Hypopnea, Sleep
Conditions
Keywords
Obstructive sleep apnea, Mouth breathing, Upper airway, Drug-induced sleep endoscopy
Brief summary
Mouth breathing is associated with increased airway resistance, pharyngeal collapsibility, and obstructive sleep apnea (OSA) severity. It is commonly believed that closing the mouth can mitigate the negative effects of mouth breathing during sleep. However, the investigators propose that mouth breathing serves as an essential route bypassing obstruction along the nasal route (e.g., velopharynx). The present study investigates the role of mouth breathing as an essential route in some OSA patients and its association with upper airway anatomical factors. Participants underwent drug-induced sleep endoscopy (DISE) with simultaneous pneumotach airflow measurements through the nose and mouth separately. During the DISE procedure, alternating mouth closure (every other breath) cycles were performed during flow-limited breathing. The investigators evaluated the overall effect mouth closure on inspiratory airflow, and the change in inspiratory airflow with mouth closure across three mouth-breathing quantiles. The investigators also evaluated if velopharyngeal obstruction was associated with mouth breathing and a negative airflow response to mouth closure.
Interventions
OTHERMouth closure
Closing the mouth during sleep by applying pressure to the mentum until the teeth were in occlusion, without altering the head position.
Sponsors
Brigham and Women's Hospital
Massachusetts Eye and Ear Infirmary
National Heart, Lung, and Blood Institute (NHLBI)
Study design
Allocation
NON_RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 89 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosed obstructive sleep apnea (AHI \> 5 events/h). * Scheduled to undergo clinical drug-induced sleep endoscopy.
Exclusion criteria
* pregnancy * age under 18 years * poor general health * allergy to propofol or dexmedetomidine * history of surgical treatment for sleep apnea, such as palate, tongue base, or epiglottis surgery.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total inspiratory flow | 1 day - the intervention of mouth closure on the outcome is applied acutely on alternating breaths, such that the effect of mouth closure is assessed based on the experiment which occurs in a single day. | Change in airflow in the transition from mouth relaxed to mouth closed (intervention). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in total inspiratory airflow with mouth closure | 1 day - the intervention of mouth closure is applied acutely on alternating breaths, such that the effect of mouth closure on the outcome is assessed based on the experiment which occurs in a single day. | We analyzed the change in total inspiratory flow within three quantiles of roughly equal sample sizes based on oral breathing; quantile 1: oral airflow \<0.05 L/min, quantile 2: oral airflow between 0.05 and 2.2 L/min, and quantile 3: oral airflow \>2.2 L/min. We also analyzed the effect of velopharyngeal obstruction on the change in total inspiratory airflow. |
Countries
United States
Outcome results
None listed