CoChat
Sign Up
Cited by 34Obstructive Sleep Apnea ResearchTemporomandibular Joint DisordersNeuroscience of respiration and sleep

Breathing Re-Education and Phenotypes of Sleep Apnea: A Review

Open access
McKeown, Patrick, O’Connor-Reina, Carlos, Plaza, Guillermo·2021·Journal of Clinical Medicine
DOI 10.3390/jcm10030471PMC PMC7865730
Open this paper in CoChat — free accountOpen PDF

Abstract

Four phenotypes of obstructive sleep apnea hypopnea syndrome (OSAHS) have been identified. Only one of these is anatomical. As such, anatomically based treatments for OSAHS may not fully resolve the condition. Equally, compliance and uptake of gold-standard treatments is inadequate. This has led to interest in novel therapies that provide the basis for personalized treatment protocols. This review examines each of the four phenotypes of OSAHS and explores how these could be targeted using breathing re-education from three dimensions of functional breathing: biochemical, biomechanical and resonant frequency. Breathing re-education and myofunctional therapy may be helpful for patients across all four phenotypes of OSAHS. More research is urgently needed to investigate the therapeutic benefits of restoring nasal breathing and functional breathing patterns across all three dimensions in order to provide a treatment approach that is tailored to the individual patient.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.3390/jcm10030471

Cites

13 of 13 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 140

  1. [2]Foldvary-Schaefer N.R. Waters T.E. Sleep-Disordered Breathing Continuum 2017 23 1093 1116 10.1212/01.CON.0000522245.13784.f6 28777178 · DOI
  2. [3]Yamauchi M. Tamaki S. Yoshikawa M. Ohnishi Y. Nakano H. Jacono F.J. Loparo K.A. Strohl K.P. Kimura H. Differences in breathing patterning during wakefulness in patients with mixed apnea-dominant vs. obstructive-dominant sleep apnea Chest 2011 140 54 61 10.1378/chest.10-1082 21393396 PMC3130526 · DOI
  3. [4]Courtney R. Breathing retraining in sleep apnoea: A review of approaches and potential mechanisms Sleep Breath 2020 24 1315 1325 10.1007/s11325-020-02013-4 31940122 · DOI
  4. [5]Messineo L. Taranto-Montemurro L. Azarbarzin A. Oliveira Marques M.D. Calianese N. White D.P. Wellman A. Sands S.A. Breath-holding as a means to estimate the loop gain contribution to obstructive sleep apnoea J. Physiol. 2018 596 4043 4056 10.1113/JP276206 29882226 PMC6117550 · DOI · Paper page
  5. [6]Jack S. Rossiter H.B. Pearson M.G. Ward S.A. Warburton C.J. Whipp B.J. Ventilatory responses to inhaled carbon dioxide, hypoxia, and exercise in idiopathic hyperventilation Am. J. Respir. Crit. Care Med. 2004 170 118 125 10.1164/rccm.200207-720OC 15059786 · DOI
  6. [7]Jones M. Harvey A. Marston L. O’Connell N.E. Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults Cochrane Database Syst. Rev. 2013 5 CD009041 10.1002/14651858.CD009041.pub2 PMC11379427 23728685 · DOI · Paper page
  7. [8]Courtney R. Multi-dimensional model of dysfunctional breathing and integrative breathing therapy–commentary on the functions of breathing and its dysfunctions and their relationship to breathing therapy J. Yoga Phys. Ther. 2016 6 4 10.4172/2157-7595.1000257 · DOI
  8. [9]Buchholz I. Breathing, voice, and movement therapy: Applications to breathing disorders Biofeedback Self Regul. 1994 19 141 153 10.1007/BF01776487 7918752 · DOI
  9. [10]Faust-Christmann C.A. Taetz B. Zolynski G. Zimmermann T. Bleser G. A Biofeedback App to Instruct Abdominal Breathing (Breathing-Mentor): Pilot Experiment JMIR Mhealth Uhealth 2019 7 e13703 10.2196/13703 31573919 PMC6792022 · DOI
  10. [11]Bruton A. Holgate S.T. Hypocapnia and asthma: A mechanism for breathing retraining? Chest 2005 127 1808 1811 10.1378/chest.127.5.1808 15888863 · DOI
  11. [13]McKeown P. The Buteyko technique: News J. Dent. Sleep Med. 2019 6 2 10.15331/jdsm.7078 · DOI
  12. [16]Ainsworth B. Bruton A. Thomas M. Yardley L. One year later: Highlighting the challenges and opportunities in disseminating a breathing-retraining digital behaviour change intervention Digit. Health 2020 6 2055207620936441 10.1177/2055207620936441 32728474 PMC7364807 · DOI
  13. [17]Bruton A. Lee A. Yardley L. Raftery J. Arden-Close E. Kirby S. Zhu S. Thiruvothiyur M. Webley F. Taylor L. Physiotherapy breathing retraining for asthma: A randomised controlled trial Lancet Respir. Med. 2018 6 19 28 10.1016/S2213-2600(17)30474-5 29248433 PMC5757422 · DOI · Paper page
