The Mechanics of Mouth-Breathing and Its Role in Nasal and Sleep Disorders

Howard Stupak

doi:10.5152/ejra.2023.22078

The Mechanics of Mouth-Breathing and Its Role in Nasal and Sleep Disorders

Abstract

Objective: This study was done to investigate the causal links between malocclusion, tongue tone, and jaw structure and the initiation of apneic/hypopneic events during sleep. Structural causes of strain on the lips and downstream tongue collapse were tested using physical models. Methods: Distinct models were used to break down the sequence of apneic events. First, the establishment of the lips as a resting closure mechanism of the mouth was tested. Next, a tongue tone model was used to determine the force required to prevent collapse into the pharynx. Finally, a pharyngeal model was used to evaluate differential negative pressure zones during collapse. Results: The lips may be the primary closure structure of the mouth due to mechanical advantage. The least radial strain placed on the lips permitted better mouth closure. There is a threshold that is required to maintain oral position of the tongue without collapse and resultant buildup of pharyngeal negative pressure. Conclusions: Apneic/hypopneic events can be simplified to 3 steps: (1) failure of mouth closure due to strain upon the lips, (2) release of tongue restraint by oral compression or intrinsic tongue tone causes collapse, and (3) partial or complete tongue collapse into the pharynx causes a distal negative pressure surge.

Keywords

References

Grippaudo C, Paolantonio EG, Antonini G, Saulle R, La Torre G, Deli R. Association between oral habits, mouth breathing and malocclusion. Acta Otorhinolaryngol Ital. 2016;36(5):386-394.
Juliano ML, Machado MA, Carvalho LB, Prado LB, do Prado GF. Mouth breathing children have cephalometric patterns similar to those of adult patients with obstructive sleep apnea syndrome. Arq Neuro Psiquiatr. 2009;67(3B):860-865.
Koutsourelakis I, Vagiakis E, Roussos C, Zakynthinos S. Obstructive sleep apnoea and oral breathing in patients free of nasal obstruction. Eur Respir J. 2006;28(6):1222-1228.
Flores-Mir C, Korayem M, Heo G, Witmans M, Major MP, Major PW. Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome: a systematic review and meta-analysis. J Am Dent Assoc. 2013;144(3):269-277.
Nogami Y, Saitoh I, Inada E, et al. Lip-closing strength in children is enhanced by lip and facial muscle training. Clin Exp Dent Res. 2022;8(1):209-216.
Lee SY, Guilleminault C, Chiu HY, Sullivan SS. Mouth breathing, “nasal disuse,” and pediatric sleep-disordered breathing. Sleep Breath. 2015;19(4):1257-1264.
Kar M, Muluk NB, Bafaqeeh SA, Cingi C. Is it possible to define the ideal lips? Acta Otorhinolaryngol Ital. 2018;38(1):67-72.
Tosello DO, Vitti M, Berzin F. EMG activity of the orbicularis oris and mentalis muscles in children with malocclusion, incompetent lips and atypical swallowing--part I. J Oral Rehabil. 1998;25(11):838-846.

