{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T13:07:46Z","timestamp":1776949666668,"version":"3.51.4"},"reference-count":38,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Ultrasonography (US) has emerged as a non-invasive method for anatomical and functional evaluation of upper airway structures in adult obstructive sleep apnea (OSA). However, its role in severity stratification, dynamic assessment, elastographic characterization, and therapeutic monitoring remain to be investigated. Background\/Objectives: The goal herein is thus to systematically review and synthesize available evidence on US assessment in adults with OSA, including structural parameters, dynamic measurements, correlation with the apnea\u2013hypopnea index (AHI), integration with artificial intelligence, and evaluation of myofunctional therapy outcomes. Methods: A PRISMA-compliant systematic review of 19 studies (2007\u20132025) was conducted, evaluating US in adult patients with polysomnography-diagnosed OSA. Observational, pilot, case\u2013control, and exploratory studies were included. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool for observational studies. Due to methodological heterogeneity, a structured qualitative meta-analytic synthesis was performed. Results: The tongue base was the most frequently studied structure. Increased tongue thickness, area, and stiffness were consistently associated with higher AHI. Elastography revealed increased intrinsic rigidity in patients with OSA. Dynamic US correlated with drug-induced sleep endoscopy findings and hyoid displacement. Machine learning integration improved severity prediction. A single study evaluated anatomical changes following myofunctional therapy, representing a nascent research area. US may become a complementary, non-invasive tool for anatomical and functional assessment of upper airway structures in adult OSA. Conclusions: Further standardization of acquisition protocols and well-designed longitudinal studies are needed to clarify the clinical role of US in phenotyping and therapeutic monitoring.<\/jats:p>","DOI":"10.3390\/jcm15093213","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T12:04:42Z","timestamp":1776945882000},"page":"3213","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasonographic Assessment of Upper Airway Structures in Adult Obstructive Sleep Apnea: A Systematic Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Cristina","family":"Rodr\u00edguez Alcal\u00e1","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Granada, 18071 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1670-4235","authenticated-orcid":false,"given":"Carlos","family":"O\u2019Connor Reina","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Quir\u00f3nsalud Marbella Hospital, 29602 Marbella, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6141-5360","authenticated-orcid":false,"given":"Eduardo Javier","family":"Correa","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Granada, 18071 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5148-5111","authenticated-orcid":false,"given":"Laura","family":"Rodr\u00edguez Alcal\u00e1","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Granada, 18071 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Mar\u00eda","family":"Ignacio Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Quir\u00f3nsalud Marbella Hospital, 29602 Marbella, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco Javier","family":"G\u00f3mez Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Granada, 18071 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1164\/rccm.200208-866OC","article-title":"Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging","volume":"168","author":"Schwab","year":"2003","journal-title":"Am. 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