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Mouth breathing, “nasal dis-use” and pediatric sleep-disordered-breathing

Seo-Young Lee* , Christian Guilleminault, Hsiao-Yean Chiu,**, Shannon S. SullivanIn Press: Sleep and Breathing (2015)


Background: 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.

Methods: 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 one year post surgery. Only a limited subgroup followed the recommendations to undergo MFT with subsequent PSG (follow-up subgroup).

Results: 64 pre-pubertal 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 9 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.

Conclusion: Assessment of mouth breathing during sleep should be systematically performed post T&A and the persistence of mouth breathing should be treated with MFT.

Model of oronasal rehabilitation in children with obstructive sleep apnea syndrome undergoing rapid maxillary expansion: Research review