  14. [18]Santino T.A. Chaves G.S. Freitas D.A. Fregonezi G.A. Mendonça K.M. Breathing exercises for adults with asthma Cochrane Database Syst. Rev. 2020 3 CD001277 10.1002/14651858.CD001277.pub4 32212422 PMC7096190 · DOI · Paper page
  15. [19]Vagedes J. Helmert E. Kuderer S. Vagedes K. Wildhaber J. Andrasik F. The Buteyko breathing technique in children with asthma: A randomized controlled pilot study Complement. Ther. Med. 2020 23 102582 10.1016/j.ctim.2020.102582 33197659 · DOI
  16. [20]Heinzer R. Vat S. Marques-Vidal P. Marti-Soler H. Andries D. Tobback N. Mooser V. Preisig M. Malhotra A. Waeber G. Prevalence of sleep-disordered breathing in the general population: The HypnoLaus study Lancet Respir. Med. 2015 3 310 318 10.1016/S2213-2600(15)00043-0 25682233 PMC4404207 · DOI · Paper page
  17. [22]Senaratna C.V. Perret J.L. Lodge C.J. Lowe A.J. Campbell B.E. Matheson M.C. Hamilton G.S. Dharmage S.C. Prevalence of obstructive sleep apnea in the general population: A systematic review Sleep Med. Rev. 2017 34 70 81 10.1016/j.smrv.2016.07.002 27568340 · DOI · Paper page
  18. [23]Subramani Y. Singh M. Wong J. Kushida C.A. Malhotra A. Chung F. Understanding Phenotypes of Obstructive Sleep Apnea: Applications in Anesthesia, Surgery, and Perioperative Medicine Anesth. Analg. 2017 124 179 191 10.1213/ANE.0000000000001546 27861433 PMC5429962 · DOI
  19. [24]Appleton S.L. Vakulin A. McEvoy R.D. Vincent A. Martin S.A. Grant J.F. Taylor A.W. Antic N.A. Catcheside P.G. Wittert G.A. Undiagnosed obstructive sleep apnea is independently associated with reductions in quality of life in middle-aged, but not elderly men of a population cohort Sleep Breath 2015 19 1309 1316 10.1007/s11325-015-1171-5 25896898 · DOI
  20. [25]Kapur V. Strohl K.P. Redline S. Iber C. O’Connor G. Nieto J. Underdiagnosis of sleep apnea syndrome in U.S. communities Sleep Breath 2002 6 49 54 10.1055/s-2002-32318 12075479 · DOI
  21. [26]Simpson L. Hillman D.R. Cooper M.N. Ward K.L. Hunter M. Cullen S. James A. Palmer L.J. Mukherjee S. Eastwood P. High prevalence of undiagnosed obstructive sleep apnoea in the general population and methods for screening for representative controls Sleep Breath 2013 17 967 973 10.1007/s11325-012-0785-0 23161476 · DOI
  22. [30]Basyuni S. Barabas M. Quinnell T. An update on mandibular advancement devices for the treatment of obstructive sleep apnoea hypopnoea syndrome J. Thorac. Dis. 2018 10 S48 S56 10.21037/jtd.2017.12.18 29445528 PMC5803051 · DOI
  23. [31]Johnston C.D. Gleadhill I.C. Cinnamond M.J. Gabbey J. Burden D.J. Mandibular advancement appliances and obstructive sleep apnoea: A randomized clinical trial Eur. J. Orthod. 2002 24 251 262 10.1093/ejo/24.3.251 12143089 · DOI · Paper page
  24. [32]Heidsieck D.S.P. Koolstra J.H. de Ruiter M.H.T. Hoekema A. de Lange J. Biomechanical effects of a mandibular advancement device on the temporomandibular joint J. Craniomaxillofac. Surg. 2018 46 288 292 10.1016/j.jcms.2017.11.015 29224971 · DOI
  25. [33]Borrie F. Keightley A. Blacker S. Serrant P. Mandibular advancement appliances for treating sleep apnoea/hypopnoea syndrome Evid. Based Dent. 2013 14 27 28 10.1038/sj.ebd.6400921 23579308 · DOI
  26. [34]Eckert D.J. White D.P. Jordan A.S. Malhotra A. Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets Am. J. Respir. Crit. Care Med. 2013 188 996 1004 10.1164/rccm.201303-0448OC 23721582 PMC3826282 · DOI · Paper page
  27. [36]Carberry J.C. Amatoury J. Eckert D.J. Personalized Management Approach for OSA Chest 2018 153 744 755 10.1016/j.chest.2017.06.011 28629917 · DOI
  28. [37]Light M. Owens R.L. Schmickl C.N. Malhotra A. Precision Medicine for Obstructive Sleep Apnea Sleep Med. Clin. 2019 14 391 398 10.1016/j.jsmc.2019.05.005 31375207 PMC8931687 · DOI
  29. [38]Malhotra A. Mesarwi O. Pepin J.L. Owens R.L. Endotypes and phenotypes in obstructive sleep apnea Curr. Opin. Pulm. Med. 2020 26 609 614 10.1097/MCP.0000000000000724 32890019 PMC7544644 · DOI
  30. [39]Coughlin K. Davies G.M. Gillespie M.B. Phenotypes of Obstructive Sleep Apnea Otolaryngol. Clin. N. Am. 2020 53 329 338 10.1016/j.otc.2020.02.010 32334874 · DOI
