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"口呼吸"對睡眠呼吸障礙的影響

先說在前,這篇2023年四月的論文,結論顯示口呼吸與阻塞性睡眠呼吸有關,同時也說明了,通過鼻呼吸可以消除打鼾,改善呼吸道阻塞的問題。原始論文以英文發表,貼於最下,供大家參考。


睡眠呼吸障礙(SDB)似乎有多種因素,舌頭造成呼吸道阻塞,除了舌根的機械性阻塞外,還有少部分使口咽部前壁塌陷。有一種理論解釋了咽部舒張肌肌肉長度縮短如何可以導致上氣道塌陷。睡眠時張口呼吸會降低舒張肌肌肉的效率,因為這些肌肉位於下顎骨和舌骨之間,從而降低了它們的長度。這種肌肌長度的減少傾向於降低氣道崩潰的抵抗力。


口呼吸可能受鼻呼吸阻力的變化以及阻塞性睡眠呼吸暫停的影響。口部呼吸時,咬肌肌電圖活動也會減少。這也可能有助於解釋口呼吸者臉部垂直生長增加的現象。僅在睡眠中張口,而不進行口呼吸也可以增加氣道崩潰。


鼻呼吸阻力的增加影響到使用口呼吸,可能是過敏以及鼻中隔和鼻甲干擾的結果。當然,扁桃體和腺樣體的肥大對口呼吸也有重大影響。另一個原因可能是下顎後縮,即下顎骨逆時針旋轉和舌骨向下和向後移動有關。其他可能的因素包括食物和其他過敏源,早產,肥胖,以及由於呼氣時睡眠位置水平導致肺活量降低,從而減少睡眠時的肌肉活動。當氣道變窄時,由於氣流增加產生的吸力會導致咽部壁進一步塌陷。(就好像吸飲料時,遇到阻力,吸管會塌陷而吸不到飲料)


打鼾只在睡眠時出現,而且通常是在仰臥位時出現;然而,它也可能在更垂直的睡眠位置出現。由於打鼾需要在睡眠中張口,並且通常伴有口呼吸,當防止口呼吸時,個體被迫通過鼻子呼吸,這可以消除打鼾。這種在夜間口呼吸(NMB)減少既可以減少症狀數量也可以減少它們的嚴重程度,但並不常在每個人身上達到完全糾正。


以下結論可以得出:


  1. 關於NMB對SDB的影響,92%的測量症狀、其嚴重程度和其指數顯示出具有統計學意義的結果。

  2. NMB的影響增加了症狀的嚴重程度,而不在夜間口呼吸的孩子則SDB的嚴重程度較低。

  3. 孩子的NMB存在傾向於增加72%的測量症狀的嚴重程度。

  4. NMB被認為對SDB的嚴重程度有重大影響,並且是所有測量症狀中最常見的,出現在68%的病例中;次常見的症狀是夜間醒來,為52%。

  5. 臨床上,解決NMB對於對SDB的大多數其他症狀產生影響是重要且有益的。

  6. 配戴矯正器藉以抬高舌頭高度,可以有效減緩SDB狀況


名詞解釋:

  • 夜間張口呼吸 (Nighttime Mouth Breathing,NMB)

  • 睡眠呼吸障礙(Sleep Disordered Breathing,SDB)

原始發表論文


Mouth Breathing and Its Impact on Sleep-Disordered Breathing

There appear to be multiple factors to SDB besides the mechanical impingement of the base of the tongue forcing at least a partial collapse of the anterior wall of the oropharynx. One theory explains how a shortening in the length of pharyngeal dilator muscles can contribute to upper airway collapse.4 Meurice et al suggested that open-mouth breathing while sleeping decreases the efficiency of the dilator muscles by reducing their length since these muscles are positioned between the mandible and the hyoid bone.5 This reduction of muscle length tends to reduce the resistance to collapse of the airway. Oral breathing may be influenced by changes in nasal breathing resistanceas well as by obstructive sleep apnea.6 There is also a reduction of masseter muscle electromyographic activity during NMB.6,7 This might also help explain the presence of increased vertical facial growth in mouth breathers. Mouth opening alone during sleep without oral breathing can also increase the collapse of the airway.


Nasal resistance to breathing influences mouth breathing8 and can be the result of allergies and septum and turbinate interference. Of course, tonsil and adenoid enlargement has a significant effect on mouth breathing. Another cause can be the counterclockwise rotation of the mandible9 and the movement of the hyoid bone in an inferior and posterior direction. Other possible factors are food and other allergies, premature birth, obesity, and reduction of muscle activity while sleeping with less lung capacity due to a horizontal sleeping position during expiration.10 When the airway becomes narrow, the suction created by an increased airflow results in further collapse of the pharyngeal walls.


Snoring only occurs when one sleeps, and it most often occurs while the individual is in the supine position; however, it can occur while in a more vertical sleeping position as well. Because snoring requires an open mouth while sleeping and usually involves mouth breathing, when one prevents oral breathing, the individual is forced to breathe through the nose, which can eliminate snoring. Such a reduction in NMB reduces both the number of symptoms present and their severities, but does not usually reach complete correction in every person.


The following conclusions can be made: (1) Statistically significant results were indicated in 92% of the measured symptoms, their severities, and their indexes regarding the influence of NMB on SDB. (2) The influence of NMB increases the severity of the symptoms, while children who do not nighttime mouth breathe have less severity of SDB. (3) The presence of NMB in a child tends to increase the severity of 72% of the symptoms measured. (4) NMB is considered to have a major impact on the severity of SDB and is the most prevalent of all symptoms measured, being present in 68% of cases; the next most common symptom is waking up at night, at 52%. (5) Clinically, it is important and advantageous to address NMB in order to produce an effect on most other symptoms of SDB.


關鍵字:口呼吸、睡眠呼吸障礙、呼吸道阻塞、夜間張口呼吸、打鼾

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