Understanding Nasal Breathing: the key to evaluating and treating sleep disordered breathing in adults and children

peter catalano, John Walker



Nasal breathing is a basic and critical function that we rarely think much about, and most would be quite surprised to learn how important and influential it is in growth and development, and a healthy productive life. Fundamentally speaking, nasal breathing provides us with a sense of smell, enhances oxygen absorption by our lungs (via nitric oxide production from the sinuses, warms and humidifies the air we breathe before it reaches the lower airway, and helps filter impurities from the air.  However, it is also responsible for proper craniofacial development, temporo-mandibular joint function head posture and more. When nasal breathing does not occur for any reason, the body is forced into a series of compromises that prioritize getting oxygen into our blood at the expense of the functions provided by the nasal breathing.  Because oxygen is required for survival, we are forced to live with a host of acquired health issues as a consequence of chronic or intermittent mouth breathing. One such consequence, known as sleep disordered breathing (SDB), is becoming pandemic in children, and directly affects their growth, development, intellect, academic performance, behavior, and much more. In the article, we will review the causes of nasal obstruction, and how it relates to craniofacial development and palatal growth, the development of ADD and ADHD, and new minimally invasive dental, nasal and airway procedures to correct the problem. On this review we will assess the different symptoms and causes, as palate shape changes or tonsils disease. Also a quick view about available therapeutic approaches will be done, including minimal invasive nasal surgery as well support devices as linguaflex an CPAP.

Full Text:

 Subscribers Only


Jankowski, R., Nguyen, D. T., Poussel, M., Chenuel, B., Gallet, P., & Rumeau, C. (2016). Sinusology. European annals of otorhinolaryngology, head and neck diseases, 133(4), 263-268.

Torre, C., & Guilleminault, C. (2018). Establishment of nasal breathing should be the ultimate goal to secure adequate craniofacial and airway development in children. Jornal de Pediatria (Versão em Português), 94(2), 101-103.

Tay, D. K. L., & Pang, K. P. (2018). Clinical phenotype of South–East Asian temporomandibular disorder patients with upper airway resistance syndrome. Journal of oral rehabilitation, 45(1), 25-33.

Bharadwaj, R., Ravikumar, A., & Krishnaswamy, N. R. (2011). Evaluation of craniofacial morphology in patients with obstructive sleep apnea using lateral cephalometry and dynamic MRI. Indian Journal of Dental Research, 22(6), 739.

Tolaymat, A., & Liu, Z. (2017). Sleep Disorders in Childhood Neurological Diseases. Children, 4(10), 84.

Wexler, D., Braverman, I., & Amar, M. (2006). Histology of the nasal septal swell body (septal turbinate). Otolaryngology—Head and Neck Surgery, 134(4), 596-600.

Ciolek, P. J., Xu, A., Anne, S., & Geelan-Hansen, K. (2017). Role of adenoidectomy in chronic nasal obstruction after nasal steroid therapy failure. American journal of otolaryngology, 38(3), 305-308.

Davcheva-Chakar, M., Kaftandzhieva, A., & Zafirovska, B. (2015). Adenoid Vegetations–Reservoir of Bacteria for Chronic Otitis Media with Effusion and Chronic Rhinosinusitis. prilozi, 36(3), 71-76.

Campos-Juanatey, F., Fernandez-Barriales, M., Gonzalez, M., & Portillo-Martin, J. A. (2017). Effects of obstructive sleep apnea and its treatment over the erectile function: a systematic review. Asian journal of andrology, 19(3), 303.

Hvolby, A. (2015). Associations of sleep disturbance with ADHD: implications for treatment. ADHD Attention Deficit and Hyperactivity Disorders, 7(1), 1-18.

Hawkins, S. M., Jensen, E. L., Simon, S. L., & Friedman, N. R. (2016). Correlates of pediatric CPAP adherence. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 12(6), 879.

Muñoz, I. C. L., & Orta, P. B. (2014). Comparison of cephalometric patterns in mouth breathing and nose breathing children. International journal of pediatric otorhinolaryngology, 78(7), 1167-1172.

Šidlauskienė, M., Smailienė, D., Lopatienė, K., Čekanauskas, E., Pribuišienė, R., & Šidlauskas, M. (2015). Relationships between malocclusion, body posture, and nasopharyngeal pathology in pre-orthodontic children. Medical science monitor: international medical journal of experimental and clinical research, 21, 1765.

Harvold, E. P., Vargervik, K., & Chierici, G. (1973). Primate experiments on oral sensation and dental malocclusions. American journal of orthodontics, 63(5), 494-508.

Ant, A., Kemaloglu, Y. K., Yilmaz, M., & Dilci, A. (2017). Craniofacial Deviations in the Children With Nasal Obstruction. Journal of Craniofacial Surgery, 28(3), 625-628.

Shah, A., Shah, P., Goje, S. K., Shah, R., & Modi, B. (2017). Palatal Expansion and its Effects in Orthodontics. Advanced Journal of Graduate Research, 2(1), 31-36.

