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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
Roshini Claire Anthony, 4 days ago

Beta-blockers could reduce mortality risk in patients with heart failure with reduced ejection fraction (HFrEF) and moderate or moderately-severe renal dysfunction without causing harm, according to the BB-META-HF* trial presented at ESC 2019.

Stephen Padilla, 5 days ago
Implementation of the collaborative care in a rheumatoid arthritis (RA) clinic has led to improvements in nonbiologic disease-modifying antirheumatic drugs (nb-DMARDs) optimization, adherence to safety recommendations on nb-DMARD monitoring and detection of adverse drug events in RA patients, according to a Singapore study.
Pearl Toh, 6 days ago
Use of menopausal hormone therapy (MHT) was associated with a significantly increased risk of invasive breast cancer, which became progressively greater with longer duration of use, a meta-analysis of worldwide prospective epidemiological studies has shown.
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Blood pressure (BP) in children is influenced by early-life exposure to several chemicals, built environment and meteorological factors, suggests a study.