Children who mouth breathe develop cranio facial changes including narrowing of the face, crooked teeth, smaller chin, undeveloped jaws and more. Mouth breathing causes the face to sink downwards. The Buteyko Method as developed by the Late Dr Buteyko addresses mouth breathing and chronic overbreathing.
Close your mouth buteyko breathing clinic self help manual -mc keown 2004trab22
This document provides an overview of the Buteyko method for treating asthma. It discusses that modern western lifestyles have increased breathing volume, which is the underlying cause of asthma according to the Buteyko method. The document outlines normal breathing volumes and how asthmatic breathing volumes are often higher. It also provides exercises and techniques for reducing breathing volume through the Buteyko method to help treat asthma symptoms.
What Can You Do For Sleep Apnea? Your Best Self-Help Treatment OptionsUninsomniaBlog
This document discusses self-help treatment options for sleep apnea. It outlines 8 options: maintaining a healthy weight, avoiding smoking, reducing alcohol consumption, using nasal decongestants before sleeping, avoiding sleeping in the supine position, doing tongue and throat exercises, not taking sedatives or muscle relaxants, and playing a wind instrument. Each option is explained in terms of why it may help and evidence of its effectiveness from studies. The document provides concise explanations and evidence for various lifestyle changes and exercises that can help treat sleep apnea without medical intervention.
1. Sleep Apnea Prepared by: dr. Mohamad Ghazi 1
2. Outline: • Sleep Apnea definition • Epidemiology • Types of Sleep Apnea • Risk factors for Obstructive sleep apnea • Diagnosis • OSA can increase the risk of ? • Treatment Options for Sleep Apnea • Conclusion 2
3. Sleep Apnea is defined as the stopping of airflow during sleep and preventing air from entering the lungs caused by an obstruction.(1) What is Sleep Apnea? 1.British Snoring & Sleep Apnoea Association . 2. Orthodontics - Current Principles and Techniques - Graber 5th edition - 2011 Just as allergic disease significantly affects quality of life, obstructive sleep apnea, if it is untreated, may affect adversely the ability of adults and children to function adequately at work and at school.(2) 3
4. 4
5. Is Sleep Apnea Significant Health Issue ? 22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstructive sleep apnea undiagnosed. (3) 3.American Sleep Apnea Association 4.Young et al 1993 5.Young et al 2002 15. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012; 130: 576-84. EPIDEMIOLOGY: OSA present in 25-58% of Male and 10-37% of Female. (4)(5) According to a report by American Academy of Pediatrics, depends on the population studied, the prevalence of OSAS is in the range of 1% to 5% (15) 5
6. Types of Sleep Apnea: Obstructive sleep apnea is the most common type of sleep apnea. It occurs when the soft tissue in the back of your throat relaxes during sleep and blocks the airway, often causing you to snore loudly. 6
7. Central sleep apnea is a much less common type of sleep apnea that involves the central nervous system, occurring when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore. Complex sleep apnea is a combination of obstructive sleep apnea and central sleep apnea. A) Obstructive sleep apnea. Note continued chest and abdominal effort in the absence of airflow. B) Central sleep apnea. Note absence of chest and abdominal effort, as well as absence of airflow 7
8. You have a higher risk for obstructive sleep apnea if you are: Overweight ??? (Most Important Factor) 5.Young et al 2002 6.National Institutes of Health 14.Malhotra et al 2002 • About 70% of those with OSA are obese (14) • Higher BMI associated with higher prevalence – BMI>30: 26% with AHI>15, 60% with AHI>5 – BMI>40: 33% with AHI>15, 98% with AHI>5 Obese people have extrinsic narrowing of the area surrounding collapsible region of the pharynx and regional soft tissue enlargement. Increased fat deposits posteriolateral to oropharyngeal airspace at level of soft palate, in the soft palate, and in submental area. Risk factors for Obstructive sleep apnea(6) 8
9. • Sex : Male are more likely than Female to have sleep apnea. • Age : the risk increases as you get older. • A family history of sleep apnea.
