Mouth breathing, “nasal disuse,” and pediatric sleep-disordered breathing
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Adenotonsillectomy (T&A) may not completely eliminate sleep-disordered breathing (SDB), and residual SDB can result in progressive worsening of abnormal breathing during sleep. Persistence of mouth breathing post-T&As plays a role in progressive worsening through an increase of upper airway resistance during sleep with secondary impact on orofacial growth.
Retrospective study on non-overweight and non-syndromic prepubertal children with SDB treated by T&A with pre- and post-surgery clinical and polysomnographic (PSG) evaluations including systematic monitoring of mouth breathing (initial cohort). All children with mouth breathing were then referred for myofunctional treatment (MFT), with clinical follow-up 6 months later and PSG 1 year post-surgery. Only a limited subgroup followed the recommendations to undergo MFT with subsequent PSG (follow-up subgroup).
Sixty-four prepubertal children meeting inclusion criteria for the initial cohort were investigated. There was significant symptomatic improvement in all children post-T&A, but 26 children had residual SDB with an AHI > 1.5 events/hour and 35 children (including the previous 26) had evidence of “mouth breathing” during sleep as defined [minimum of 44 % and a maximum of 100 % of total sleep time, mean 69 ± 11 % “mouth breather” subgroup and mean 4 ± 3.9 %, range 0 and 10.3 % “non-mouth breathers”]. Eighteen children (follow-up cohort), all in the “mouth breathing” group, were investigated at 1 year follow-up with only nine having undergone 6 months of MFT. The non- MFT subjects were significantly worse than the MFT-treated cohort. MFT led to normalization of clinical and PSG findings.
Assessment of mouth breathing during sleep should be systematically performed post-T&A and the persistence of mouth breathing should be treated with MFT.
KeywordSleep-disordered breathing Adenotonsillectomy Mouth breathing Myofunctional treatment Apnea-hypopnea index worsening
Dr. Seo-Young Lee was a visiting associate professor at the Stanford University Sleep Medicine Division and was financially supported by the Kangwon National University College of Medicine during her sabbatical year. We greatly appreciated advices, comments, and corrections from Dr. Stacey Quo DDS, University of California San Francisco Dental School.
This retrospective study on data rendered anonymous was approved by the IRB.
Conflict of interest
None of the authors has conflict of interest.
- 6.Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N, Kaditis AG, Splaingard D, Splaingard M, Brooks LJ, Marcus CL, Sin S, Arens R, Verhulst SL, Gozal D (2010) Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med 182:676–683CrossRefPubMedGoogle Scholar
- 11.Linder-Aronson S (1969) Dimensions of face and palate in nose breathers and habitual mouth breathers. Odontol Revy 14:187–200Google Scholar
- 12.Linder-Aronson S (1970) Adenoids. Their effect on mode of breathing and nasal airflow and their relationship to characteristics of the facial skeleton and the denition. A biometric, rhino-manometric and cephalometro-radiographic study on children with and without adenoids. Acta Otolaryngol Suppl 265:1–132PubMedGoogle Scholar
- 14.Lime M (1993) Orthognathic and orthodontic consequences of mouth breathing. Acta Otorhinolaryngol Belg 47:145–155Google Scholar
- 15.Ricketss RM (1958) Respiratory obstructions and their relation to tongue posture. Cleft Palate Bull 8:3–6Google Scholar
- 20.Chauvois A, Fournier M, Girardin F (1991) Reeducation des fonctions dans la therapeutique orthodontiques. Paris, S.I.DGoogle Scholar
- 24.Denotti G, Ventura S, Arena O, Fortini A (2014) Oral breathing: new early treatment protocol. JP J Pediatr Neonatal Individualized Med 3:e030108Google Scholar
- 25.Villa MP, Brasili L, Ferretti A, Vitelli O, Rabasco J, Mazzotta AR, Pietropaoli N, Martella S (2014) Oropharyngeal exercises to reduce symptoms of OSA after AT. Sleep Breath. doi: 10.1007/-s11325-014-1011
- 26.Guilleminault C, Sullivan SS (2014) Toward restauration of continuous nasal breathing as the ultimate treatment goal in pediatric obstructive sleep apnea. Pediatr Neonatol Biol 1:1–7Google Scholar
- 27.Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, Kushida C (2014) Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep (in press)Google Scholar
- 32.Carrillo O, Sullivvan SS, Blake J (2010) A novel method for detecting oral breathing during PSG. Sleep 33 supplA139 (abstract)Google Scholar
- 33.Iber C, Ancoli-Israel S, Chesson AL, Jr., Quan SF. for the American Academy of Sleep Medicine (addended Berry RB, Brooks R, Gamaldo CE). (2012) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Version 2.0. www.aasmnet.org, Darian Ill: American Academy of Sleep Medicine