Objective: Both obesity and craniofacial deformity are important etiologies of obstructive sleep apnea (OSA). The present research aimed to explore their interaction and different impacts on OSA severity. Methods: A total of 207 consecutive OSA patients (169 males, 38 females) were included in the research. Based on the body mass index (BMI) value, patients were divided into 77 normal-weight patients (BMI <24 kg m−2), 105 overweight patients (24 ≤ BMI<28 kg m−2) and 26 obese patients (BMI ≥28 kg m−2). All accepted overnight polysomnography and standard lateral cephalogram. Cephalometric measurements involved 25 cephalometric variables. The correlations between these cephalometric variables, BMI and the apnea-hypopnea index (AHI) were evaluated. Results: For the whole sample after controlling for gender and age, stepwise regression analysis showed that the factors affecting AHI were increased BMI, narrowing posterior airway space, inferior displacement of hyoid and elongation of the tongue. When grouped by BMI, normal-weight group exhibited with more reduced maxillary length and mandible length, and steeper mandible plane than overweight and obese patients (p < 0.0167). Obe
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