The majority of us don’t think of the nose as the primary organ that facilitates breathing and is a part of our airway anatomy. That is until we have a cold and suffer nasal congestion, and then we become conscious the role the nose plays in breathing.
Nasal breathing provides us with more than a sense of smell. Nasal breathing helps with oxygen absorption by our lungs [1], warms and humidifies the air we breathe before it reaches the lower airway, and helps filter impurities from the air.
When nasal breathing does not occur due to congestion, allergies, or other forms of nasal obstruction the body is forced to mouth breathe, this is necessary because getting oxygen into our blood is needed for survival. Mouth breathing is not normal, mouth breathing is known to lead to facial structure changes, and skeletal alignment issues this is because a common sleeping position for mouth breathers is a forward head posture, this is in order to mouth breath better, the oral airway needs to be aligned with the trachea, this produces a chin up, head extended position. Other issues associated with mouth breathing include dental tooth decay, gum disease and chronic bad breathe.
Regardless of the cause(s), nasal obstruction can have serious health consequence, and be a treatment barrier for those prescribed CPAP for the treatment of Obstructive Sleep Apnea (OSA).
CPAP is the most common treatment prescribed for OSA however, very difficult to tolerate especially if nasal breathing is a problem. The CPAP is creating an airway splint via the nose forcing a continuous flow of air through the airway and keeping in efforts to keep the airway open. if the nasal cavity is compromised by congestion, the mouth will open and the CPAP air flow escapes through the mouth resulting in no treatment.
Fullface mask is often the solution offered when mouth breathing occurs. However, recent clinical studies has alerted us that full face masks push the jaw back, which can lead to increase apnea severity; this then means an increase in CPAP pressure is needed. The higher CPAP pressure and the size of the mask covering the nose and mouth often result in quitting CPAP therapy.
If you tried CPAP and were unable to tolerate the treatment it could be a factor of nasal congestion, but you would think you would know if you suffered from nasal congestion right? ……..Not necessarily.
It isn’t unusual that patients with OSA or SDB are unaware of their nasal congestion. The two most common reasons for this are that often times nasal obstruction is positional and only occurs once you are lying down for sleep. It can takes anywhere between 30 to 90 minutes for the nasal congestion to develop when first lying down; and by then you may have fallen asleep and unaware of the problem. The second reason is the lack of self-awareness of nasal breathing. Often times nasal obstruction has been a factor since early childhood, thus leading to no frame of reference for what normal breathing should be.
There is building clinical evidence that nasal congestion is a risk factor in sleep disordered breathing.
- Nasal obstruction due to allergic rhinitis associated with OSAS (McNicholas WT 1982, Lavie P 1981)
- Experimentally induced nasal obstruction induced episodes of apnoea and episodes of arousal from sleep (Zwillich C 1981, Lavie 1983)
- A significant longitudinal population study reported 3-fold increase in the incidence of snoring and daytime sleepiness in volunteers with self-reported nocturnal nasal congestion (Young T 2001).
- Nasal obstruction has been shown to be a risk factor for sleep apnea syndrome, studying 541 unselected snorers (Lofaso et al. Eur Respir J 2000)
- Open-mouth breathing during sleep is a risk factor for OSA and is associated with increased disease severity and upper airway collapsibility (Kim et al. .Eur Arch Otorhinolaryngol. 2011)
- Mouth breathing is associated with up to 2.5 times higher total resistance (M.F. Fitzpatrick et al. Eur Respir J 2003;22:827-832)
This significant issue of nasal congestion is not addressed by existing oral appliances and CPAP therapy.
Nasal congestion or obstruction are commonly cited as a complication and reason for non-adherence and/or non-response to both oral appliance therapy and CPAP (Sugiura T 2007, Zeng et al SLEEP 2008).
The Oventus Treatment Platform and patented airway technology are helping to address this challenge. Further studies are underway to validate the Oventus Airway Technology’s impact on efficacy and compliance for patients with nasal obstruction.