Robin sequence (RS) is a rare congenital condition characterized by retrognathia, glossoptosis, and upper airway obstruction, with highly variable respiratory severity at birth. Prenatal measurement of the inferior facial angle (IFA) is used to support diagnosis, but its prognostic value for respiratory outcomes remains uncertain. This study assessed whether fetal MRI-measured IFA predicts early respiratory status in infants with RS. We conducted a retrospective monocentric study including consecutive infants with prenatal suspicion and postnatal confirmation of RS who underwent fetal MRI between 2009 and 2021. Respiratory status was assessed at delivery and at 6 months and categorized as room air breathing, noninvasive respiratory support, or intubation/tracheostomy. Five blinded operators independently measured the IFA and the anteroposterior skull size (APSS) on median sagittal MRI slice. Interobserver agreement was evaluated using intraclass correlation coefficients. Potential predictors of respiratory outcomes were analyzed using ordinal logistic regression. Among 43 infants, 72% required respiratory support at birth. More than half required ongoing respiratory assistance during early infancy. IFA values did not differ across respiratory outcome categories and were not associated with respiratory status at birth or during follow-up. Interobserver reliability was poor for IFA measurements, whereas APSS showed excellent agreement. In multivariable analyses, higher gestational age at birth was the only factor associated with reduced respiratory morbidity during the first 6 months.  These findings indicate that, although IFA is useful for diagnosing RS, it lacks reproducibility and prognostic value for respiratory outcomes, highlighting the need for delivery in specialized centers. • In Pierre Robin sequence, no reliable prenatal predictor of respiratory status at birth exists. Although the inferior facial angle is used for prenatal diagnosis, its ability to predict neonatal respiratory severity is unknown. • The inferior facial angle in prenatal fetal MRI shows limited predictive value for respiratory status at birth and during early infancy in infants with Robin sequence, with substantial measurement variability reducing its reliability as an isolated prognostic imaging marker.
The optimal initial corticosteroid strategy for idiopathic sudden sensorineural hearing loss (SSNHL) remains uncertain, and randomized trials may not capture real-world variability. Observational comparisons are vulnerable to confounding, particularly when post-treatment variables are inappropriately adjusted. We evaluated the real-world comparative effectiveness of initial systemic versus intratympanic corticosteroids using a prespecified causal inference framework. We conducted a retrospective cohort study (2012-2019) of adults with idiopathic SSNHL and complete baseline and discharge audiometry. Patients receiving combined systemic-intratympanic therapy or missing exposure data were excluded. The exposure was the initial corticosteroid route (systemic oral/IV vs. intratympanic). Propensity scores were estimated from baseline covariates including age, sex, symptom profile, comorbidities, baseline PTA, and time from symptom onset to treatment initiation. Primary estimation used augmented inverse probability of treatment weighting (AIPW) to retain all eligible patients; 1:1 propensity-score matching (caliper 0.2 SD of logit PS) with regression adjustment addressed residual imbalance as a sensitivity analysis. Outcomes were PTA gain (primary), complete recovery (≥30 dB gain), and effective improvement (≥15 dB gain). Among 284 adults (systemic = 240; intratympanic = 44), crude mean PTA gain was 13.8 vs. 3.8 dB (difference 10.0 dB). In AIPW analysis, systemic therapy was associated with greater PTA gain (adjusted mean difference 10.1 dB; 95% bootstrap CI 1.8-19.5) and a higher probability of complete recovery (adjusted risk difference 16.9%; 95% CI 9.4-23.4). The risk difference for effective improvement was 11.4% (95% CI - 15.3 to 30.9). Findings were directionally consistent in IPTW, overlap-weighted, and matched analyses. In this single-center real-world cohort, initial systemic corticosteroids were associated with greater short-term hearing improvement and a higher likelihood of complete recovery compared with intratympanic therapy. Weighting-based doubly robust estimators improved precision and generalizability, while matched analyses yielded consistent direction but wider uncertainty.