  31. [40]Bosi M. De Vito A. Eckert D. Steier J. Kotecha B. Vicini C. Poletti V. Qualitative Phenotyping of Obstructive Sleep Apnea and Its Clinical Usefulness for the Sleep Specialist Int. J. Environ. Res. Public Health 2020 17 2058 10.3390/ijerph17062058 PMC7143772 32244892 · DOI
  32. [41]Gleadhill I.C. Schwartz A.R. Schubert N. Wise R.A. Permutt S. Smith P.L. Upper airway collapsibility in snorers and in patients with obstructive hypopnea and apnea Am. Rev. Respir. Dis. 1991 143 1300 1303 10.1164/ajrccm/143.6.1300 2048817 · DOI · Paper page
  33. [42]Hillman D.R. Platt P.R. Eastwood P.R. The upper airway during anaesthesia Br. J. Anaesth. 2003 91 31 39 10.1093/bja/aeg126 12821563 · DOI
  34. [43]Carlisle T. Ward N.R. Atalla A. Cowie M.R. Simonds A.K. Morrell M.J. Investigation of the link between fluid shift and airway collapsibility as a mechanism for obstructive sleep apnea in congestive heart failure Physiol. Rep. 2017 5 e12956 10.14814/phy2.12956 28057850 PMC5256151 · DOI
  35. [44]Deacon N.L. Jen R. Li Y. Malhotra A. Treatment of Obstructive Sleep Apnea. Prospects for Personalized Combined Modality Therapy Ann. Am. Thorac. Soc. 2016 13 101 108 10.1513/AnnalsATS.201508-537FR 26569377 PMC5461982 · DOI
  36. [45]Rassovsky Y. Abrams K. Kushner M.G. Suffocation and respiratory responses to carbon dioxide and breath holding challenges in individuals with panic disorder J. Psychosom. Res. 2006 60 291 298 10.1016/j.jpsychores.2005.08.005 16516662 · DOI
  37. [46]Dempsey J.A. Smith C.A. Przybylowski T. Chenuel B. Xie A. Nakayama H. Skatrud J.B. The ventilatory responsiveness to CO2 below eupnoea as a determinant of ventilatory stability in sleep J. Physiol. 2004 560 1 11 10.1113/jphysiol.2004.072371 15284345 PMC1665213 · DOI
  38. [47]Deacon-Diaz N. Malhotra A. Inherent vs. Induced Loop Gain Abnormalities in Obstructive Sleep Apnea Front. Neurol. 2018 9 896 10.3389/fneur.2018.00896 30450076 PMC6224344 · DOI · Paper page
  39. [48]Buterbaugh J. Wynstra C. Provencio N. Combs D. Gilbert M. Parthasarathy S. Cerebrovascular reactivity in young subjects with sleep apnea Sleep 2015 38 241 250 10.5665/sleep.4406 25409111 PMC4288605 · DOI
  40. [49]Jordan A.S. McSharry D.G. Malhotra A. Adult obstructive sleep apnoea Lancet 2014 383 736 747 10.1016/S0140-6736(13)60734-5 23910433 PMC3909558 · DOI · Paper page
  41. [50]Bonsignore M.R. Suarez Giron M.C. Marrone O. Castrogiovanni A. Montserrat J.M. Personalised medicine in sleep respiratory disorders: Focus on obstructive sleep apnoea diagnosis and treatment Eur. Respir. Rev. 2017 26 170069 10.1183/16000617.0069-2017 29070581 PMC9489118 · DOI
  42. [51]Edwards B.A. Eckert D.J. Jordan A.S. Obstructive sleep apnoea pathogenesis from mild to severe: Is it all the same? Respirology 2017 22 33 42 10.1111/resp.12913 27699919 · DOI
  43. [52]Guilleminault C. Li K. Chen N.H. Poyares D. Two-point palatal discrimination in patients with upper airway resistance syndrome, obstructive sleep apnea syndrome, and normal control subjects Chest 2002 122 866 870 10.1378/chest.122.3.866 12226025 · DOI
  44. [53]Nguyen A.T. Jobin V. Payne R. Beauregard J. Naor N. Kimoff R.J. Laryngeal and velopharyngeal sensory impairment in obstructive sleep apnea Sleep 2005 28 585 593 10.1093/sleep/28.5.585 16171271 · DOI
  45. [54]Grandner M.A. Malhotra A. Connecting insomnia, sleep apnoea and depression Respirology 2017 22 1249 1250 10.1111/resp.13090 28556352 PMC5597470 · DOI
  46. [56]Butler M.P. Emch J.T. Rueschman M. Sands S.A. Shea S.A. Wellman A. Redline S. Apnea-Hypopnea Event Duration Predicts Mortality in Men and Women in the Sleep Heart Health Study Am. J. Respir. Crit. Care Med. 2019 199 903 912 10.1164/rccm.201804-0758OC 30336691 PMC6444651 · DOI
  47. [57]Richardson H.L. Walker A.M. Horne R.S. Sleep position alters arousal processes maximally at the high-risk age for sudden infant death syndrome J. Sleep Res. 2008 17 450 457 10.1111/j.1365-2869.2008.00683.x 19090953 · DOI
  48. [58]Pizzorno J.E. Murray M.T. Joiner-Bey H. Hyperventilation syndrome/breathing pattern disorders The Clinician’s Handbook of Natural Medicine E-Book Elsevier Health Sciences Amsterdam, The Netherlands 2016 431 447
  49. [59]Huang T. Lin B.M. Markt S.C. Stampfer M.J. Laden F. Hu F.B. Tworoger S.S. Redline S. Sex differences in the associations of obstructive sleep apnoea with epidemiological factors Eur. Respir. J. 2018 51 1702421 10.1183/13993003.02421-2017 29449424 PMC6110385 · DOI
