Mouth breathing, particularly during sleep, can have significant long-term effects on facial development and increase the risk of obstructive sleep apnea (OSA). Various studies have documented how mouth breathing affects the structure of the face and airways, leading to a range of health issues.
Mouth breathing causes the tongue to rest in a low, downward position, creating an airspace which allows the person to breathe more freely. Normally, the tongue should rest against the roof of the mouth, helping to shape the palate and jaw correctly. When the tongue is not in its proper position, it can lead to the underdevelopment of the jaws and a high vaulted palate (collapsed palate). This abnormal development restricts the upper nasal airways, making it harder to breathe through the nose.
Let us now examine some comprehensive scientific studies that show the link between mouth breathing, facial development, and sleep apnea.
A study by Kim et al. investigated the impact of open-mouth breathing on the upper airway space in patients with obstructive sleep apnea (OSA) using three-dimensional multi-detector computed tomography (3-D MDCT). The findings revealed that that the airway becomes more elongated and narrower when the mouth is open, which can increase the collapsibility of the upper airway and worsen the severity of OSA. Thus, underscoring the importance of maintaining nasal breathing to reduce airway collapsibility and manage OSA effectively
One notable study explored the relationship between oral breathing and nasal obstruction in patients with obstructive sleep apnea (OSA) (Ohki et al., 1996). The researchers measured the nasal fraction of total respiratory air volume in 30 normal subjects and 20 patients with snoring or sleep apnea. They found that patients with higher nasal respiratory resistance were more likely to switch from nasal to oral breathing, despite not always perceiving nasal obstruction. This switch to mouth breathing can exacerbate OSA symptoms by increasing airway collapsibility during sleep. The study suggests that chronic nasal obstruction is a significant factor contributing to OSA, as it forces patients to breathe through their mouths, thereby worsening the condition.
An important study by Lee et al., 2007 assessed the effect of open-mouth breathing on upper airway anatomy using lateral cephalometry and fiberoptic nasopharyngoscopy. This cross-sectional study involved 28 subjects with a mean age of 36.7 years. The researchers compared the anatomical changes in the upper airway when the mouth was open versus closed. They found that open-mouth breathing significantly reduced the retropalatal and retroglossal distances and increased the pharyngeal length. The study also suggests that these changes can complicate nasal continuous positive airway pressure (CPAP) therapy, leading to lower adherence among mouth breathers.
One comprehensive review focused on the diagnostic and treatment implications of nasal obstruction in snoring and obstructive sleep apnea (OSA) (Scharf & Cohen, 1998). It emphasized that nasal obstruction in predisposed individuals often leads to sleep fragmentation, nocturnal mouth breathing, and snoring, which can ultimately result in OSA. The review underscored that breathing through the nose is the preferred route during sleep. Therefore, nasal obstruction forces individuals to breathe through their mouths, exacerbating sleep disturbances and increasing the risk of OSA.
A study by Wasilewska & Kaczmarski in 2010 focused on obstructive sleep apnea-hypopnea syndrome (OSAHS) in children. The study emphasized that when children experience nocturnal breathing difficulties, snoring, and apnea events. It could lead to daytime symptoms such as fatigue, mouth breathing, concentration problems, irritability, and hyperactivity.
Rappai et al. examined the relationship between sleep-disordered breathing (SDB) and nasal obstruction. This review analyzed data from studies involving normal control subjects, patients with isolated nasal obstruction, and those with SDB. The findings indicate that nasal obstruction can both cause and exacerbate SDB. The study stated that in children, chronic mouth breathing due to nasal obstruction can result in facial structural abnormalities associated with SDB. The review suggests that oronasal breathing, which often results from chronic nasal conditions, serves as a common pathway leading to SDB.
One study highlighted the impact of neuromuscular diseases on sleep, emphasizing the critical role of breathing during sleep (Culebras, 2005). This research reinforces the importance of addressing all factors that can affect breathing during sleep, including mouth breathing.
Knowing this, it is crucial to take steps to breathe nasally and properly in order to avoid sleep issues. Dr. Patrick McKeown, a world-renowned breathing expert, offers a range of effective online breathing courses that have been proven to eliminate sleep disordered breathing and bolster your overall health. He also offers a free online breathing course for kids, designed to help parents inculcate healthy breathing habits in their children.
Furthermore, you can visit our MyoTape online shop to learn about out safe, gentle, and effective mouth tapes for sleeping.
References:
Culebras A. Long- face syndrome and upper airways obstruction. Sleep disorders and neurological disease. 2005 : 242-243.
Kim EJ, Choi JH, Kim KW, Kim TH, Lee SH, Lee HM, Shin C, Lee KY, Lee SH.
The impacts of open-mouth breathing on upper airway space in obstructive sleep apnea: 3-D MDCT analysis. Eur Arch Otorhinolaryngol. 2010 Oct 19.
Lee SH, Choi JH, Shin C, Lee HM, Kwon SY, Lee SH. How does open-mouth breathing influence upper airway anatomy? Laryngoscope. 2007 Jun;117(6):1102-6.
Ohki M, Usui N, Kanazawa H, Hara I, Kawano K. Relationship between oral breathing and nasal obstruction in patients with obstructive sleep apnea. Acta Otolaryngol Suppl. 1996;523:228-30.
Scharf MB, Cohen AP Diagnostic and treatment implications of nasal obstruction in snoring and obstructive sleep apnea. Ann Allergy Asthma Immunol. 1998 Oct;81(4):279-87; quiz 287-90.
Wasilewska J, Kaczmarski M Obstructive sleep apnea-hypopnea syndrome in children [Article in Polish] Wiad Lek. 2010;63(3):201-12.