Saccomanno S, Deli R, Di Cintio G, DE Corso E, Paludetti G, Grippaudo C. Retrospective epidemiological study of mandibular rotational types in patients with orthodontical malocclusion. Acta Otorhinolaryngol Ital. 2018;38(2):160-165.
Pereira TC, Furlan RMMM, Motta AR. Relationship between mouth breathing etiology and maximum tongue pressure. CoDAS. 2019;31(2):e20180099.
Suzuki M, Tanuma T. The effect of nasal and oral breathing on airway collapsibility in patients with obstructive sleep apnea: computational fluid dynamics analyses. PLoS One. 2020;15(4):e0231262.
Stupak HD, Park SY. Gravitational forces, negative pressure and facial structure in the genesis of airway dysfunction during sleep: a review of the paradigm. Sleep Med. 2018;51:125-132.
Rues S, Lenz J, Türp JC, Schweizerhof K, Schindler HJ. Muscle and joint forces under variable equilibrium states of the mandible. Clin Oral Investig. 2011 October;15(5):737-747.
Kijak E, Margielewicz J, Gąska D, Lietz-Kijak D, Więckiewicz W. Identification of mastication organ muscle forces in the biocybernetic perspective. BioMed Res Int. 2015;2015:436595.
D'Andrea E, Barbaix E. Anatomic research on the perioral muscles, functional matrix of the maxillary and mandibular bones. Surg Radiol Anat. 2006;28(3):261-266.
Yang SF, Xie Y, Kim JC. Outcomes of facial symmetry and tone at rest after masseteric-to-facial nerve transfer. Facial Plast Surg Aesthet Med. 2021;23(5):357-361
Ikävalko T, Tuomilehto H, Pahkala R, et al. Craniofacial morphology but not excess body fat is associated with risk of having sleep-disordered breathing—the PANIC Study (a questionnaire-based inquiry in 6-8-year-olds). Eur J Pediatr. 2012;171(12):1747-1752.
Souki BQ, Lopes PB, Pereira TB, Franco LP, Becker HM, Oliveira DD. Mouth breathing children and cephalometric pattern: does the stage of dental development matter? Int J Pediatr Otorhinolaryngol. 2012;76(6):837-841.
Anderson S, Alsufyani N, Isaac A, Gazzaz M, El-Hakim H. Correlation between gonial angle and dynamic tongue collapse in children with snoring/sleep disordered breathing - an exploratory pilot study. J Otolaryngol Head Neck Surg. 2018;47(1):41.
Huynh NT, Morton PD, Rompré PH, Papadakis A, Remise C. Associations between sleep-disordered breathing symptoms and facial and dental morphometry, assessed with screening examinations. Am J Orthod Dentofacial Orthop. 2011;140(6):762-770.
Wang SH, Keenan BT, Wiemken A, et al. Effect of weight loss on upper airway anatomy and the apnea-hypopnea index. The importance of tongue fat. Am J Respir Crit Care Med. 2020;201(6):718-727.
Kohno A, Kitamura Y, Kato S, et al. Displacement of the hyoid bone by muscle paralysis and lung volume increase: the effects of obesity and obstructive sleep apnea. Sleep. 2019;42(1):zsy198.
Kulkas A, Duce B, Leppänen T, Hukins C, Töyräs J. Severity of desaturation events differs between hypopnea and obstructive apnea events and is modulated by their duration in obstructive sleep apnea. Sleep Breath. 2017;21(4):829-835.
Koo SK, Park GH, Koh TK, Jung SH, Lee HB, Ji CL. Effect of mouth closure on upper airway obstruction in patients with obstructive sleep apnoea exhibiting mouth breathing: a drug-induced sleep endoscopy study. Eur Arch Otorhinolaryngol. 2020;277(6):1823-1828.
Huang TW, Young TH. Novel porous oral patches for patients with mild obstructive sleep apnea and mouth breathing: a pilot study. Otolaryngol Head Neck Surg. 2015;152(2):369-373.

Details

Primary Language

English

Subjects

Otorhinolaryngology

Journal Section

Research Article

Authors

Howard Stupak This is me
0000-0001-7946-9650
United States

Publication Date

April 30, 2023

Submission Date

September 9, 2022

Acceptance Date

October 13, 2022

Published in Issue

Year 2023 Volume: 6 Number: 1

DOI

https://doi.org/10.5152/ejra.2023.22078

IZ

https://izlik.org/JA96RK86LJ

Cite

RIS / Bibtex

APA

Stupak, H. (2023). The Mechanics of Mouth-Breathing and Its Role in Nasal and Sleep Disorders. European Journal of Rhinology and Allergy, 6(1), 21-27. https://doi.org/10.5152/ejra.2023.22078

AMA

1.Stupak H. The Mechanics of Mouth-Breathing and Its Role in Nasal and Sleep Disorders. Eur J Rhinol Allergy. 2023;6(1):21-27. doi:10.5152/ejra.2023.22078

Chicago

Stupak, Howard. 2023. “The Mechanics of Mouth-Breathing and Its Role in Nasal and Sleep Disorders”. European Journal of Rhinology and Allergy 6 (1): 21-27. https://doi.org/10.5152/ejra.2023.22078.

EndNote

Stupak H (April 1, 2023) The Mechanics of Mouth-Breathing and Its Role in Nasal and Sleep Disorders. European Journal of Rhinology and Allergy 6 1 21–27.

IEEE

[1]H. Stupak, “The Mechanics of Mouth-Breathing and Its Role in Nasal and Sleep Disorders”, Eur J Rhinol Allergy, vol. 6, no. 1, pp. 21–27, Apr. 2023, doi: 10.5152/ejra.2023.22078.

ISNAD

Stupak, Howard. “The Mechanics of Mouth-Breathing and Its Role in Nasal and Sleep Disorders”. European Journal of Rhinology and Allergy 6/1 (April 1, 2023): 21-27. https://doi.org/10.5152/ejra.2023.22078.

JAMA

1.Stupak H. The Mechanics of Mouth-Breathing and Its Role in Nasal and Sleep Disorders. Eur J Rhinol Allergy. 2023;6:21–27.

MLA

Stupak, Howard. “The Mechanics of Mouth-Breathing and Its Role in Nasal and Sleep Disorders”. European Journal of Rhinology and Allergy, vol. 6, no. 1, Apr. 2023, pp. 21-27, doi:10.5152/ejra.2023.22078.

Vancouver

1.Howard Stupak. The Mechanics of Mouth-Breathing and Its Role in Nasal and Sleep Disorders. Eur J Rhinol Allergy. 2023 Apr. 1;6(1):21-7. doi:10.5152/ejra.2023.22078