obstructive Sleep Apnea Syndrome.
abstract: OBJECTIVE
  To investigate the anatomy of the upper airway (UA) of a representative sample of the adult population of São Paulo city, Brazil, and to identify factors associated with the presence of obstructive sleep apnea syndrome (OSAS), as confirmed using full-night polysomnography (PSG).
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Population-based sample.
  
  
  METHODS
  A 3-stage sampling procedure was used to proportionally recruit adult residents of São Paulo city according to gender, age, and socioeconomic status. A complete evaluation was performed, including a systematic evaluation of the UA prior to conducting PSG.
  
  
  RESULTS
  Nine-hundred ninety-three (90.2%) of the participants were seen by an ear, nose, and throat (ENT) specialist. Individuals who were diagnosed with OSAS (32.9%) presented a higher frequency of nasal symptoms and structural abnormalities (both nasal and oropharyngeal) compared with those without OSAS. No anatomical differences were observed in the facial skeleton. An abnormal nasal structure visible via anterior rhinoscopy was the only UA factor predicting OSAS after adjustments for the other common OSAS risk factors (male sex, aging, obesity, and increased neck circumference).
  
  
  CONCLUSIONS
  This is the first study in which a systematic evaluation of the UA was followed by a sleep study in a population-based sample. In a sample of the general population that had not previously been screened for OSAS, having an abnormal nasal structure was found to be a risk factor for OSAS, in conjunction with other well-established clinical and demographic factors, such as male gender, increased age, increased neck circumference, and body mass index.
authors.affiliation: Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, Brazil mariaclaudiasoares@yahoo.com.
authors.forename: Maria Claudia Soares
authors.initials: MC
authors.lastname: Oliveira
authors.affiliation: Disciplina de Medicina e Biologia do Sono-Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil.
authors.forename: Sergio
authors.initials: S
authors.lastname: Tufik
authors.affiliation: Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, Brazil Disciplina de Medicina e Biologia do Sono-Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil.
authors.forename: Fernanda Louise Martinho
authors.initials: FL
authors.lastname: Haddad
authors.affiliation: Disciplina de Medicina e Biologia do Sono-Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil.
authors.forename: Rogerio
authors.initials: R
authors.lastname: Santos-Silva
authors.affiliation: Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, Brazil.
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Gregório
authors.affiliation: Disciplina de Medicina e Biologia do Sono-Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil.
authors.forename: Lia
authors.initials: L
authors.lastname: Bittencourt
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009056:Mouth Abnormalities / Q000150:complications; D009666:Nose / Q000002:abnormalities; D009960:Oropharynx / Q000002:abnormalities; D017286:Polysomnography; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000209:etiology
keywords: facial skeleton; nose; obstructive sleep apnea syndrome; oropharynx; population-based sample; upper airway examination