Department of Physiotherapy, LIM-54, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Sleep Laboratory, Pulmonary Division, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
J Appl Physiol (1985). 2019 Dec 1;127(6):1579-1585. doi: 10.1152/japplphysiol.00964.2018. Epub 2019 Aug 29.
Oronasal breathing may adversely impact obstructive sleep apnea (OSA) patients either by increasing upper airway collapsibility or by influencing continuous positive airway pressure (CPAP) treatment outcomes. Predicting a preferential breathing route would be helpful to guide CPAP interface prescription. We hypothesized that anthropometric measurements but not self-reported oronasal breathing are predictors of objectively measured oronasal breathing. Seventeen OSA patients and nine healthy subjects underwent overnight polysomnography with an oronasal mask with two sealed compartments attached to independent pneumotacographs. Subjects answered questionnaires about nasal symptoms and perceived breathing route. Oronasal breathing was more common ( = <0.001) among OSA patients than controls while awake (62 ± 44 vs. 5 ± 6%) and during sleep (59 ± 39 vs. 25 ± 21%, respectively). Oronasal breathing was associated with OSA severity ( = 0.009), age ( = 0.005), body mass index ( = 0.044), and neck circumference ( = 0.004). There was no agreement between objective measurement and self-reported breathing route among OSA patients while awake (κ = -0.12) and asleep (κ = -0.02). The breathing route remained unchanged after 92% of obstructive apneas. These results suggest that oronasal breathing is more common among OSA patients than controls during both wakefulness and sleep and is associated with OSA severity and anthropometric measures. Self-reporting is not a reliable predictor of oronasal breathing and should not be considered an indication for oronasal CPAP. Continuous positive airway pressure (CPAP) interface choice for obstructive sleep apnea (OSA) patients is often guided by nasal symptoms and self-reported breathing route. We showed that oronasal breathing can be predicted by anthropometric measurements and OSA severity but not by self-reported oronasal breathing. Self-reported breathing and nasal symptoms should not be considered for CPAP interface choice.
口鼻腔呼吸可能通过增加上呼吸道塌陷性或影响持续气道正压通气 (CPAP) 治疗效果，对阻塞性睡眠呼吸暂停 (OSA) 患者产生不利影响。预测优先呼吸途径将有助于指导 CPAP 接口处方。我们假设，人体测量学测量值而不是自我报告的口鼻腔呼吸是客观测量的口鼻腔呼吸的预测因素。17 名 OSA 患者和 9 名健康受试者接受了整夜多导睡眠图检查，使用附有两个密封隔室的口鼻面罩和独立的气动描记器。受试者回答了关于鼻腔症状和感知呼吸途径的问卷。OSA 患者在清醒时（62 ± 44%比 5 ± 6%）和睡眠时（59 ± 39%比 25 ± 21%）口鼻腔呼吸更为常见（<0.001）。口鼻腔呼吸与 OSA 严重程度（=0.009）、年龄（=0.005）、体重指数（=0.044）和颈围（=0.004）相关。在 OSA 患者清醒时（κ=-0.12）和睡眠时（κ=-0.02），客观测量与自我报告的呼吸途径之间没有一致性。92%的阻塞性呼吸暂停后，呼吸途径保持不变。这些结果表明，与对照组相比，OSA 患者在清醒和睡眠期间更常出现口鼻腔呼吸，且与 OSA 严重程度和人体测量学指标相关。自我报告不是口鼻腔呼吸的可靠预测因素，不应作为口鼻腔 CPAP 的指征。阻塞性睡眠呼吸暂停（OSA）患者的 CPAP 接口选择通常基于鼻腔症状和自我报告的呼吸途径。我们发现，口鼻腔呼吸可以通过人体测量学测量值和 OSA 严重程度来预测，但不能通过自我报告的口鼻腔呼吸来预测。自我报告的呼吸和鼻腔症状不应作为 CPAP 接口选择的依据。