  50. [60]Fietze I. Laharnar N. Obst A. Ewert R. Felix S.B. Garcia C. Gläser S. Glos M. Schmidt C.O. Stubbe B. Prevalence and association analysis of obstructive sleep apnea with gender and age differences—Results of SHIP-Trend J. Sleep Res. 2019 28 e12770 10.1111/jsr.12770 30272383 · DOI
  51. [61]LoMauro A. Aliverti A. Sex differences in respiratory function Breathe 2018 14 131 140 10.1183/20734735.000318 29875832 PMC5980468 · DOI
  52. [62]Ott H.W. Mattle V. Zimmermann U.S. Licht P. Moeller K. Wildt L. Symptoms of premenstrual syndrome may be caused by hyperventilation Fertil. Steril. 2006 86 1001.e17 1001.e19 10.1016/j.fertnstert.2006.01.062 17027367 · DOI
  53. [63]Gargaglioni L.H. Marques D.A. Patrone L.G.A. Sex differences in breathing Comp. Biochem. Physiol. A Mol. Integr. Physiol. 2019 238 110543 10.1016/j.cbpa.2019.110543 31445081 · DOI
  54. [64]Stavaras C. Pastaka C. Papala M. Gravas S. Tzortzis V. Melekos M. Seitanidis G. Gourgoulianis K.I. Sexual function in pre- and post-menopausal women with obstructive sleep apnea syndrome Int. J. Impot. Res. 2012 24 228 233 10.1038/ijir.2012.20 22673583 · DOI
  55. [65]Spacone A. Paolucci T. Prosperi P. Giannandrea N. Pezzi L. Bellomo R.G. Saggini R. Possible phenotyping of apnoea obstructive sleep of female patients J. Biol. Regul. Homeost. Agents 2020 34 1545 1547 10.23812/19-548-L 32957770 · DOI
  56. [66]Sutherland T.J. McLachlan C.R. Sears M.R. Poulton R. Hancox R.J. The relationship between body fat and respiratory function in young adults Eur. Respir. J. 2016 48 734 747 10.1183/13993003.02216-2015 27471202 · DOI
  57. [67]Mafort T.T. Rufino R. Costa C.H. Lopes A.J. Obesity: Systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function Multidiscip. Respir. Med. 2016 11 28 10.1186/s40248-016-0066-z 27408717 PMC4940831 · DOI
  58. [68]Kunitomo F. Kimura H. Tatsumi K. Kuriyama T. Watanabe S. Honda Y. Sex differences in awake ventilatory drive and abnormal breathing during sleep in eucapnic obesity Chest 1988 93 968 976 10.1378/chest.93.5.968 3359850 · DOI
  59. [69]Hsu Y.B. Lan M.Y. Huang Y.C. Kao M.C. Lan M.C. Association Between Breathing Route, Oxygen Desaturation, and Upper Airway Morphology Laryngoscope 2020 10.1002/lary.28774 32473063 · DOI
  60. [70]Baptista P.M. Lugo-Saldana R. Garaycochea O. Endoscopic Evaluation of Upper Airway While Playing the Didgeridoo Glob. J. Otolaryngol. 2017 6 555699 10.19080/GJO.2017.06.555699 · DOI
  61. [71]Eley R. Gorman D. Didgeridoo playing and singing to support asthma management in Aboriginal Australians J. Rural Health 2010 26 100 104 10.1111/j.1748-0361.2009.00256.x 20105276 · DOI
  62. [72]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 e0231262 10.1371/journal.pone.0231262 32282859 PMC7153879 · DOI
  63. [73]Madronio M.R. Di Somma E. Stavrinou R. Kirkness J.P. Goldfinch E. Wheatley J.R. Amis T.C. Older individuals have increased oro-nasal breathing during sleep Eur. Respir. J. 2004 24 71 77 10.1183/09031936.04.00004303 15293607 · DOI
  64. [75]Trevisan M.E. Boufleur J. Soares J.C. Haygert C.J. Ries L.G. Corrêa E.C. Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth-breathing adults: A cross-sectional study J. Electromyogr. Kinesiol. 2015 25 463 468 10.1016/j.jelekin.2015.03.006 25900327 · DOI
  65. [76]Yi L.C. Jardim J.R. Inoue D.P. Pignatari S.S. The relationship between excursion of the diaphragm and curvatures of the spinal column in mouth breathing children J. Pediatr. (Rio J.) 2008 84 171 177 10.2223/JPED.1771 18372937 · DOI
  66. [77]Veron H.L. Antunes A.G. Milanesi J.M. Correa E.C.R. Implications of mouth breathing on the pulmonary function and respiratory muscles Rev. CEFAC 2016 18 242 251 10.1590/1982-0216201618111915 · DOI
  67. [78]Kolar P. Neuwirth J. Sanda J. Suchanek V. Svata Z. Volejnik J. Pivec M. Analysis of diaphragm movement during tidal breathing and during its activation while breath holding using MRI synchronized with spirometry Physiol. Res. 2009 58 383 392 18637703
  68. [79]Gunhan K. Pathophysiology of Obstructive Sleep Apnea Nasal Physiology and Pathophysiology of Nasal Disorders Önerci T.M. Springer Berlin/Heidelberg, Germany 2013 313 330
  69. [80]Swift A.C. Campbell I.T. McKown T.M. Oronasal obstruction, lung volumes, and arterial oxygenation Lancet 1988 1 73 75 10.1016/S0140-6736(88)90282-6 2891980 · DOI
