title: Orofacial-cervical alterations in individuals with upper airway resistance syndrome.
abstract: BACKGROUND
  Studies that assess the upper airways in sleep-related breathing disorders have been performed only in patients with obstructive sleep apnea syndrome who seek medical attention. Therefore, in addition to the need for population studies, there are no data on the orofacial-cervical physical examination in subjects with upper airway resistance syndrome.
  
  
  OBJECTIVE
  To compare the orofacial-cervical examination between volunteers with upper airway resistance syndrome and without sleep-related breathing disorders.
  
  
  METHODS
  Through questionnaires, physical measurements, polysomnography, and otorhinolaryngological evaluation, this study compared the orofacial-cervical physical examination, through a systematic analysis of the facial skeleton, mouth, throat, and nose, between volunteers with upper airway resistance syndrome and volunteers without sleep-related breathing disorders in a representative sample of the adult population of the city of São Paulo.
  
  
  RESULTS
  There were 1042 volunteers evaluated; 49 subjects (5%) were excluded as they did not undergo otorhinolaryngological evaluation, 381 (36%) had apnea-hypopnea index>5 events/hour, and 131 (13%) had oxyhemoglobin saturation<90%. Among the remaining 481 subjects (46%), 30 (3%) met the criteria for the upper airway resistance syndrome definition and 53 (5%) met the control group criteria. At the clinical evaluation of nasal symptoms, the upper airway resistance syndrome group had more oropharyngeal dryness (17% vs. 29.6%; p=0.025) and septal deviation grades 1-3 (49.1% vs. 57.7%; p=0.025) when compared to controls. In the logistic regression model, it was found that individuals from the upper airway resistance syndrome group had 15.6-fold higher chance of having nose alterations, 11.2-fold higher chance of being hypertensive, and 7.6-fold higher chance of complaining of oropharyngeal dryness when compared to the control group.
  
  
  CONCLUSIONS
  Systematic evaluation of the facial skeleton, mouth, throat, and nose, between volunteers with upper airway resistance syndrome and volunteers without sleep-related breathing disorders, showed that the presence of upper airway resistance syndrome is mainly associated with nasal alterations and oropharyngeal dryness, in addition to the risk of hypertension, regardless of gender and obesity.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Pedro Wey Barbosa
authors.initials: PW
authors.lastname: de Oliveira
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Electronic address: gregorioluciano@me.com.
authors.forename: Luciano Lobato
authors.initials: LL
authors.lastname: Gregorio
authors.affiliation: Post-graduate Program, Department of Pneumology, Faculdade de Medicina, Universidade de São Paulo (FM-USP), São Paulo, SP, Brazil.
authors.forename: Rogério Santos
authors.initials: RS
authors.lastname: Silva
authors.affiliation: Centro de Estudos do Instituto do Sono, São Paulo, SP, Brazil.
authors.forename: Lia Rita Azevedo
authors.initials: LR
authors.lastname: Bittencourt
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Sergio
authors.initials: S
authors.lastname: Tufik
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Gregório
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005145:Face / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000033:anatomy & histology; D009960:Oropharynx / Q000473:pathology* / Q000503:physiopathology; D010808:Physical Examination; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000209:etiology* / Q000503:physiopathology; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Airway resistance; Nasal obstruction; Obstrução nasal; Resistências das vias respiratórias; Sleep disorders; Transtornos do sono