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Fundamental to the pathogenesis of obstructive sleep apnea (OSA) is the interaction of physiologic and anatomic alterations of the upper airway. However, many patients with OSA have no identifiable abnormality of the upper airway, and they have been termed idiopathic. In an attempt to find a structural deviation in upper airway anatomy, we performed acoustic echography and cephalometric roentgenograms in 9 male patients with OSA and no clinical evidence of upper airway abnormality. Mean cross-sectional area of the pharynx by acoustic reflection was less in these patients (3.7 ± 0.8 cm²) than in subjects in a control group (5.3 ± 0.6 cm²) (p < 0.001). Mean glottic cross-sectional area was less in the patient group (1.5 ± 0.5 cm²) than in the control group (2.7 ± 0.5) (p < 0.001). There was a significant correlation between the number of apneas per sleep hour and pharyngeal cross-sectional area (r = 0.87, p < 0 …