  70. [81]Bartley J. Wong C. Nasal Pulmonary Interactions Nasal Physiology and Pathophysiology of Nasal Disorders Önerci T.M. Springer Berlin/Heidelberg, Germany 2013 559 566
  71. [82]Khaleghipour S. Masjedi M. Kelishadi R. The effect of breathing exercises on the nocturnal enuresis in the children with the sleep-disordered breathing Iran. Red Crescent Med. J. 2013 15 e8986 10.5812/ircmj.8986 24719691 PMC3971783 · DOI
  72. [83]Fitzpatrick M.F. McLean H. Urton A.M. Tan A. O’Donnell D. Driver H.S. Effect of nasal or oral breathing route on upper airway resistance during sleep Eur. Respir. J. 2003 22 827 832 10.1183/09031936.03.00047903 14621092 · DOI · Paper page
  73. [84]Young T. Finn L. Kim H. Nasal obstruction as a risk factor for sleep-disordered breathing. The University of Wisconsin Sleep and Respiratory Research Group J. Allergy Clin. Immunol. 1997 99 S757 S762 10.1016/S0091-6749(97)70124-6 9042068 · DOI · Paper page
  74. [85]Bachour A. Maasilta P. Mouth breathing compromises adherence to nasal continuous positive airway pressure therapy Chest 2004 126 1248 1254 10.1378/chest.126.4.1248 15486389 · DOI
  75. [86]Kohler M. Bloch K.E. Stradling J.R. The role of the nose in the pathogenesis of obstructive sleep apnoea and snoring Eur. Respir. J. 2007 30 1208 1215 10.1183/09031936.00032007 18055705 · DOI
  76. [87]Menezes V.A. Cavalcanti L.L. Cavalcanti de Albuquerque T. Garcia A.F.G. Leal R.B. Mouth breathing within a multidisciplinary approach: Perception of orthodontists in the city of Recife, Brazil Dent. Press J. Orthod. 2011 16 84 92 2176-9451 10.1590/S2176-94512011000600014 · DOI
  77. [88]Lee S.Y. Guilleminault C. Chiu H.Y. Sullivan S.S. Mouth breathing, “nasal disuse,” and pediatric sleep-disordered breathing Sleep Breath 2015 19 1257 1264 10.1007/s11325-015-1154-6 25877805 · DOI
  78. [89]Zaghi S. Peterson C. Shamtoob C. Fung B. Ng D.K.K. Jagomagi T. Archambault N. O’Connor B. Winslow K. Peeran Z. Assessment of Nasal Breathing Using Lip Taping: A Simple and Effective Screening Tool Int. J. Otorhinolaryngol. 2020 6 10 15 10.11648/j.ijo.20200601.13 · DOI
  79. [90]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 1222 1228 10.1183/09031936.00058406 17005578 · DOI · Paper page
  80. [91]Tafil-Klawe M. Klawe J.J. Role of nose breathing in genioglossus muscle response to hypoxia in older and younger subjects J. Physiol. Pharmacol. 2003 54 Suppl. S1 48 54 15886411
  81. [92]Meurice J.C. Marc I. Carrier G. Sériès F. Effects of mouth opening on upper airway collapsibility in normal sleeping subjects Am. J. Respir. Crit. Care Med. 1996 153 255 259 10.1164/ajrccm.153.1.8542125 8542125 · DOI · Paper page
  82. [93]Stanley N.N. Cunningham E.L. Altose M.D. Kelsen S.G. Levinson R.S. Cherniack N.S. Evaluation of breath holding in hypercapnia as a simple clinical test of respiratory chemosensitivity Thorax 1975 30 337 343 10.1136/thx.30.3.337 1145539 PMC470288 · DOI
  83. [95]Jack S. Rossiter H.B. Warburton C.J. Whipp B.J. Behavioral influences and physiological indices of ventilatory control in subjects with idiopathic hyperventilation Behav. Modif. 2003 27 637 652 10.1177/0145445503256318 14531159 · DOI
  84. [97]Courtney R. Cohen M. Investigating the claims of Konstantin Buteyko, M.D., Ph.D.: The relationship of breath holding time to end tidal CO2 and other proposed measures of dysfunctional breathing J. Altern. Complement. Med. 2008 14 115 123 10.1089/acm.2007.7204 18315509 · DOI · Paper page
  85. [98]Nardi A.E. Freire R. Zin W.A. Panic disorder and control of breathing Respir. Physiol. Neurobiol. 2009 167 133 143 10.1016/j.resp.2008.07.011 18707030 · DOI · Paper page
  86. [99]Kiesel K. Rhodes T. Mueller J. Waninger A. Butler R. Development of a screening protocol to identify individuals with dysfunctional breathing Int. J. Sports Phys. Ther. 2017 12 774 786 10.26603/ijspt20170774 29181255 PMC5685417 · DOI · Paper page
  87. [100]Singh U.P. Evidence-Based Role of Hypercapnia and Exhalation Phase in Vagus Nerve Stimulation: Insights into Hypercapnic Yoga Breathing Exercises J. Yoga Phys. Ther. 2017 7 276 10.4172/2157-7595.1000276 · DOI
  88. [101]Edwards B.A. Andara C. Landry S. Sands S.A. Joosten S.A. Owens R.L. White D.P. Hamilton G.S. Wellman A. Upper-Airway Collapsibility and Loop Gain Predict the Response to Oral Appliance Therapy in Patients with Obstructive Sleep Apnea Am. J. Respir. Crit. Care Med. 2016 194 1413 1422 10.1164/rccm.201601-0099OC 27181367 PMC5148143 · DOI
