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1 Depts of Medicine, and 2 Otolaryngology, Queen's University, and 3 Kingston General Hospital, Kingston, Ontario, Canada
CORRESPONDENCE: M. Fitzpatrick, Division of Respiratory and Critical Care Medicine, Queen's University, 102 Stuart Street, Kingston, Ontario, K7L 2V6, Canada. Fax: 1 6135491459. E-mail: mf19@post.queensu.ca
Keywords: breathing route, mouth breathing, sleep apnoea, upper airway resistance
Received: April 30, 2003
Accepted June 16, 2003
This study was funded by grants from the William M. Spear Foundation, Queen's University and the Physicians' Service Incorporated Foundation, Ontario.
Healthy subjects with normal nasal resistance breathe almost exclusively through the nose during sleep. This study tested the hypothesis that a mechanical advantage might explain this preponderance of nasal over oral breathing during sleep.
A randomised, single-blind, crossover design was used to compare upper airway resistance during sleep in the nasal and oral breathing conditions in 12 (seven male) healthy subjects with normal nasal resistance, aged 30±4 (mean±sem) yrs, and with a body mass index of 23±1 kg·m2.
During wakefulness, upper airway resistance was similar between the oral and nasal breathing routes. However, during sleep (supine, stage two) upper airway resistance was much higher while breathing orally (median 12.4 cmH2O·L–1·s–1, range 4.5–40.2) than nasally (5.2 cmH2O·L–1·s–1, 1.7–10.8). In addition, obstructive (but not central) apnoeas and hypopnoeas were profoundly more frequent when breathing orally (apnoea-hypopnoea index 43±6) than nasally (1.5±0.5).
Upper airway resistance during sleep and the propensity to obstructive sleep apnoea are significantly lower while breathing nasally rather than orally. This mechanical advantage may explain the preponderance of nasal breathing during sleep in normal subjects.
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