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BACKGROUND:The purpose of this observational study was to investigate the relationship between upper-airway configuration assessed by CT imaging during the Müller maneuver state and the severity of obstructive sleep apnea syndrome(OSAS).METHODS:A total of 358 snoring subjects who underwent standard polysomnography and upper-airway configuration by using CT imaging were enrolled.According to the apnea-hypopnea index(AHI),subjects were classified into 4 groups:snoring group(simple snoring),AHI<5;mild OSAS,530.We also divided the upper airway into 3 parts,named the nasopharynx,oropharynx,and hypopharynx,from the CT scan and evaluated the minimal cross-sectional area(mCSA)and the shape of each airway level and calculated upper-airway length and distance from mandibular plane to hyoid bone(MPH).RESULTS:Multivariate logistic stepwise regression analysis identified body mass index(BMI),mCSA of nasopharynx,upper-airway length,and MPH as risk factors for the severity of OSAS.When subdivided for BMI and sex,upper-airway length was a risk factor for OSAS in non-obese(BMI<27 kg/m2)and male subjects,and MPH was a risk factor only in obese(BMI>27 kg/m2)subjects.Meanwhile,mCSA of nasopharynx was significantly associated with the severity of OSAS independent of BMI.CONCLUSIONS:Subjects with severe OSAS have more significant abnormalities of the upper airway.Obesity,mCSA of nasopharynx,upper-airway length,and MPH may contribute to the severity of OSAS.Obesity and sex should be taken into account when evaluating the abnormalities of upper-airway anatomy in snorers and patients with OSAS.