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Alzheimer's disease (AD) is a growing public health concern, with neuroinflammation implicated in its pathogenesis. Allergic rhinitis (AR), a prevalent chronic inflammatory disorder, may contribute to systemic inflammation and potentially influence AD risk. This study sought to critically assess the association between a history of AR and subsequent AD development in a large, representative Taiwanese cohort. Leveraging Taiwan's National Health Insurance Research Database (LHID2010), this nationwide case-control study identified 4,681 individuals aged ≥ 65 years with a first-time AD diagnosis (cases) and 14,043 propensity-score-matched controls. A rigorous definition of prior AR required at least two clinical diagnoses, including one by an otolaryngology specialist. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for potential confounders. The prevalence of prior AR was significantly higher in AD patients than in controls (25.29% vs. 21.01%, p < 0.001). Following meticulous adjustment for demographic variables, socioeconomic status, geographic factors, and medical comorbidities (including hyperlipidemia, diabetes, coronary heart disease, hearing loss, and hypertension), prior AR was robustly associated with elevated odds of AD (adjusted OR = 1.279, 95% CI = 1.182 ~ 1.384). This association remained significant for both males (adjusted OR = 1.196, 95% CI = 1.053 ~ 1.358) and females (adjusted OR = 1.339, 95% CI = 1.210 ~ 1.482). This study suggests a significant association between prior AR and an increased odds of developing AD in an elderly Taiwanese population. These findings highlight chronic peripheral inflammation as a factor potentially associated with neurodegeneration.
To analyze the lagged effects of pollen concentration on allergic conjunctivitis (AC) healthcare visits and investigate the influence of environmental factors and pathogen infections on AC risk. Daily AC outpatient and emergency cases from Beijing Shijitan Hospital, along with concurrent meteorological and pollen concentration data from March 1 to October 31 in 2023-2024, were collected. Spearman rank correlation analysis, generalized additive models (GAM), and distributed lag non-linear models (DLNM) were employed to plot lag-response curves for specific cumulative effects and incremental cumulative effects of relative risks. AC visits significantly increased during spring and autumn, closely aligning with peak pollen concentrations (April in spring, September in autumn). Spearman correlation analysis revealed a strong positive association between pollen concentration and AC visits (2023: r = 0.599; 2024: r = 0.637), while meteorological factors (including temperature, air pressure, etc.) showed weaker correlations. Lagged effect analysis demonstrated that the AC lag effect associated with pollen exposure in 2024 was significantly stronger than in 2023, displaying a strict dose-response relationship with pollen concentration levels. The peak value increase from baseline in relative risk (RR) for specific cumulative effects was 2.6 times higher (0.0018 in 2024 vs. 0.0007 in 2023), with a 1.9-fold longer lag duration (28 days vs. 15 days). For incremental cumulative effects, the time to peak doubled (day 28 in 2024 vs. day 15 in 2023), and the lag duration exceeded 50 days in 2024 (vs. 27 days in 2023). The lag-response curve exhibited biphasic peaks in 2024, contrasting with the unimodal pattern in 2023. This study confirms that pollen concentration is the dominant factor affecting the lagged effects of AC visits, with a clear dose-response relationship. The findings provide a scientific basis for AC prevention strategies and public health early-warning systems.
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Near-infrared photoimmunotherapy (NIR-PIT) has been approved by the Japanese national health insurance for approximately five years, and clinical experience has steadily accumulated. However, reports analyzing treatment outcomes and pain-related factors remain limited. This study aimed to identify predictors of therapeutic response and pain following NIR-PIT. This retrospective cohort study included 25 patients who underwent NIR-PIT for head and neck cancer between January 2021 and June 2025. Lesion diameter and thickness were evaluated in relation to complete response (CR), and the frequency and predictors of post-treatment pain were assessed. Among 22 evaluable patients, eight achieved CR. Lesions with a shorter longest diameter and thinner thickness were significantly associated with higher CR rates (p = 0.011 and p = 0.024). Moderate-to-severe pain (Numerical Rating Scale ≥4) occurred in 18 of 48 treatment cycles (37.5%) but was significantly less frequent in patients with a history of reconstructive surgery (p = 0.017). NIR-PIT demonstrated particularly favorable efficacy for short, thin lesions, suggesting that early introduction of treatment may be associated with improved therapeutic outcomes. A history of reconstructive surgery was associated with reduced post-treatment pain, highlighting the importance of individualized treatment and pain management strategies in head and neck cancer patients undergoing NIR-PIT.