Hiccups are involuntary spasms of the diaphragm that cause a "hic" sound when they abruptly pull air into the lungs and close the vocal cords. They can occur in any animal with a diaphragm separating the respiratory and digestive systems. One man held the Guinness World Record for the longest hiccup attack at 68 years until his death shortly after being cured. Various home remedies and medical treatments exist to try to stop hiccups.
Children who mouth breathe develop cranio facial changes including narrowing of the face, crooked teeth, smaller chin, undeveloped jaws and more. Mouth breathing causes the face to sink downwards. The Buteyko Method as developed by the Late Dr Buteyko addresses mouth breathing and chronic overbreathing.
Close your mouth buteyko breathing clinic self help manual -mc keown 2004trab22
This document provides an overview of the Buteyko method for treating asthma. It discusses that modern western lifestyles have increased breathing volume, which is the underlying cause of asthma according to the Buteyko method. The document outlines normal breathing volumes and how asthmatic breathing volumes are often higher. It also provides exercises and techniques for reducing breathing volume through the Buteyko method to help treat asthma symptoms.
What Can You Do For Sleep Apnea? Your Best Self-Help Treatment OptionsUninsomniaBlog
This document discusses self-help treatment options for sleep apnea. It outlines 8 options: maintaining a healthy weight, avoiding smoking, reducing alcohol consumption, using nasal decongestants before sleeping, avoiding sleeping in the supine position, doing tongue and throat exercises, not taking sedatives or muscle relaxants, and playing a wind instrument. Each option is explained in terms of why it may help and evidence of its effectiveness from studies. The document provides concise explanations and evidence for various lifestyle changes and exercises that can help treat sleep apnea without medical intervention.
1. Sleep Apnea Prepared by: dr. Mohamad Ghazi 1
2. Outline: • Sleep Apnea definition • Epidemiology • Types of Sleep Apnea • Risk factors for Obstructive sleep apnea • Diagnosis • OSA can increase the risk of ? • Treatment Options for Sleep Apnea • Conclusion 2
3. Sleep Apnea is defined as the stopping of airflow during sleep and preventing air from entering the lungs caused by an obstruction.(1) What is Sleep Apnea? 1.British Snoring & Sleep Apnoea Association . 2. Orthodontics - Current Principles and Techniques - Graber 5th edition - 2011 Just as allergic disease significantly affects quality of life, obstructive sleep apnea, if it is untreated, may affect adversely the ability of adults and children to function adequately at work and at school.(2) 3
4. 4
5. Is Sleep Apnea Significant Health Issue ? 22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstructive sleep apnea undiagnosed. (3) 3.American Sleep Apnea Association 4.Young et al 1993 5.Young et al 2002 15. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012; 130: 576-84. EPIDEMIOLOGY: OSA present in 25-58% of Male and 10-37% of Female. (4)(5) According to a report by American Academy of Pediatrics, depends on the population studied, the prevalence of OSAS is in the range of 1% to 5% (15) 5
6. Types of Sleep Apnea: Obstructive sleep apnea is the most common type of sleep apnea. It occurs when the soft tissue in the back of your throat relaxes during sleep and blocks the airway, often causing you to snore loudly. 6
7. Central sleep apnea is a much less common type of sleep apnea that involves the central nervous system, occurring when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore. Complex sleep apnea is a combination of obstructive sleep apnea and central sleep apnea. A) Obstructive sleep apnea. Note continued chest and abdominal effort in the absence of airflow. B) Central sleep apnea. Note absence of chest and abdominal effort, as well as absence of airflow 7
8. You have a higher risk for obstructive sleep apnea if you are: Overweight ??? (Most Important Factor) 5.Young et al 2002 6.National Institutes of Health 14.Malhotra et al 2002 • About 70% of those with OSA are obese (14) • Higher BMI associated with higher prevalence – BMI>30: 26% with AHI>15, 60% with AHI>5 – BMI>40: 33% with AHI>15, 98% with AHI>5 Obese people have extrinsic narrowing of the area surrounding collapsible region of the pharynx and regional soft tissue enlargement. Increased fat deposits posteriolateral to oropharyngeal airspace at level of soft palate, in the soft palate, and in submental area. Risk factors for Obstructive sleep apnea(6) 8
9. • Sex : Male are more likely than Female to have sleep apnea. • Age : the risk increases as you get older. • A family history of sleep apnea.
