European Archives of Oto-Rhino-Laryngology

, Volume 268, Issue 4, pp 533–539 | Cite as

The impacts of open-mouth breathing on upper airway space in obstructive sleep apnea: 3-D MDCT analysis

  • Eun Joong Kim
  • Ji Ho Choi
  • Kang Woo Kim
  • Tae Hoon Kim
  • Sang Hag Lee
  • Heung Man Lee
  • Chol Shin
  • Ki Yeol Lee
  • Seung Hoon Lee


Open-mouth breathing during sleep is a risk factor for obstructive sleep apnea (OSA) and is associated with increased disease severity and upper airway collapsibility. The aim of this study was to investigate the effect of open-mouth breathing on the upper airway space in patients with OSA using three-dimensional multi-detector computed tomography (3-D MDCT). The study design included a case–control study with planned data collection. The study was performed at a tertiary medical center. 3-D MDCT analysis was conducted on 52 patients with OSA under two experimental conditions: mouth closed and mouth open. Under these conditions, we measured the minimal cross-sectional area of the retropalatal and retroglossal regions (mXSA-RP, mXSA-RG), as well as the upper airway length (UAL), defined as the vertical dimension from hard palate to hyoid. We also computed the volume of the upper airway space by 3-D reconstruction of both conditions. When the mouth was open, mXSA-RP and mXSA-RG significantly decreased and the UAL significantly increased, irrespective of the severity of OSA. However, between the closed- and open-mouth states, there was no significant change in upper airway volume at any severity of OSA. Results suggest that the more elongated and narrow upper airway during open-mouth breathing may aggravate the collapsibility of the upper airway and, thus, negatively affect OSA severity.


Computed tomography Mouth breathing Obstructive sleep apnea Three-dimensional imaging 



This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A090084), and the authors are grateful to Angela Oh (North Hollywood) for syntax and structure work.

Conflict of interest

The authors have no conflict of interest to declare.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Eun Joong Kim
    • 1
  • Ji Ho Choi
    • 1
  • Kang Woo Kim
    • 1
  • Tae Hoon Kim
    • 1
  • Sang Hag Lee
    • 1
  • Heung Man Lee
    • 1
  • Chol Shin
    • 2
  • Ki Yeol Lee
    • 3
  • Seung Hoon Lee
    • 1
    • 4
  1. 1.Department of Otorhinolaryngology-Head and Neck SurgeryKorea University College of MedicineSeoulKorea
  2. 2.Division of Respiratory and Critical Care Medicine, Department of Internal MedicineKorea University College of MedicineSeoulKorea
  3. 3.Department of RadiologyKorea University College of MedicineSeoulKorea
  4. 4.Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan HospitalKorea University College of MedicineAnsanKorea

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