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Mouth breathing during oronasal CPAP may compromise treatment efficacy

05 Jul 2019

Oronasal continuous positive airway pressure (CPAP) functions less effectively in mouth breathers and when positive pressure is transmitted through the mouth, a study has found.

Researchers monitored 13 obstructive sleep apnoea (OSA) patients, who were well adapted to oronasal CPAP, using full polysomnography, pharyngeal pressure catheter and nasoendoscope. In sleep, patients received low doses of midazolam via an oronasal mask with sealed nasal and oral compartments.

CPAP was titrated during oronasal and nasal routes, then decreased to generate stable flow limitation and abruptly switched to the alternate route. Pressure transmission to the oral cavity was blocked using a tape sealing the mouth.

Best titrated CPAP was markedly better in oronasal than nasal route (p=0.005), and patients who breathed through their mouths >25 percent (n=5) failed to achieve stable breathing during oronasal CPAP.

During stable flow limitation, oronasal route was associated with lower inspiratory peak flow, higher driving pressure, higher upper airway inspiratory resistance, and retropalatal and retroglossal area as compared with nasal route (p<0.05 for all comparisons). Differences were seen even among patients with no oral flow, but it disappeared when a tape sealing the mouth was used (n=6).

Another study has reported that open-mouth breathing significantly narrows the retropalatal and retroglossal areas, lengthens the pharynx, and shortens the mandible and hyoid bone. These changes are said to contribute to the understanding of the increase in OSA severity and low adherence to nasal CPAP therapy in mouth breathers. [Laryngoscope 2007;117:1102-1106]

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Most Read Articles
Pearl Toh, 31 Dec 2019
Adding the neuraminidase inhibitor oseltamivir to usual care speeds up recovery from influenza-like illness by a day compared with usual care alone, with even greater benefits seen in older, sicker patients with comorbidities, according to the ALIC4E study.
09 Jan 2020
Acute ischaemic stroke patients who are current or recent smokers are at greater odds of having unfavourable functional outcomes 3 months after the index event, a study has found.
Stephen Padilla, 2 days ago
Brodalumab has exhibited long-term efficacy and consistent safety profile for more than 2 years in the treatment of patients with psoriasis, results of the phase III AMAGINE-2 trial show.
2 days ago
Anaemia increases mortality risk in heart failure (HF) patients across the ejection fraction (EF) spectrum, a recent study has found. The effect appears to be stronger in preserved (HFpEF) and midrange (HFmrEF) than in reduced (HFrEF) EF disease.