Role of Nose in Sleep-Disordered Breathing

Sleep-disordered breathing (SDB) includes a wide range of breathing difficulties during sleep from primary snoring to obstructive sleep apnea (OSA) and its estimated prevalence is from 0.9% to 13% in children.1 Repeated partial (flow limitation, hypopnea) or complete (apnea) airway obstruction and increased respiratory effort are usually observed in subjects with SDB and these disrupted breathing cause adverse effects on body, growth, academic performance, et al. The prevalence of habitual snoring (mild form of SDB) has been reported to be 3 to 6 times higher than that of OSA. Although habitual snoring does not always imply the presence of OSA, habitual snoring itself is also related to a variety of adverse effects on children.2 Therefore, it can be said that undisrupted breathing during sleep is very essential for physical and mental health in children and any factors to negatively affect sleep can be negative factors of physical and mental health in children. Unfortunately, to date, the exact pathophysiology and mechanisms of SDB have not been completely understood and the role of nose in SDB has been much less understood. The nose accounts for more than 50% of the total resistance of the upper airway and nasal breathing serves important physiological functions, including humidification, heating and filtration.3-6 In addition to physiologic role of nose, it must be noted that normal respiratory route during sleep is nose and mouth breathing by nasal obstruction can make mandible, hyoid bone downward and backward and finally upper airway narrowed. Therefore, any conditions to affect normal respiratory route during sleep (nasal breathing) can make breathing during sleep difficult and strenuous, and finally have negative effects on sleep and daily life. Although our understanding of sleep physiology and the effects of nasal and oral breathing on sleep apneas and total airway resistance has progressed over the last decade, the results of previous studies have been inconsistent. This review highlights the role of nose on physiology of sleep, sleep apnea and SDB. Received: September 16, 2014 Revised: October 13, 2014 Accepted: October 21, 2014 Correspondence Chan-Soon Park, MD, PhD Department of Otorhinolaryngology-Head and Neck Surgery, St. Vincent’s Hopital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 442-723, Korea Tel +82-31-249-8304 Fax +82-31-248-5520 E-mail [email protected] Role of Nose in Sleep-Disordered Breathing