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Regulation of Mouth Taping and Obstructive Sleep Apnea Therapies
TAKE-HOME MESSAGE
- Mouth taping is a sleep technique that is currently being widely touted on social media as a seemingly benign and low-cost method to reduce the risk of obstructive sleep apnea. Although forced mouth closure increases the total inspiratory airflow in many patients, this outcome varies significantly depending on the baseline oral airflow. In addition to velopharyngeal collapse, undiagnosed upper airway nasal obstructions may result in a dependence on open-mouth sleep breathing and contraindicate therapies resulting in mouth closure.
- Obstructive sleep apnea is a complex, multifactorial disorder that requires the assessment of individual patients and the development of comprehensive treatment pathways to effectively assist patients and clinicians in appropriate clinical decision–making for this condition.
abstract
This abstract is available on the publisher's site.
Access this abstract nowA deluge of coverage regarding the benefits of mouth taping on sleep quality has recently flooded social media. Within the US, more than 7000 posts garnering 7 million views on TikTok with the hashtag #mouthtape are available for public consumption. Individuals featured on these platforms tout a myriad of benefits including improved respiratory health, reduced risk for obstructive sleep apnea (OSA) development, and enhanced oral health using this seemingly benign and low-cost intervention. As national news outlets and nearly every academic sleep medicine program have scrambled to release communications and opinion pieces on this trend, a spotlight has been cast on the limited objective data available on forced mouth closure during sleep, and worse, on the lack of protocols and regulations to ensure its appropriate implementation.
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Should Mouth Taping and Obstructive Sleep Apnea Therapies Be Regulated?
JAMA Otolaryngol Head Neck Surg 2024 Oct 03;[EPub Ahead of Print], JW Chadwick, AT HuangFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Both reviewed studies1,2 are related to the recent hot topic in the public domain of mouth taping during sleep to foster nasal breathing. One study1 is an editorial on the subject, and the other is an original clinical trial.2 First, Chadwick and Huang's commentary on mouth taping cautions against the purported benefits of mouth taping, which has recently deluged social media.
This social phenomenon may be the public's response to several factors attempting to take more control over their health. The first is an increased awareness of a condition (obstructive sleep apnea [OSA]) that was, until recently, perceived to be limited to overweight older men but turns out to affect a more significant segment of the population. Another factor is the real and reported lack of compliance with the current "gold standard" management with continuous positive airway pressure therapy to improve sleep quality and avert the well-known health consequences of disordered breathing during sleep.
The junk science that arises from social media influencers may also occur from a self-help response to a disease management healthcare system that offers few proactive solutions to the increased awareness of the pandemic incidence of sleep-breathing disorders.3-6
With this in mind, to address the emergence of mouth taping as a solution to sleep disorders, this editorial points to the nonrandomized clinical trial by Yang et al2 who examined the impact of mouth closure on the anatomic factors related to nasal airflow and the diagnosis of OSA. A total of 54 patients with a wide spectrum of sleep disorders were evaluated for inspiratory flow limitation in open- and closed-mouth positions using drug-induced sleep endoscopy, used as a surrogate sleep condition mimicking natural sleep. This protocol facilitated the detection of the effects of breathing and sleeping with open- and closed-mouth postures on sleep by the lead investigator. The cohort was nonrandomized because the protocol excluded the possibility of an otherwise randomized population.
The results of the trial demonstrated that nasal breathing during sleep increased the overall airflow by a physiologically meaningful magnitude, providing a promising strategy for obviating pharyngeal collapse (increased critical pressure for pharyngeal collapse) during sleep and, thus, preventing OSA. The proviso in these results is that changes in airflow with mouth closure were highly heterogeneous. In other words, some patients had worse breathing and consequent obstruction due to mouth closure during sleep.
These findings are not surprising in understanding the complexities of the risk factors associated with acquiring OSA. The condition of the airway beyond the considerations of size and shape is essential, as well as flow-limiting structural and functional risk factors that include enlarged turbinates, deviated nasal septa, or pathology that may obstruct nasal breathing and cause hypoglossal nerve dysfunction. Lip taping in these ordinary circumstances will often worsen breathing during sleep.
Regarding structural risk factors, in the 90s, Kushida et al established a morphometric model to predict OSA, with a 97.6% sensitivity and a 100.0% specificity for screening OSA.7 In 2002, Dempsey et al defined the anatomic risk factors related to acquiring a sleep disorder beyond the BMI, which had primarily been considered a significant risk factor for OSA.8 Stupak and Park reviewed 100 years of otolaryngology literature related to oral tidal breathing secondary to swollen lymphatic tissues and stated that oral tidal breathing leads to an increased nasopharyngeal negative pressure and subsequent intraluminal airway collapse (critical collapse pressure).9
Mouth taping may obviate oral tidal breathing during sleep by sealing the lips; however, it does nothing to address oropharyngeal collapse from a prolapsing tongue that may block the preferred breathing route via the nasopharynx. Although lip taping may improve nasal breathing during sleep in specific circumstances and worsen sleep breathing in other circumstances, there may be better questions to ask beyond whether mouth taping should be regulated.
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