title: Mouth breathing, "nasal disuse," and pediatric sleep-disordered breathing.
abstract: BACKGROUND
  Adenotonsillectomy (T&A) may not completely eliminate sleep-disordered breathing (SDB), and residual SDB can result in progressive worsening of abnormal breathing during sleep. Persistence of mouth breathing post-T&As plays a role in progressive worsening through an increase of upper airway resistance during sleep with secondary impact on orofacial growth.
  
  
  METHODS
  Retrospective study on non-overweight and non-syndromic prepubertal children with SDB treated by T&A with pre- and post-surgery clinical and polysomnographic (PSG) evaluations including systematic monitoring of mouth breathing (initial cohort). All children with mouth breathing were then referred for myofunctional treatment (MFT), with clinical follow-up 6 months later and PSG 1 year post-surgery. Only a limited subgroup followed the recommendations to undergo MFT with subsequent PSG (follow-up subgroup).
  
  
  RESULTS
  Sixty-four prepubertal children meeting inclusion criteria for the initial cohort were investigated. There was significant symptomatic improvement in all children post-T&A, but 26 children had residual SDB with an AHI > 1.5 events/hour and 35 children (including the previous 26) had evidence of "mouth breathing" during sleep as defined [minimum of 44 % and a maximum of 100 % of total sleep time, mean 69 ± 11 % "mouth breather" subgroup and mean 4 ± 3.9 %, range 0 and 10.3 % "non-mouth breathers"]. Eighteen children (follow-up cohort), all in the "mouth breathing" group, were investigated at 1 year follow-up with only nine having undergone 6 months of MFT. The non- MFT subjects were significantly worse than the MFT-treated cohort. MFT led to normalization of clinical and PSG findings.
  
  
  CONCLUSIONS
  Assessment of mouth breathing during sleep should be systematically performed post-T&A and the persistence of mouth breathing should be treated with MFT.
authors: Stanford Outpatient Medical Center, Stanford University Sleep Medicine Division, 450 Broadway Street, Pavilion B 2nd floor, MC 5730, Redwood City, CA, 94063-5730, USA.|Kangwon National University College of Medicine, Kanwon-do, Republic of Korea.
authors: Seo-Young
authors: SY
authors: Lee
authors: Stanford Outpatient Medical Center, Stanford University Sleep Medicine Division, 450 Broadway Street, Pavilion B 2nd floor, MC 5730, Redwood City, CA, 94063-5730, USA. cguil@STANFORD.EDU.
authors: Christian
authors: C
authors: Guilleminault
authors: Stanford Outpatient Medical Center, Stanford University Sleep Medicine Division, 450 Broadway Street, Pavilion B 2nd floor, MC 5730, Redwood City, CA, 94063-5730, USA.|Graduate Institute of Nursing College of Nursing, Taipei Medical University, Taipei, Taiwan.
authors: Hsiao-Yean
authors: HY
authors: Chiu
authors: Stanford Outpatient Medical Center, Stanford University Sleep Medicine Division, 450 Broadway Street, Pavilion B 2nd floor, MC 5730, Redwood City, CA, 94063-5730, USA.
authors: Shannon S
authors: SS
authors: Sullivan
mesh_terms: D000233:Adenoidectomy; D000403:Airway Resistance / Q000502:physiology; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009058:Mouth Breathing / Q000503:physiopathology*; D020247:Myofunctional Therapy; D017286:Polysomnography; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D012123:Pulmonary Ventilation / Q000502:physiology*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D014068:Tonsillectomy
keywords: Adenotonsillectomy; Apnea-hypopnea index worsening; Mouth breathing; Myofunctional treatment; Sleep-disordered breathing