Emerging evidence suggests vitamin D deficiency might be linked to increased headache risk, though consistent conclusions are lacking due to population and methodological heterogeneity. In addition, childhood and adolescent obesity may influence headache development through metabolic and inflammatory pathways, but the specific role of body mass index (BMI) in the relationship between vitamin D and headache is currently unclear. Therefore, this study used National Health and Nutrition Examination Survey (NHANES) large-scale population-based data to investigate the association between vitamin D levels and headache risk in children and adolescents aged 6 to 19 years and to analyze the possible mediating effect of BMI on this relationship. The aim of this study was to explore the complex association between vitamin D levels and headache. We analyzed 2 cycles of the NHANES dataset, which included a total of 7066 children and adolescents aged 6 to 19 years. Multivariate linear regression models, subgroup analyses and smoothed curve fitting were used to investigate the associations between vitamin D levels and headache, and the potential mediating role of BMI was explored. The results of the present study revealed a evident negative correlation between vitamin D levels and headache risk in children and adolescents, a finding that was further supported by smoothed curve fitting. Notably, this negative correlation was stronger in the female and adolescent groups. The results of the mediation analysis revealed that BMI had a evident mediating effect, with a mediation ratio of 20.94%. This study found that lower vitamin D levels were associated with a higher likelihood of headache in children and adolescents, and that BMI may play a partial mediating role. This finding provides new strategies for the prevention and treatment of headache in children and adolescents. More prospective studies are necessary to further validate this association and its underlying mechanisms.
Multi-level factors, including demographic and neighborhood social conditions, related to disparities in oral cavity cancer (OCC) are not fully understood. We examined the association between these factors and survival outcomes among patients diagnosed with OCC. We identified 14,416 patients diagnosed with OCC from 1995 to 2020 using population-based data from the Texas Cancer Registry. Neighborhood-level social vulnerability was measured using the 2010 US Centers for Disease Control and Prevention's Neighborhood Social Vulnerability Index (CDC-SVI). We examined race and ethnicity, CDC-SVI (as sample-based quintiles), and their joint effects with survival outcomes. Five-year survival probability was 38.6% (95% CI: 35.3, 42.0) for non-Hispanic Black patients, 55.1% (95% CI: 54.1, 56.0) for non-Hispanic White patients, 44.8% (95% CI: 42.9, 46.6) for patients in the most vulnerable neighborhoods, and 61.5% (95% CI: 59.6, 63.2) for patients in the least vulnerable neighborhoods. In adjusted models, Non-Hispanic Black patients (hazard ratio (HR) 1.79, 95% CI: 1.63, 1.95) and patients in the most vulnerable neighborhoods (HR 1.50, 95% CI: 1.40, 1.61) had a higher risk of all-cause mortality compared to non-Hispanic White patients and those in the least vulnerable neighborhoods, respectively. There were no racial and ethnic differences in all-cause mortality in the least vulnerable neighborhoods compared to non-Hispanic White patients (Non-Hispanic Black: HR 1.44, 95% CI: 0.95, 2.18). Findings underscore the importance of mitigating inequities in survival outcomes among patients with OCC and demonstrate that racial and ethnic disparities in survival outcomes were largely attenuated among patients living in the least socially vulnerable neighborhoods.
Cochlear implantation is a common treatment for adults with single-sided deafness (SSD), but patient-reported benefits vary. The relationships among tinnitus burden, perceived hearing ability, psychological distress, disease-specific health-related quality of life, and whether early postoperative outcomes predict later results are not well understood. This study explores how disease-specific quality of life relates to tinnitus burden, hearing, stress, depression, and anxiety after cochlear implantation in SSD. It also seeks early markers linked to 2-year outcomes. This secondary complete-case analysis was based on a previously reported prospective longitudinal SSD cohort. Of 70 adults with postlingual SSD, 36 (51.4%) had complete Nijmegen Cochlear Implant Questionnaire (NCIQ) data at baseline and at 6 months, 1 year, and 2 years after unilateral cochlear implantation and were included. Additional measures included the Tinnitus Questionnaire (TQ), Oldenburg Inventory (OI), PerceivFed Stress Questionnaire (PSQ), General Depression Scale (ADS-L), Generalized Anxiety Disorder 7-item scale (GAD-7), and Freiburg Monosyllable Test (FMT) at 65 dB. Timepoint-specific correlations with the NCIQ were analyzed using Spearman's rank correlations. Exploratory multivariable analyses employed linear regression on rank-transformed variables to assess whether baseline and 6-month patient-reported profiles were associated with 2-year NCIQ outcomes. Longitudinal within-patient comparisons were conducted as a secondary descriptive analysis. Higher NCIQ scores were linked to lower tinnitus burden and better hearing across all assessments. Associations with depression and anxiety persisted, while connections with perceived stress emerged after surgery. At baseline, higher tinnitus burden was associated with lower 2-year NCIQ scores. At 6 months, higher tinnitus is still associated with lower 2-year NCIQ scores, whereas better hearing is associated with higher 2-year NCIQ scores. Early postoperative improvement was followed by stabilization over 2 years. Improvement in health-related quality of life after cochlear implantation in adults with SSD is complex and extends beyond hearing alone. Tinnitus was the most consistent negative factor, while improved subjective hearing at 6 months was associated with better outcomes at 2 years. These results support a structured, multidimensional approach to patient-reported follow-up after cochlear implantation in SSD and suggest that early postoperative patient-reported status may serve as an early candidate marker for later quality-of-life outcomes.