Hiccups are involuntary spasms of the diaphragm that cause a "hic" sound when they abruptly pull air into the lungs and close the vocal cords. They can occur in any animal with a diaphragm separating the respiratory and digestive systems. One man held the Guinness World Record for the longest hiccup attack at 68 years until his death shortly after being cured. Various home remedies and medical treatments exist to try to stop hiccups.
Types of sleep apnea exist, and your physician diagnoses the specific type you have. The most common types are obstructive sleep apnea (OSA) and central sleep apnea (CSA). While not actually a separate category, mixed sleep apnea (MSA), which shows characteristics of both OSA and CSA at different times during sleep, is also diagnosed.
There are many tests used to provide a diagnosis for OSA, depending on whether you go to a pulmonologist or an otolaryngologist/head & neck surgeon. But all initial diagnostic procedures are designed to determine if your airway becomes blocked while you are asleep. If so, this will cause your brain to "wake up" several times throughout the night, generally resulting in loud snoring, pauses of breathing (apnea), and more frequent awakenings.
The document discusses obstructive sleep apnea (OSA). It provides a brief history and epidemiology of OSA, describing the normal anatomy of the upper airway. It discusses the etiology and pathophysiology of OSA, including how reduced muscle tone during sleep can lead to airway collapse when the airway is structurally narrow. It notes that most OSA patients have an anatomically narrowed airway as seen on CT scan. OSA is characterized by repetitive pauses in breathing during sleep due to pharyngeal obstruction, which can cause cardiovascular and other health issues if left untreated.
Snoring has a much greater clinical impact on Women and Children. The condition we know as snoring is in fact much more serious. Snoring is the sound that partial airway obstruction makes.
Hiccups, also known as singultus, are involuntary contractions of the diaphragm that occur in quick succession. They are caused by an involuntary reflex arc that involves the vagus nerve and phrenic nerve. Hiccups may occur individually or in bouts, and tend to resolve on their own, though many home remedies are used to try to shorten their duration. Medical treatment is sometimes necessary for cases of chronic hiccups.
Obstructive sleep apnea /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document discusses obstructive sleep apnea (OSA), a common sleep disorder where breathing stops or decreases during sleep. Key points:
- OSA involves cessation or decrease of airflow despite breathing efforts and is the most common sleep disordered breathing.
- It is characterized by recurrent collapse of the upper airway during sleep, associated with oxygen desaturations and arousals from sleep.
- OSA is diagnosed based on the apnea hypopnea index (AHI), which counts apneas and hypopneas per hour of sleep. AHI of 5 or more with symptoms indicates OSA.
- Risk factors include obesity, age, male sex, and anatomical features restricting the upper
This document discusses pediatric obstructive sleep apnea syndrome (OSAS). It provides definitions of OSAS and reviews the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment options. Regarding treatment, adenotonsillectomy is discussed as the most common initial treatment for childhood OSAS, while CPAP, oral appliances, orthodontic interventions, and other surgical procedures are also reviewed. The document concludes by discussing sequelae of untreated OSAS in children and references several studies on OSAS diagnosis and management.
