Effect of treating severe nasal obstruction on the severity of obstructive sleep apnoea

McLean, Heather; Urton, A M; Driver, Helen S.; Tan, Alfonse; Day, Andrew G.; Munt, Peter W.; Fitzpatrick, Michael

doi:10.1183/09031936.05.00045004

Cited by 124 publications

(89 citation statements)

References 40 publications

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“…Mouth breathing during the growth phase is an important factor responsible for a sequence of events that commonly result in growth changes and abnormalities of cranial and maxillomandibular development 14 . An association between mouth breathing during sleep and increased propensity for upper airway collapse has been well documented 20 . Moreover, there seems to be a correlation between the anatomical shape of the upper airways and abnormalities in craniofacial morphology among mouth breathing individuals 21 .…”

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confidence: 99%

“…Children with abnormal craniofacial patterns show a predisposition towards some types of respiratory sleep disorder, as do children with tonsillar and adenoid hypertrophy. These factors favor the development of mouth breathing 10,20 . Mouth breathing during the growth phase is an important factor responsible for a sequence of events that commonly result in growth changes and abnormalities of cranial and maxillomandibular development 14 .…”

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Mouth breathing children have cephalometric patterns similar to those of adult patients with obstructive sleep apnea syndrome

Juliano

Machado

Carvalho

et al. 2009

Arq. Neuro-Psiquiatr.

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-Objective: To determine whether mouth breathing children present the same cephalometric patterns as patients with obstructive sleep apnea syndrome (OSAS). Method: Cephalometric variables were traced and measured on vertical lateral cephalometric radiographs. The cephalometric measurements of 52 mouth and 90 nose breathing children were compared with apneic patients. The children had not undergone adenoidectomy or tonsillectomy and had not had or were not receiving orthodontic or orthopedic treatment. Results: Mouth breathing children showed same cephalometric pattern observed in patients with OSAS: a tendency to have a retruded mandible (p=0.05), along with greater inclination of the mandibular and occlusal planes (p<0.01) and a tendency to have greater inclination of the upper incisors (p=0.08). The nasopharyngeal and posterior airway spaces were greatly reduced in mouth breathing children, as observed in patients with apnea (p<0.01). Conclusion: Mouth breathing children present abnormal cephalometric parameters and their craniofacial morphology resembles that of patients with OSAS.Key WOrdS: cephalometry, mouth breathing, obstructive sleep apnea.crianças respiradoras bucais apresentam padrão cefalométrico semelhante àquele observado em pacientes adultos com síndrome da apnéia obstrutiva do sono resumo -Objetivo: determinar se crianças respiradoras bucais apresentam o mesmo padrão cefalométrico que os pacientes que tem síndrome da apnéia obstrutiva do sono (SAOS). Método: Foram traçadas radiografias laterais verticais da cabeça para a mensuração das variáveis cefalométricas. As medidas cefalométricas de 52 crianças respiradoras bucais e de 90 crianças respiradoras nasais foram comparadas à de pacientes com apnéia. Foram excluídas as crianças que haviam sido submetidas à cirurgia de remoção de amídalas ou adenóides, ou que haviam recebido tratamento ortodôntico prévio ou em andamento. Resultados: As crianças respiradoras bucais apresentaram o mesmo padrão cefalométrico observado em pacientes com SAOS: tendência a ter retrusão de mandíbula (p=0,05), assim como uma maior inclinação dos planos mandibular e oclusal (p<0,01) e tendência a ter maior inclinação dos incisivos superiores (p=0,08). O espaço da nasofaringe e o espaço aéreo posterior se apresentaram muito diminuídos nas crianças respiradoras bucais, como é observado em pacientes com SAOS (p<0,01). Conclusão: Crianças respiradoras bucais apresentam padrão cefalométrico alterado e sua morfologia craniofacial é semelhante àquela observada em pacientes com SAOS.PAlAvrAS-ChAve: cefalometria, respiração bucal, apnéia obstrutiva do sono. Obstructive sleep apnea syndrome (OSAS) in adults is characterized by repeated episodes of cessation of breathing during sleep. These episodes result from obstruction of the upper airways, which collapse at different levels ranging from the nasal fossae to the lower portion of the hypopharynx 1 . The nocturnal symptoms include snoring, restless sleep, frequent arousals, apneas and excessive sweating. The daytime problems...