Motro, M., Schauseil, M., Ludwig, B., Zorkun, B., Mainusch, S., Ateş, M., ... & Korbmacher-Steiner, H. (2016). Rapid-maxillary-expansion induced rhinological effects: a retrospective multicenter study. European Archives of Oto-Rhino-Laryngology, 273(3), 679-687.

Bellerive, A., Montpetit, A., El-Khatib, H., Carra, M. C., Remise, C., Desplats, E., & Huynh, N. (2015). The effect of rapid palatal expansion on sleep bruxism in children. Sleep and Breathing, 19(4), 1265-1271.

Goyal, A., Pakhare, A. P., Bhatt, G. C., Choudhary, B., & Patil, R. (2018). Association of pediatric obstructive sleep apnea with poor academic performance: A school-based study from India. Lung India: Official Organ of Indian Chest Society, 35(2), 132.

Owens, J. A. (2009). Neurocognitive and behavioral impact of sleep disordered breathing in children. Pediatric pulmonology, 44(5), 417-422.

Smith, D. L., Gozal, D., Hunter, S. J., & Kheirandish-Gozal, L. (2017). Parent-reported behavioral and psychiatric problems mediate the relationship between sleep-disordered breathing and cognitive deficits in school-aged children. Frontiers in neurology, 8, 410.

Zaffanello, M., Piacentini, G., Lippi, G., Fanos, V., Gasperi, E., & Nosetti, L. (2017). Obstructive sleepdisordered breathing, enuresis and combined disorders in children: chance or related association. Swiss Med Wkly, 147, w14400.

Laurikainen, E., Aitasalo, K., Erkinjuntti, M., & Wanne, O. (1992). Sleep apnea syndrome in children—secondary to adenotonsillar hypertrophy?. Acta Oto-Laryngologica, 112(sup492), 38-41.

Huang, Y. S., Guilleminault, C., Lee, L. A., Lin, C. H., & Hwang, F. M. (2014). Treatment outcomes of adenotonsillectomy for children with obstructive sleep apnea: a prospective longitudinal study. Sleep, 37(1), 71-76.

Thadikonda, K. M., Shaffer, A. D., & Stapleton, A. L. (2018). Outcomes of adenoidectomy-alone in patients less than 3-years old. International Journal of Pediatric Otorhinolaryngology.

Catalano, P. J., Gupta, R. C., Warman, M., & Wijewickrama, R. C. (2014). Sinus Surgical Techniques from Caldwell-Luc to MIST. In Diseases of the Sinuses (pp. 389-410). Springer, New York, NY.

Setliff III, R. C. (1996). MIN IMALLY IN VASIVE SIN US SURGERY. Otolaryngologic Clinics of North America, 29(1), 115.

Dolan, R. W., Catalano, P. J., Innis, W., & Wanees, E. (2009). In-office surgical repair of nasal valve stenosis. American journal of rhinology & allergy, 23(1), 111-114.

Catalano, P., Ashmead, M. G., & Carlson, D. (2015). Radiofrequency ablation of septal swell body. Ann Otolaryngol Rhinol, 2(11), 1069.

De Yun Wang, H. P. L., & Gordon, B. R. (2012). Impacts of fluid dynamics simulation in study of nasal airflow physiology and pathophysiology in realistic human three-dimensional nose models. Clinical and experimental otorhinolaryngology, 5(4), 181.

Tan, J., Han, D., Wang, J., Liu, T., Wang, T., Zang, H., ... & Wang, X. (2012). Numerical simulation of normal nasal cavity airflow in Chinese adult: a computational flow dynamics model. European archives of oto-rhino-laryngology, 269(3), 881-889.

Peter Catalano Curative role of MIST in OSA (Publishing in progress).

Poirier, J., George, C., & Rotenberg, B. (2014). The effect of nasal surgery on nasal continuous positive airway pressure compliance. The Laryngoscope, 124(1), 317-319.

Woodson, B. T., Strohl, K. P., Soose, R. J., Gillespie, M. B., Maurer, J. T.,

de Vries, N., ... & Mickelson, S. (2018). Upper Airway Stimulation for Obstructive Sleep Apnea: 5-Year Outcomes. Otolaryngology–Head and Neck Surgery, 0194599818762383.

Catalano, P. J. (2014). U.S. Patent Application No. 14/055,159.

Alsufyani, N. A., Noga, M. L., Witmans, M., Cheng, I., El-Hakim, H., & Major, P. W. (2017). Using cone beam CT to assess the upper airway after surgery in children with sleep disordered breathing symptoms and maxillary-mandibular disproportions: a clinical pilot. Journal of Otolaryngology-Head & Neck Surgery, 46(1), 31.

Peter Catalano, Michael schlewet Nasal airway changes after nasal and sinus surgery in children with sleep disordered breathing (Publishing in progress).

ClinicalTrials.gov Identifier: NCT03181594.

DOI: http://dx.doi.org/10.18103/imr.v4i6.725


  • There are currently no refbacks.
Copyright 2016. All rights reserved.