To compare the intraoperative and postoperative outcomes of using oxidized regenerated cellulose (Surgicel®) versus absorbable gelatin sponge (Spongostan®) for supporting graft material in endoscopic tympanoplasty. We retrospectively analyzed 92 patients who underwent endoscopic type 1 tympanoplasty between 2020 and 2024. Patients were divided into 2 groups based on the supporting graft material used: 47 received Surgicel® and 45 received Spongostan®. Primary outcome measures included intraoperative hemostasis quality, duration of graft placement, postoperative graft success, graft lateralization, and hearing outcomes at 6 and 12 months. Hemostasis during graft placement was better in the Surgicel® group (P = .017), and shorter graft placement duration was observed (P = .047). At ≥ 6 months, graft success rates were comparable between the groups (89.4% for Surgicel® vs 82.2% for Spongostan®; P = .380). However, graft lateralization was significantly less frequent in the Surgicel® group (2.1%) compared to the Spongostan® group (15.6%; P = .029). While the Spongostan® group showed significantly better hearing results at 6 months (mean ABG 16.9 dB vs 28.6 dB; P < .001), hearing outcomes were similar by 12 months. Both Spongostan® and Surgicel® are effective supporting graft materials in endoscopic tympanoplasty. However, Surgicel® was associated with certain intraoperative advantages, including superior hemostasis and shorter operative time, along with a significantly lower risk of postoperative graft lateralization. These benefits suggest Surgicel® may be a preferable option for enhancing surgical efficiency and optimizing outcomes in endoscopic ear surgery.
Sinonasal inverted papilloma (SNIP) is histologically benign but locally aggressive, with high recurrence rates and a relevant risk of malignant transformation. Tumor involvement of the nasal root and overlying skin may result in a full-thickness craniofacial defect with direct intracranial-external communication. Reconstruction is particularly challenging after failure of conventional skull base techniques (e.g., titanium mesh and pericranial flaps), which may lead to pneumocephalus, cerebrospinal fluid (CSF) leakage, and infection. To describe a multidisciplinary staged salvage strategy combining bifrontal craniotomy with a vascularized anterolateral thigh (ALT) free flap for definitive reconstruction of complex anterior skull base and nasion defects after failed conventional reconstruction. We report a recurrent SNIP case with failed initial skull base reconstruction. After infection control and resolution of pneumocephalus, an ALT free flap was used. The pedicle was routed transcranially through an enlarged skull base defect to temporal recipient vessels, enabling three-layer reconstruction from dura to skin and restoration of nasal dorsum contour. Definitive reconstruction was completed in 7 h. The flap survived without vascular compromise. During the postoperative course and early follow-up, no CSF leak, infection, or recurrent pneumocephalus was observed. Stable intracranial-extracranial separation and satisfactory functional/aesthetic outcomes were achieved. Bifrontal re-exploration followed by staged ALT free-flap reconstruction represents a viable salvage option for complex anterior skull base defects after failed primary repair. In our experience, transcranial pedicle routing and a three-layer reconstruction approach can facilitate effective intracranial-extracranial separation.
The glymphatic system plays a critical role in brain waste clearance and has been implicated in neurodegenerative diseases. Primary angle-closure glaucoma (PACG) is increasingly recognized as a neurodegenerative disorder extending beyond the eye. This study aimed to investigate glymphatic system function in patients with PACG using diffusion tensor imaging analysis along the perivascular space (DTI-ALPS). This cross-sectional study included patients with PACG and age- and sex-matched healthy controls. All participants underwent magnetic resonance imaging, including diffusion tensor imaging. The DTI-ALPS index was calculated to assess glymphatic function. Group differences and correlations with disease severity were analyzed. Patients with PACG showed a significantly lower whole-brain DTI-ALPS index compared with healthy controls (1.50 ± 0.14 vs 1.60 ± 0.15, P = .030; Cohen d = 0.63). Lower DTI-ALPS values were significantly correlated with worse visual field mean deviation and thinner retinal nerve fiber layer thickness (P < .05). Glymphatic system function appears to be impaired in PACG and is associated with disease severity. These findings provide further evidence supporting the concept of glaucoma as a neurodegenerative disease involving the central nervous system.