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confidence: 99%

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confidence: 99%

Mouth breathing children have cephalometric patterns similar to those of adult patients with obstructive sleep apnea syndrome

Juliano

Machado

Carvalho

et al. 2009

Arq. Neuro-Psiquiatr.

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“…Mouth opening is associated with increased upper airway collapsibility during sleep. 1 It has been reported that upper airway collapsibility and resistance during sleep were significantly higher in subjects who were breathing through the mouth than in those who were breathing through the nose, which is different from that seen during the conscious state. 2,3 Other reasons for nasal breathing over mouth breathing during normal sleep are based on the physiological effects of decreased nasal airflow.…”

Section: Of Patterns the Nasal Airway And Sdbmentioning

confidence: 40%

“…However, in nasal diseases such as nasal deviation or inferior turbinate hypertrophy, nasal obstruction can be bypassed by opening the mouth and allowing a greater volume of air to be inspired and expired. McLean et al 1 showed that oral breathing during sleep is induced by increased nasal resistance. Mouth opening increased upper airway collapsibility during sleep, which is different from that seen when awake.…”

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Relationship between Oral Flow Patterns, Nasal Obstruction, and Respiratory Events during Sleep

Suzuki

Furukawa

Sugimoto

et al. 2015

Journal of Clinical Sleep Medicine

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We conducted an observational cross-sectional study of 85 Japanese adult patients examined by our sleep laboratory for Study Objectives: Sleep breathing patterns are altered by nasal obstruction and respiratory events. This study aimed to describe the relationships between specifi c sleep oral fl ow (OF) patterns, nasal airway obstruction, and respiratory events. Methods: Nasal fl ow and OF were measured simultaneously by polysomnography in 85 adults during sleep. OF was measured 2 cm in front of the lips using a pressure sensor. Results: OF could be classifi ed into three patterns: postrespiratory event OF (postevent OF), during-respiratory event OF (during-event OF), and spontaneous arousal-related OF (SpAr-related OF). Postevent OFs begin at the end of airfl ow reduction, are preceded by respiratory arousal, and are accompanied by postapneic hyperventilation; duringevent OFs occur during nasal fl ow reduction; and SpAr-related OFs to OF begin during stable breathing, and are preceded by spontaneous arousal but are rarely accompanied by apnea/hypopnea. Multivariate regression showed that nasal obstruction was predictive of SpAr-related OF. The relative frequency of SpAr-related OF events was negatively correlated with the apnea-hypopnea index. The fraction of SpAr-related OF duration relative to total OF duration was signifi cantly greater in patients with nasal obstruction than in those without. Conclusions: SpAr-related OF was associated with nasal obstruction, but not respiratory events. This pattern thus functions as a "nasal obstruction bypass", mainly in normal subjects and patients with mild sleep disordered breathing (SDB). By contrast, the other two types were related to respiratory events and were typical patterns seen in patients with moderate and severe SDB. 1 showed that oral breathing during sleep is induced by increased nasal resistance. Mouth opening increased upper airway collapsibility during sleep, which is different from that seen when awake.2 Fitzpatrick et al. 3 confi rmed that during sleep, upper airway resistance during oral breathing was 2.5 times higher than that during nasal breathing. Mouth opening may be associated with narrowing of the pharyngeal lumen and decreases in the retroglossal diameter. Mouth opening and oral breathing may, but not necessarily, lead to hypopnea or apnea. However, Lavie et al. 4 showed that nasal obstruction caused a signifi cant increase in the number of arousals during sleep in patients with nonapneic breathing disorders. In another recent study, Hsia et al.5 described a snoring pattern during nasal breathing in patients with nasal obstruction that was alleviated with oral breathing.Against this background, we hypothesized that different kinds of oral fl ow (OF) patterns exist during sleep and are associated with distinct sleep related respiratory events. The BRIEF SUMMARYCurrent Knowledge/Study Rationale: The relationship between oral fl ow (OF) patterns, nasal obstruction, and obstructive respiratory events is unclear. We hypothesized that specifi c O...

