Mouth Puffing Phenomenon and Upper Airway Features May Be Used to Predict the Severity of Obstructive Sleep Apnea

Nat Sci Sleep. 2023 Apr 3:15:165-174. doi: 10.2147/NSS.S384387. eCollection 2023.


Purpose: This study aimed to investigate (1) the role of mouth puffing phenomenon and upper airway features in obstructive sleep apnea (OSA) and (2) whether mouth-taping during sleep alleviated the severity of OSA.

Participants and methods: Seventy-one participants underwent a two-night home sleep test (the first day sleeping normally; the second day sleeping with their mouths being taped); their oximetry desaturation index (ODI) and mouth puffing signals (non-mouth puffing, complete mouth puffing, intermittent mouth puffing (IMP), and side mouth puffing) were detected by a validated fingertip pulse oximeter and a mouth puffing detector. The participants were grouped into the ODI-improved group and the ODI-not-improved group according to their sleeping test results. The radiograph was taken by cone-beam computed tomography and cephalometries. Upper airway features including airways, soft tissues, and oral cavity variables were measured.

Results: Participants with severe OSA showed a higher IMP percentage compared with those with normal, mild, and moderate OSA (severe: 33.78%, moderate: 22.38%, mild: 14.55%, normal: 0.31%, p < 0.001). In all participants, the ODI and the percentage of SpO2 under 90 (T90) were positively related to body mass index (BMI) (r = 0.310 and 0.333, respectively), while ODI and T90 were negatively correlated with the minimum width of the airway (r = -0.473 and -0.474, respectively); all mentioned relationships were significant (p < 0.05).

Conclusion: IMP proportions were found to be higher in the half of participants whose ODI did not improve after mouth-taping and in those with severe OSA. Moreover, OSA patients with higher ODI, higher T90, and higher proportions of IMP were more likely to have a narrower upper airway.

Keywords: accelerometer; mouth breathing; mouth puffing; oximeter; sleep apnea; sleep phenomena.

Grants and funding

This study is financially supported by a grant (CY10615, & CY10820) from the Cheng Hsin General Hospital (Taiwan), and a grant (109BRC-B504) from the project “Aim for the Top University” from the Ministry of Education, Taiwan. The authors do not receive any other financial support from any other organization or person.