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Cheeks asymmetry is not associated with sleep apnea severity


Obstructive sleep apnea (OSA) is a prevalent health condition among adults and one of the most underdiagnosed diseases worldwide. Polysomnography is the golden standard assessment to precisely diagnose sleep-related disorders. Craniofacial anatomical phenotypes are established risk factors for OSA in children and adult populations. Abnormalities such as mandibular deficiency, maxillary hypoplasia, inferior position of the hyoid bone, a narrowed posterior air space in adults are risk factors for OSA. Therefore, investigating the facial symmetry may be of clinical interest in OSA adult population.


Verify whether cheeks appearance asymmetry is a predictor of OSA risk.


Adult patients with sleep complaint were assessed in a sleep clinic between October of 2018 and March of 2019. They underwent overnight polysomnography and face photography was taken by one of the evaluators while assessing them in loco. Two other blinded and independents evaluators assessed all the patients based on photographic data. The cheeks appearance evaluation was based on the volume and the tone of the structures, assessing the right and the left cheek separately.


A total of 248 subjects were included (mean age, 46 years; 147 [59 %] male; 114 [46 %] obese). 29% were non-OSA cases, 26% had mild OSA, 23% had moderate OSA and 22% had severe OSA. 33 (13.3%) of the subjects had cheeks asymmetry based on the protocol used. The results show no statistical difference in AHI when comparing the symmetric (19±23/h) to the asymmetric cheeks groups (18±15; p=0.15) when associating to apnea-hypopnea index (IAH). The binary logistic regression analysis including cheeks asymmetry as dependent variable and adjusting for BMI, age and gender remained non-significant.


Cheeks appearance asymmetry is not related to OSA severity and does not seem to imply in a higher risk for OSA, suggesting that soft tissue asymmetry is irrelevant as OSA predictor.


diagnostic accuracy; speech, language and hearing sciences; obstructive sleep apnea (OSA); polysomnography (PSG)


Área Clínica


Universidade Federal do Rio Grande do Sul - Rio Grande do Sul - Brasil


Aline Prikladnicki, Laura Carolina Cortes Reis Sousa, Lisette Carolina Redondo Cotes, Jéssica Cristina de Cezaro, Jhoana Uribe Ramos, Lauren Sezerá, Chaiane Facco Piccin, Erissandra Gomes, Denis Martinez