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“…CPAP can worsen the congestion and exacerbate the problem. 18 Increased nasal resistance may lead to mouth opening and oral breathing, 19 which are associated with a significantly higher upper airway resistance than nasal breathing. 20 Oral breathing may also be associated with higher air leak, which itself has been linked to lower CPAP adherence.…”

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confidence: 99%

Impact of Randomization, Clinic Visits, and Medical and Psychiatric Cormorbidities on Continuous Positive Airway Pressure Adherence in Obstructive Sleep Apnea

Budhiraja

Kushida

Nichols

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives:To evaluate factors associated with continuous positive airway pressure (CPAP) adherence in patients with obstructive sleep apnea (OSA) in the Apnea Positive Pressure Long-term Efficacy Study (APPLES) cohort. Methods: The data from a prospective 6-mo multicenter randomized controlled trial with 558 subjects randomized to active CPAP and 547 to sham CPAP were analyzed to assess adherence to CPAP during first 2 mo (early period) and during months 5-6 (late period). Results: Participants randomized to active CPAP had higher hours of nightly adherence compared to the sham CPAP group at both 2 (4.9 ± 2.0 h versus 4.07 ± 2.14 h, p < 0.001) and 6 mo (4.70 ± 2.08 h versus 3.41 ± 2.19 h, p < 0.001). Those assigned to sham CPAP were more likely to correctly identify their treatment group (70.0% versus 55.2%, p < 0.001). Irrespective of treatment group assignment, those who believed they were receiving active CPAP had higher hours of adherence than those who thought they were in the sham CPAP group at both 2 mo (4.91 ± 2.01 versus 4.17 ± 2.17, p < 0.001) and 6 mo (4.65 ± 2.10 versus 3.65 ± 2.22, p < 0.001). Among those randomized to active CPAP, older age was significantly related to CPAP use > 4 h per night. Presence of cardiovascular disorders was associated with higher hours of CPAP use, whereas presence of anxiety was associated with a trend toward lower hours of CPAP use. Presence of nasal congestion was associated with a decrease in mean daily CPAP use between the early and the late adherence period. The adherence during the week prior to a clinic visit was higher than the average adherence during the 2-mo period prior to the visit. Conclusions: Randomization to active therapy, belief that one is in the active treatment group, older age, and possibly presence of cardiovascular disorders are positively linked to CPAP adherence. Nasal congestion and anxiety are negatively associated with CPAP adherence. CPAP nightly usage increases as clinic visits approach. Keywords: adherence, age, comorbid, compliance, continuous positive airway pressure, CPAP, medical disorders, obstructive sleep apnea, psychiatric disorders, race, sex, sleep disordered breathing Citation: Budhiraja R, Kushida CA, Nichols DA, Walsh JK, Simon RD, Gottlieb DJ, Quan SF. Impact of randomization, clinic visits, and medical and psychiatric cormorbidities on continuous positive airway pressure adherence in obstructive sleep apnea. J Clin Sleep Med 2016;12(3):333-341. I NTRO DUCTI O NObstructive sleep apnea (OSA) is a common disorder, 1 and continuous positive airway pressure (CPAP) therapy continues to be the first-line treatment for the majority of patients with OSA. This therapy is associated with multiple salutary effects including improvement in daytime sleepiness, reduction in blood pressure 2 and improvement in diabetic control. However, poor adherence to CPAP continues to be a major impediment to effective therapy of this disorder. Long-term adherence to CPAP of greater than 4 h per night is achieved by only 50% to 70% of patients....

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Effect of treating severe nasal obstruction on the severity of obstructive sleep apnoea

Cited by 124 publications

References 40 publications

Mouth breathing children have cephalometric patterns similar to those of adult patients with obstructive sleep apnea syndrome

Mouth breathing children have cephalometric patterns similar to those of adult patients with obstructive sleep apnea syndrome

Relationship between Oral Flow Patterns, Nasal Obstruction, and Respiratory Events during Sleep

Impact of Randomization, Clinic Visits, and Medical and Psychiatric Cormorbidities on Continuous Positive Airway Pressure Adherence in Obstructive Sleep Apnea

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