  89. [102]Op de Beeck S. Dieltjens M. Azarbarzin A. Willemen M. Verbraecken J. Braem M.J. Wellman A. Sands S.A. Vanderveken O.M. Mandibular Advancement Device Treatment Efficacy is Associated with Polysomnographic Endotypes Ann. Am. Thorac Soc. 2020 10.1513/AnnalsATS.202003-220OC PMC7919144 32946702 · DOI
  90. [103]Deacon-Diaz N.L. Sands S.A. McEvoy R.D. Catcheside P.G. Daytime loop gain is elevated in obstructive sleep apnea but not reduced by CPAP treatment J. Appl. Physiol. 2018 125 1490 1497 10.1152/japplphysiol.00175.2018 30161007 PMC6295487 · DOI · Paper page
  91. [104]Kubin L. Neural Control of the Upper Airway: Respiratory and State-Dependent Mechanisms Compr. Physiol. 2016 6 1801 1850 10.1002/cphy.c160002 27783860 PMC5242202 · DOI
  92. [105]Brown E.C. Cheng S. McKenzie D.K. Butler J.E. Gandevia S.C. Bilston L.E. Respiratory Movement of Upper Airway Tissue in Obstructive Sleep Apnea Sleep 2013 36 1069 1076 10.5665/sleep.2812 23814344 PMC3669065 · DOI
  93. [107]Cori J.M. O’Donoghue F.J. Jordan A.S. Sleeping tongue: Current perspectives of genioglossus control in healthy individuals and patients with obstructive sleep apnea Nat. Sci. Sleep. 2018 10 169 179 10.2147/NSS.S143296 29942169 PMC6007201 · DOI
  94. [108]Mediano O. Romero-Peralta S. Resano P. Cano-Pumarega I. Sánchez-de-la-Torre M. Castillo-García M. Martínez-Sánchez A.B. Ortigado A. García-Río F. Obstructive Sleep Apnea: Emerging Treatments Targeting the Genioglossus Muscle J. Clin. Med. 2019 8 1754 10.3390/jcm8101754 31652594 PMC6832267 · DOI
  95. [109]Mohamed A. Sharshar R. Elkolaly R.M. Serageldin S. Upper airway muscle exercises outcome in patients with obstructive sleep apnea syndrome Egypt. J. Chest Dis. Tuberc. 2017 66 121 125 10.1016/j.ejcdt.2016.08.014 · DOI
  96. [110]Camacho M. Certal V. Abdullatif J. Zaghi S. Ruoff C.M. Capasso R. Kushida C.A. Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis Sleep 2015 38 669 675 10.5665/sleep.4652 25348130 PMC4402674 · DOI
  97. [111]Wishney M. Darendeliler M.A. Dalci O. Myofunctional therapy and prefabricated functional appliances: An overview of the history and evidence Aust. Dent. J. 2019 64 135 144 10.1111/adj.12690 30921479 · DOI
  98. [112]Guimarães K.C. Drager L.F. Genta P.R. Marcondes B.F. Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome Am. J. Respir. Crit. Care Med. 2009 179 962 966 10.1164/rccm.200806-981OC 19234106 · DOI
  99. [113]O’Connor-Reina C. Plaza G. Garcia-Iriarte M.T. Ignacio-Garcia J.M. Baptista P. Casado-Morente J.C. De Vicente E. Tongue peak pressure: A tool to aid in the identification of obstruction sites in patients with obstructive sleep apnea/hypopnea syndrome Sleep Breath 2020 24 281 286 10.1007/s11325-019-01952-x 31745755 · DOI
  100. [114]O’Connor-Reina C. Plaza G. Ignacio-Garcia J.M. Baptista P. Garcia-Iriarte M.T. Casado-Morente J.C. De Vicente E. Gonzalez V. Rodriguez-Reina A. New mHealth Application software based on myofunctional therapy applied to sleep-disordered breathing in non-compliant subjects Sleep Sci. Pract. 2020 4 3 10.1186/s41606-019-0040-8 · DOI
  101. [115]O’Connor-Reina C. Ignacio-Garcia J.M. Rodriguez-Ruiz E. Morillo Dominguez M.D.C. Ignacio Barrios V. Baptista Jardin P. Casado Morente J.C. Garcia Iriarte M.T. Plaza G. Myofunctional therapy app for severe apnea–hypopnea sleep obstructive syndrome: A pilot randomized controlled trial JMIR mHealth uHealth 2020 10.2196/23123 PMC7683258 33093013 · DOI
  102. [116]Suzuki M. Okamoto T. Akagi Y. Matsui K. Sekiguchi H. Satoya N. Inoue Y. Tatsuta A. Hagiwara N. Efficacy of oral myofunctional therapy in middle-aged to elderly patients with obstructive sleep apnoea treated with continuous positive airway pressure J. Oral Rehabil. 2020 10.1111/joor.13119 33080062 · DOI
  103. [117]Huang Y.S. Hsu S.C. Guilleminault C. Chuang L.C. Myofunctional Therapy: Role in Pediatric OSA Sleep Med. Clin. 2019 14 135 142 10.1016/j.jsmc.2018.10.004 30709528 · DOI
  104. [118]Diaféria G. Santos-Silva R. Truksinas E. Haddad F.L.M. Santos R. Bommarito S. Gregório L.C. Tufik S. Bittencourt L. Myofunctional therapy improves adherence to continuous positive airway pressure treatment Sleep Breath 2017 21 387 395 10.1007/s11325-016-1429-6 27913971 · DOI
  105. [119]De Felício C.M. da Silva Dias F.V. Trawitzki L.V.V. Obstructive sleep apnea: Focus on myofunctional therapy Nat. Sci. Sleep 2018 10 271 286 10.2147/NSS.S141132 30233265 PMC6132228 · DOI