Artesunate (ART), a semisynthetic derivative of artemisinin, has demonstrated antitumor activity in multiple malignancies; however, its cytotoxic activity and underlying mechanisms in head and neck squamous cell carcinoma (HNSCC) remain incompletely understood. Network pharmacology and molecular docking were employed to predict potential molecular targets of ART in HNSCC. The effects of ART on cell viability, migration, invasion, and apoptosis were evaluated in SCC-25 and CAL27 cells in vitro. Expression changes in the Bcl-2/Bax/Caspase-3 axis were assessed using Western blotting and RT-qPCR. A xenograft model was further established to examine the in vivo antitumor activity of ART. Network pharmacology analysis identified 77 potential ART-associated targets related to HNSCC. GO and KEGG enrichment analyses suggested that these targets were involved in several cancer-related pathways. PPI analysis highlighted six core targets, among which CASP3 exhibited the most favorable predicted interaction with ART in docking analysis. Experimental results showed that ART treatment was associated with reduced cell viability, migration, and invasion, along with increased apoptotic activity in HNSCC cells. These effects were accompanied by an increased Bax/Bcl-2 ratio and elevated cleaved Caspase-3 levels. In the xenograft model, ART treatment suppressed tumor growth and increased tumor cell apoptosis. ART demonstrates preclinical antitumor activity in HNSCC and is associated with activation of Bcl-2/Bax/Caspase-3 axis. These findings provide preliminary mechanistic insight and support further investigation of ART in preclinical models of HNSCC.
Communicating hydrocephalus may occur following stereotactic radiosurgery (SRS) for vestibular schwannomas (VSs), yet identifying individual patient risk factors associated with this post-SRS complication remains a challenge. This study examined predictors of nonobstructive ventricular enlargement and symptomatic communicating hydrocephalus following primary SRS treatment for VS via a single-center institutional cohort review and meta-analysis of the literature. A retrospective single-institution cohort study and systematic literature review and meta-analysis examining post-SRS communicating hydrocephalus in VS was performed. The institutional cohort consisted of 634 patients who received primary SRS as treatment for VS. The cohort was 51.6% female, with a median age of 64 (range 18-89) years. Following SRS treatment, 364 patients (57.4%) experienced tumor shrinkage, 218 (34.4%) had no change in the size of their lesion, and 52 (8.2%) experienced tumor growth. Nonobstructive ventricular enlargement was observed in 23 patients (3.6%) following SRS treatment, of whom 9 (39.1%) remained asymptomatic and 14 (60.9%) required placement of a ventriculoperitoneal (VP) shunt, with a median time to shunt placement of 8 months. In the multivariate analysis, patients ≥ 65 years old (p = 0.038), SRS target volume ≥ 5 cm3 (p < 0.001), maximum SRS dose ≥ 26 Gy (p = 0.015), and tumor growth at the most recent follow-up (p = 0.002) were associated with an increased risk of post-SRS ventricular enlargement. Similarly, patients with older age (p = 0.049), increased SRS target volume (p = 0.002), and tumor growth (p = 0.016) were at an increased risk of symptomatic communicating hydrocephalus requiring VP shunt placement. Twenty-nine studies, including the cohort in this study, met inclusion criteria in the meta-analysis. Of the pooled 7825 patients, the overall incidence of hydrocephalus following SRS was 5%, and a subanalysis of 7081 patients demonstrated the incidence of symptomatic hydrocephalus requiring a VP shunt to be 4%. In this subanalysis, the overall shunting rate in patients who experienced post-SRS ventriculomegaly was 92%. Among individual studies in the literature, increased tumor size was most commonly found to be a statistically significant risk factor for post-SRS hydrocephalus. Approximately 5% of patients may experience nonobstructive ventricular enlargement following primary SRS treatment for VS. However, not all patients may be symptomatic and require shunting. Patients who are older (≥ 65 years), those with larger tumor volumes, and those with post-SRS tumor growth may be at increased risk of communicating hydrocephalus and may benefit from closer clinical monitoring.