This document provides information about sleep apnea, including its causes, signs and symptoms, risk factors, diagnosis, treatment, and self-care strategies. It defines two main types of sleep apnea - obstructive, which occurs when throat muscles relax and block the airway, and central, which occurs when the brain fails to signal breathing muscles. Common signs include loud snoring, breathing pauses during sleep, daytime sleepiness, and morning headaches. Risk factors include excess weight, neck size, and family history. Treatments may include devices like CPAP machines, oral appliances, surgery, weight loss, and yoga practices targeting the breathing, throat, and nasal areas.
Urooj Umer is studying hiccups for her Pharm-D degree at Riphah International University. The document discusses the causes, process, nerves involved, and treatment of both normal and chronic hiccups. It provides details on the longest recorded case of chronic hiccups lasting 68 years, as well as diagnostic tests and potential surgical treatments for severe chronic hiccups. Hiccups are more common in males than females.
Sleep apnea01 /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Sleep apnea occurs when throat muscles relax during sleep, obstructing the airway and reducing oxygen in the blood. This causes brief awakenings that patients often don't remember. Left untreated, it can cause excessive daytime sleepiness. While CPAP is commonly used, many find it uncomfortable. Alternative treatments include exercises to strengthen throat muscles like the tongue, jaw, and soft palate. Lifestyle changes such as weight loss and quitting smoking may also help reduce sleep apnea.
Obstructive sleep apnea/hypopnea (OSAH) is defined as 5 or more respiratory events per hour of sleep lasting at least 10 seconds, accompanied by oxygen desaturation and arousal from sleep. It is caused by collapse of the upper airway during sleep due to reduced muscle tone. Diagnosis involves polysomnography and is treated primarily with continuous positive airway pressure (CPAP) or oral appliances. Surgical treatments aim to enlarge the upper airway through procedures such as uvulopalatopharyngoplasty (UPPP) or maxillomandibular advancement.
This document provides an overview of obstructive sleep apnea (OSA), including its definitions, pathophysiology, clinical features, diagnosis, and management. OSA is characterized by frequent episodes of apnea and hypopnea during sleep and associated daytime symptoms. Diagnosis involves evaluating risk factors, symptoms, and using polysomnography to measure the apnea-hypopnea index. Treatment options include continuous positive airway pressure, oral appliances, and surgery for more severe cases or when other treatments are not effective or tolerated.
OSA is an entity that is increasingly being managed by otolaryngologists...Hope this presentation helps to clear any doubts regarding its diagnosis and management!
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Obstructive sleep apnea /certified fixed orthodontic courses by Indian dental...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document discusses the differential diagnosis of sleep-related breathing disorders including obstructive sleep apnea syndrome (OSAS). It lists the diagnostic criteria for OSAS as loud snoring, intermittent pauses in breathing, sleep fragmentation, excessive daytime sleepiness, and upper airway narrowing. Some common symptoms are loud snoring, excessive daytime sleepiness, choking or shortness of breath at night, while less common symptoms include morning headaches, nocturnal sweating, and a spouse worried by apneic pauses.
Obstructive sleep apnea (OSA) is a common sleep disorder where the airway becomes blocked during sleep, interrupting breathing. It is characterized by loud snoring, breathing pauses, and fatigue. Risk factors include obesity, large neck size, and family history. OSA can be classified by the site of airway obstruction and is diagnosed using tests like polysomnography. Untreated OSA has health consequences and increased mortality. Dentofacial features associated with OSA include a narrow upper airway and retrognathic mandible.
Sleep occurs in stages, with the deepest stages characterized by paralysis of voluntary muscles and rapid eye movements. Sleep apnea is a disorder where breathing stops briefly during sleep, often due to airway obstruction, which interrupts sleep quality. The main types are obstructive sleep apnea, caused by relaxation of throat muscles blocking the airway, and central sleep apnea, caused by failure of the brain to signal breathing muscles. Risk factors include obesity, large neck size, and family history. Treatment options include devices that use air pressure to keep the airway open as well as surgery in severe cases. Untreated sleep apnea can increase health risks like hypertension, heart disease, and diabetes.