  106. [120]Smith J.C. Ellenberger H.H. Ballanyi K. Richter D.W. Feldman J.L. Pre-Bötzinger complex: A brainstem region that may generate respiratory rhythm in mammals Science 1991 254 726 729 10.1126/science.1683005 1683005 PMC3209964 · DOI
  107. [121]Yackle K. Schwarz L.A. Kam K. Sorokin J.M. Huguenard J.R. Feldman J.L. Luo L. Krasnow M.A. Breathing control center neurons that promote arousal in mice Science 2017 355 1411 1415 10.1126/science.aai7984 28360327 PMC5505554 · DOI · Paper page
  108. [122]Gleeson K. Zwillich C.W. Adenosine stimulation, ventilation, and arousal from sleep Am. Rev. Respir. Dis. 1992 145 453 457 10.1164/ajrccm/145.2_Pt_1.453 1736756 · DOI
  109. [123]Cottle M.H. The work, ways, positions and patterns of nasal breathing (relevance in heart and lung illness) Proceedings of the American Rhinologic Society New Orleans, LA, USA 19 September 1972 377 385
  110. [124]Barelli P. Nasopulmonary physiology Behavioral and Psychological Approaches to Breathing Disorders Timmons B.H. Ley R. Springer Science + Business Media New York, NY, USA 1994 47 58
  111. [126]Mendels J. Criteria for selection of appropriate benzodiazepine hypnotic therapy J. Clin. Psychiatry 1991 52 42 46 1680126
  112. [127]Chong Y. Fryer C.D. Gu Q. Prescription sleep aid use among adults: United States, 2005–2010 NCHS Data Brief 2013 127 1 8 24152538
  113. [129]Narkiewicz K. van de Borne P. Montano N. Hering D. Kara T. Somers V.K. Sympathetic neural outflow and chemoreflex sensitivity are related to spontaneous breathing rate in normal men Hypertension 2006 47 51 55 10.1161/01.HYP.0000197613.47649.02 16344363 · DOI
  114. [130]Watson C.J. Baghdoyan H.A. Lydic R. Neuropharmacology of Sleep and Wakefulness Sleep Med. Clin. 2010 5 513 528 10.1016/j.jsmc.2010.08.003 21278831 PMC3026477 · DOI
  115. [131]Huang T.W. Young T.H. Novel porous oral patches for patients with mild obstructive sleep apnea and mouth breathing: A pilot study Otolaryngol. Head Neck Surg. 2015 152 369 373 10.1177/0194599814559383 25450408 · DOI
  116. [133]Ayuse T. Kirkness J. Sanuki T. Kurata S. Okayasu I. Pathogenesis of upper airway obstruction and mechanical intervention during sedation and sleep J. Dent. Sleep Med. 2016 3 11 19 10.15331/jdsm.5364 · DOI
  117. [134]Birch M. Obstructive sleep apnoea and breathing retraining Aust. Nurs. J. 2004 12 27 29 19160562
  118. [135]Birch M. Sleep apnoea: A survey of breathing retraining Aust. Nurs. J. 2012 20 40 41 23252114
  119. [136]Lum L.C. Hyperventilation syndromes Behavioral and Psychological Approaches to Breathing Disorders Timmons B.H. Ley R. Springer Science + Business Media New York, NY, USA 1994 113 124
  120. [137]Courtney R. Breathing training for dysfunctional breathing in asthma: Taking a multidimensional approach ERJ Open Res. 2017 3 00065 02017 10.1183/23120541.00065-2017 PMC5721258 29234673 · DOI · Paper page
  121. [139]Lum L.C. Hyperventilation: The tip and the iceberg J. Psychosom. Res. 1975 19 375 383 10.1016/0022-3999(75)90017-3 1214233 · DOI · Paper page
  122. [140]Law N. Ruane L.E. Low K. Hamza K. Bardin P.G. Dysfunctional breathing is more frequent in chronic obstructive pulmonary disease than in asthma and in health Respir. Physiol. Neurobiol. 2018 247 20 23 10.1016/j.resp.2017.08.011 28870869 · DOI
  123. [141]Folgering H. Colla P. Some anomalies in the control of PACO2 in patients with a hyperventilation syndrome Bull. Eur. Physiopathol. Respir. 1978 14 503 512 37954
  124. [142]Trembach N. Zabolotskikh I. Breath-holding test in evaluation of peripheral chemoreflex sensitivity in healthy subjects Respir. Physiol. Neurobiol. 2017 235 79 82 10.1016/j.resp.2016.10.005 27756650 · DOI
  125. [143]Courtney R. The functions of breathing and its dysfunctions and their relationship to breathing therapy Int. J. Osteopat. Med. 2009 12 78 85 10.1016/j.ijosm.2009.04.002 · DOI · Paper page
  126. [146]Barker N. Everard M.L. Getting to grips with ‘dysfunctional breathing’ Paediatr. Respir. Rev. 2015 16 53 61 10.1016/j.prrv.2014.10.001 25499573 · DOI · Paper page
  127. [147]Douglas N.J. White D.P. Weil J.V. Zwillich C.W. Effect of breathing route on ventilation and ventilatory drive Respir. Physiol. 1983 51 209 218 10.1016/0034-5687(83)90041-5 6844756 · DOI · Paper page
