Breathing Re-Education and Phenotypes of Sleep Apnea: A Review

Abstract

Four phenotypes of obstructive sleep apnea hypopnea syndrome (OSAHS) have been identified. Only one of these is anatomical. As such, anatomically based treatments for OSAHS may not fully resolve the condition. Equally, compliance and uptake of gold-standard treatments is inadequate. This has led to interest in novel therapies that provide the basis for personalized treatment protocols. This review examines each of the four phenotypes of OSAHS and explores how these could be targeted using breathing re-education from three dimensions of functional breathing: biochemical, biomechanical and resonant frequency. Breathing re-education and myofunctional therapy may be helpful for patients across all four phenotypes of OSAHS. More research is urgently needed to investigate the therapeutic benefits of restoring nasal breathing and functional breathing patterns across all three dimensions in order to provide a treatment approach that is tailored to the individual patient.

Mouth puffing phenomena of patients with obstructive sleep apnea when mouth-taped: device’s efficacy confirmed with physical video observation

“…A plausible explanation for the phenomenon is that when the patient breathes with the mouth, the ODI drops or fluctuates, which engenders a higher standard deviation of SpO 2 , a lower mean SpO 2 , and a higher T90 during sleep. After a period of apnea a big mouth breathe often occurs as if the patient is trying to catch up after being deprived of oxygen [10,26].…”

Prevalence of Obstructive Sleep Apnea Syndrome: A Single-Center Retrospective Study

“…However, this has significant physical and psychological drawbacks such as xerostomia, throat dryness, difficulty on handling such equipment during sleep, nasal obstruction, etc. [ 22 , 23 ]. However, several evidence in the literature reports the need, especially in young subjects, for a tailored OSAS treatment, which is facilitated by innovative methods such as drug-induced sleep endoscopy and robotic surgery [ 24 , 25 ].…”

Improving Adherence to Myofunctional Therapy in the Treatment of Sleep-Disordered Breathing

“…MT is a promising treatment for SDB and is based on daily exercises to strengthen the oropharyngeal muscles and facilitate the opening of the airway [6][7][8][9][10][11][12][13]. However, the main drawbacks of MT are the low adherence, which has been reported to be as low as 10% [18][19][20][21], and the absence of objective feedback [9,11,12].…”

“…As mentioned above, because OSAHS originates from the suboptimal function of the dilator muscles of the airway, MT is designed, theoretically, to treat the mechanism underlying this disease. Several papers have reported its effectiveness, including randomized controlled trials, meta-analyses, and reviews [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

“…In most cases, patients complete the exercises independently at home without substantial feedback and without providing precise information about their performance of the exercises to the therapist. Thus, the main drawback of MT is the low patient adherence, which has been reported to be as low as 10% in some investigations [18][19][20][21].…”