Snoring and Obstructive Sleep Apnea:ManagementDr. Paulose
By Dr.K.O.Paulose FRCS DLO
Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, South India.www.drpaulose.com
www.snorefreesleep.com
Presentation in Indian Medical Association meeting on 07102011, Trivandrum Chapter.
This document discusses dynamic hyperinflation and its relationship to dyspnea. Dynamic hyperinflation occurs when expiration is incomplete before the next breath is taken, leading to increased lung volumes. This can happen in COPD patients during exercise or periods of increased breathing. It causes dyspnea through several mechanisms, including impairing the inspiratory muscles, decreasing inspiratory capacity, and stimulating various receptors in the lungs and chest wall. Managing dynamic hyperinflation and the resulting dyspnea involves strategies like pharmacotherapy, pulmonary rehabilitation, breathing techniques, CPAP, and lung volume reduction.
Reading material on COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE) for Nursing students and teachers. It tells pathophysiology, clinical manifestations, diagnostic evaluations, medical and nursing management of COPD.
Types of sleep apnea exist, and your physician diagnoses the specific type you have. The most common types are obstructive sleep apnea (OSA) and central sleep apnea (CSA). While not actually a separate category, mixed sleep apnea (MSA), which shows characteristics of both OSA and CSA at different times during sleep, is also diagnosed.
There are many tests used to provide a diagnosis for OSA, depending on whether you go to a pulmonologist or an otolaryngologist/head & neck surgeon. But all initial diagnostic procedures are designed to determine if your airway becomes blocked while you are asleep. If so, this will cause your brain to "wake up" several times throughout the night, generally resulting in loud snoring, pauses of breathing (apnea), and more frequent awakenings.
The document discusses obstructive sleep apnea (OSA). It provides a brief history and epidemiology of OSA, describing the normal anatomy of the upper airway. It discusses the etiology and pathophysiology of OSA, including how reduced muscle tone during sleep can lead to airway collapse when the airway is structurally narrow. It notes that most OSA patients have an anatomically narrowed airway as seen on CT scan. OSA is characterized by repetitive pauses in breathing during sleep due to pharyngeal obstruction, which can cause cardiovascular and other health issues if left untreated.
Snoring has a much greater clinical impact on Women and Children. The condition we know as snoring is in fact much more serious. Snoring is the sound that partial airway obstruction makes.
Hiccups, also known as singultus, are involuntary contractions of the diaphragm that occur in quick succession. They are caused by an involuntary reflex arc that involves the vagus nerve and phrenic nerve. Hiccups may occur individually or in bouts, and tend to resolve on their own, though many home remedies are used to try to shorten their duration. Medical treatment is sometimes necessary for cases of chronic hiccups.
Obstructive sleep apnea /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document discusses obstructive sleep apnea (OSA), a common sleep disorder where breathing stops or decreases during sleep. Key points:
- OSA involves cessation or decrease of airflow despite breathing efforts and is the most common sleep disordered breathing.
- It is characterized by recurrent collapse of the upper airway during sleep, associated with oxygen desaturations and arousals from sleep.
- OSA is diagnosed based on the apnea hypopnea index (AHI), which counts apneas and hypopneas per hour of sleep. AHI of 5 or more with symptoms indicates OSA.
- Risk factors include obesity, age, male sex, and anatomical features restricting the upper
This document discusses pediatric obstructive sleep apnea syndrome (OSAS). It provides definitions of OSAS and reviews the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment options. Regarding treatment, adenotonsillectomy is discussed as the most common initial treatment for childhood OSAS, while CPAP, oral appliances, orthodontic interventions, and other surgical procedures are also reviewed. The document concludes by discussing sequelae of untreated OSAS in children and references several studies on OSAS diagnosis and management.