  128. [148]Tavel M.E. Hyperventilation syndrome: Why is it regularly overlooked? Am. J. Med. 2020 10.1016/j.amjmed.2020.07.006 32791056 · DOI
  129. [149]Du Pasquier D. Fellrath J.M. Sauty A. Syndrome d’hyperventilation et respiration dysfonctionnelle: Mise à jour [Hyperventilation syndrome and dysfunctional breathing: Update] Rev. Med. Suisse 2020 16 1243 1249 (In French) 32558453
  130. [150]Mangin D. Bequignon E. Zerah-Lancner F. Isabey D. Louis B. Adnot S. Papon J.F. Coste A. Boyer L. Devars du Mayne M. Investigating hyperventilation syndrome in patients suffering from empty nose syndrome Laryngoscope 2017 127 1983 1988 10.1002/lary.26599 28407251 · DOI
  131. [151]Stupak H.D. The Invisible Forces in Our Nasal Airway: Air Flow and Cavity Negative Pressure. Nasal Obstruction Versus Nasal Underuse: Are the Turbinates the Problem or the Solution? Stupak HD: Rethinking Rhinoplasty and Facial Surgery Springer Nature Switzerland AG Cham, Switzerland 2020 13 36 10.1007/978-3-030-44674-1_2 · DOI
  132. [152]Hudgel D.W. Hendricks C. Dadley A. Alteration in obstructive apnea pattern induced by changes in oxygen- and carbon-dioxide-inspired concentrations Am. Rev. Respir. Dis. 1988 138 16 19 10.1164/ajrccm/138.1.16 3144203 · DOI
  133. [153]Yokhana S.S. Gerst D.G. 3rd Lee D.S. Badr M.S. Qureshi T. Mateika J.H. Impact of repeated daily exposure to intermittent hypoxia and mild sustained hypercapnia on apnea severity J. Appl. Physiol. 2012 112 367 377 10.1152/japplphysiol.00702.2011 22052874 PMC3289424 · DOI
  134. [154]Wang T.G. Wang Y.H. Tang F.T. Lin K.H. Lien I.N. Resistive inspiratory muscle training in sleep-disordered breathing of traumatic tetraplegia Arch. Phys. Med. Rehabil. 2002 83 491 496 10.1053/apmr.2002.30937 11932850 · DOI
  135. [155]Ritz T. Meuret A.E. Wilhelm F.H. Roth W.T. Changes in pCO2, symptoms, and lung function of asthma patients during capnometry-assisted breathing training Appl. Psychophysiol. Biofeedback 2009 34 1 6 10.1007/s10484-008-9070-1 19048369 · DOI
  136. [156]Grammatopoulou E.P. Skordilis E.K. Georgoudis G. Haniotou A. Evangelodimou A. Fildissis G. Katsoulas T. Kalagiakos P. Hyperventilation in asthma: A validation study of the Nijmegen Questionnaire—NQ J. Asthma 2014 51 839 846 10.3109/02770903.2014.922190 24823322 · DOI · Paper page
  137. [157]Bianchini A.P. Guedes Z.C. Vieira M.M. A study on the relationship between mouth breathing and facial morphological pattern Braz. J. Otorhinolaryngol. 2007 73 500 505 10.1016/S1808-8694(15)30101-4 17923920 PMC9443712 · DOI
  138. [158]Knösel M. Klein S. Bleckmann A. Engelke W. Coordination of tongue activity during swallowing in mouth-breathing children Dysphagia 2012 27 401 407 10.1007/s00455-011-9383-8 22207245 PMC3417098 · DOI
  139. [159]Löth S. Petruson B. Wirén L. Wilhelmsen L. Better quality of life when nasal breathing of snoring men is improved at night Arch. Otolaryngol. Head Neck Surg. 1999 125 64 67 10.1001/archotol.125.1.64 9932590 · DOI
  140. [160]Bowler S.D. Green A. Mitchell C.A. Buteyko breathing techniques in asthma: A blinded randomised controlled trial Med. J. Aust. 1998 169 575 578 10.5694/j.1326-5377.1998.tb123422.x 9887897 · DOI · Paper page

Cited by

Sorted by citations

Authors
McKeown, P., O’Connor-Reina, C., & Plaza, G.
Affiliations
  • Buteyko Clinic International, Loughwell, Moycullen, Co., H91 H4C1 Galway, Ireland
  • IDCQ Hospitales y Sanidad, S.L.U. (ES)
  • Universidad Rey Juan Carlos (ES)
Corresponding author
Plaza, Guillermo
ORCID
Venue
Journal of Clinical Medicine
Publisher
MDPI AG
Published
2021-01-26
Volume
10
Issue
3
Pages
471
ISSN
2077-0383 (ISSN-L)
DOI
10.3390/jcm10030471
PMC
PMC7865730
OpenAlex
W3123934865
Cited by
34
References
13
Citations by year
2026: 10 · 2025: 3 · 2024: 9 · 2023: 5 · 2022: 3 · 2021: 4
FWCI
0.70
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Clinical Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, cc-by-nc-nd)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Deposito de Investigacion Universidad de Sevilla (University of Seville) (submittedVersion, cc-by-nc-nd)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
Keywords
obstructive sleep apnea-hypopnea syndrome, myofunctional therapy, nasal breathing, resonant frequency, biomechanics, personalized treatment, medication adherence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review