To evaluate cochlear function using distortion product otoacoustic emissions (DPOAEs) in adolescents with β-thalassemia major receiving regular desferrioxamine chelation therapy who exhibit normal pure-tone audiometric thresholds, and to compare the findings with those of healthy controls. This cross-sectional controlled study included 21 adolescents with β-thalassemia major aged 15-18 years receiving regular desferrioxamine therapy and 21 age- and sex-matched healthy controls. All participants demonstrated normal pure-tone audiometry. DPOAE measurements were performed at frequencies ranging from 500 Hz to 10,000 Hz, and distortion product amplitudes (DP1) and signal-to-noise ratio (SNR) values were analyzed. Mean values of both ears were used for statistical comparisons. To control for type I error due to multiple frequency comparisons, p values were adjusted using the Holm-Bonferroni method separately for DP1 and SNR analyses. At 1 kHz, the mean DP1 amplitude was significantly higher in the patient group compared to controls (10.07 ± 5.73 vs. 4.95 ± 5.63 dB SPL; p = 0.005). At 10 kHz, DP1 amplitude was significantly lower in patients than in controls (p = 0.004), and this difference remained statistically significant after Holm-Bonferroni correction. Although SNR values at 10 kHz were lower in the patient group in the unadjusted analysis (p = 0.039), this difference did not retain statistical significance after correction for multiple comparisons. No significant differences were observed at the other tested frequencies (p > 0.05). Adolescents with β-thalassemia major receiving regular desferrioxamine chelation therapy may exhibit subclinical high-frequency cochlear dysfunction despite normal pure-tone audiometric findings. The presence of significantly reduced DP1 amplitudes at 10 kHz highlights the sensitivity of DPOAE testing in detecting early cochlear alterations not identified by conventional audiometry. Incorporating high-frequency DPOAE measurements into routine audiological monitoring may facilitate earlier detection of cochlear involvement and improve long-term auditory surveillance in this patient population.
Clinical trials of melasma are difficult to compare due to variation in the outcomes reported. The purpose of this study was to develop a core set of outcome domains to be assessed in all clinical trials of melasma. Identification of outcomes was performed via a literature review. Thereafter, two rounds of Delphi surveys were conducted, followed by consensus meetings to determine which outcomes should be in the final core domain set. Seven core outcomes were recommended: relative intensity of representative area of pigmentation relative to baseline; color of dark spots; area and distribution of pigmentation; overall severity of melasma; patient satisfaction with treatment; quality of life; presence and severity of persistent versus transient treatment-related adverse events. Hormonal and intrinsic vascular factors were not included in the core outcome set due to limited feasibility and lack of routine measurement as outcomes in clinical trials and in clinical practice. Additionally, there were very few Hispanic individuals in the Delphi group, although melasma is very common in Hispanic individuals. A core outcome set has been developed for melasma trials. Routine use of this may improve comparability and pooling of data emanating from such trials.
To investigate the electromyographic activity (sEMG) of the suprahyoid/submental (SH) muscles during swallowing in adults with different OSA severities, controlled for body mass index (BMI), and to establish predictive factors for changes in muscle activity. This cross-sectional observational study included 37 adults diagnosed with OSA (AHI > 5). The patients were divided into two groups according to the apnea-hypopnea index (AHI): Group I (AHI = 5 ≤ 30) and Group II (AHI > 30). sEMG activity was recorded during the voluntary swallowing of 10 mL and 15 mL of thin liquid (water). The sEMG peak, integral, and maximum velocity (Vmax) were calculated. Groups were compared by general multivariate analysis of covariance, with BMI as a covariate. A general multivariate linear regression model (GRM) was applied to analyze the contribution of predictors to the EMG parameters. The significance level was set at p < 0.05. There was a predominance of males (n = 24, 64.9%) and obese individuals (BMI > 30, n = 25, 67.6%) in the sample. Compared with Group I, Group II presented significantly lower peak, Vmax and integral values (P ≤ 0.006). The GRM revealed that the peak and integral were explained by the AHI and BMI, whereas the tongue volume and behavior during swallowing together explained the Vmax. Activation of the suprahyoid (SH) muscles was reduced in patients with severe OSA. In addition to disease severity, BMI and the myofunctional condition of the tongue also contribute to impaired activation. Taken together, these findings indicate that muscle weakness and deficits in motor control compromise the activation of SH muscles during swallowing.