This document provides information about sleep apnea, including its causes, signs and symptoms, risk factors, diagnosis, treatment, and self-care strategies. It defines two main types of sleep apnea - obstructive, which occurs when throat muscles relax and block the airway, and central, which occurs when the brain fails to signal breathing muscles. Common signs include loud snoring, breathing pauses during sleep, daytime sleepiness, and morning headaches. Risk factors include excess weight, neck size, and family history. Treatments may include devices like CPAP machines, oral appliances, surgery, weight loss, and yoga practices targeting the breathing, throat, and nasal areas.
Urooj Umer is studying hiccups for her Pharm-D degree at Riphah International University. The document discusses the causes, process, nerves involved, and treatment of both normal and chronic hiccups. It provides details on the longest recorded case of chronic hiccups lasting 68 years, as well as diagnostic tests and potential surgical treatments for severe chronic hiccups. Hiccups are more common in males than females.
Sleep apnea01 /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Sleep apnea occurs when throat muscles relax during sleep, obstructing the airway and reducing oxygen in the blood. This causes brief awakenings that patients often don't remember. Left untreated, it can cause excessive daytime sleepiness. While CPAP is commonly used, many find it uncomfortable. Alternative treatments include exercises to strengthen throat muscles like the tongue, jaw, and soft palate. Lifestyle changes such as weight loss and quitting smoking may also help reduce sleep apnea.
Obstructive sleep apnea/hypopnea (OSAH) is defined as 5 or more respiratory events per hour of sleep lasting at least 10 seconds, accompanied by oxygen desaturation and arousal from sleep. It is caused by collapse of the upper airway during sleep due to reduced muscle tone. Diagnosis involves polysomnography and is treated primarily with continuous positive airway pressure (CPAP) or oral appliances. Surgical treatments aim to enlarge the upper airway through procedures such as uvulopalatopharyngoplasty (UPPP) or maxillomandibular advancement.
This document provides an overview of obstructive sleep apnea (OSA), including its definitions, pathophysiology, clinical features, diagnosis, and management. OSA is characterized by frequent episodes of apnea and hypopnea during sleep and associated daytime symptoms. Diagnosis involves evaluating risk factors, symptoms, and using polysomnography to measure the apnea-hypopnea index. Treatment options include continuous positive airway pressure, oral appliances, and surgery for more severe cases or when other treatments are not effective or tolerated.
OSA is an entity that is increasingly being managed by otolaryngologists...Hope this presentation helps to clear any doubts regarding its diagnosis and management!
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Obstructive sleep apnea /certified fixed orthodontic courses by Indian dental...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document discusses the differential diagnosis of sleep-related breathing disorders including obstructive sleep apnea syndrome (OSAS). It lists the diagnostic criteria for OSAS as loud snoring, intermittent pauses in breathing, sleep fragmentation, excessive daytime sleepiness, and upper airway narrowing. Some common symptoms are loud snoring, excessive daytime sleepiness, choking or shortness of breath at night, while less common symptoms include morning headaches, nocturnal sweating, and a spouse worried by apneic pauses.
Obstructive sleep apnea (OSA) is a common sleep disorder where the airway becomes blocked during sleep, interrupting breathing. It is characterized by loud snoring, breathing pauses, and fatigue. Risk factors include obesity, large neck size, and family history. OSA can be classified by the site of airway obstruction and is diagnosed using tests like polysomnography. Untreated OSA has health consequences and increased mortality. Dentofacial features associated with OSA include a narrow upper airway and retrognathic mandible.
Sleep occurs in stages, with the deepest stages characterized by paralysis of voluntary muscles and rapid eye movements. Sleep apnea is a disorder where breathing stops briefly during sleep, often due to airway obstruction, which interrupts sleep quality. The main types are obstructive sleep apnea, caused by relaxation of throat muscles blocking the airway, and central sleep apnea, caused by failure of the brain to signal breathing muscles. Risk factors include obesity, large neck size, and family history. Treatment options include devices that use air pressure to keep the airway open as well as surgery in severe cases. Untreated sleep apnea can increase health risks like hypertension, heart disease, and diabetes.
Snoring and Obstructive Sleep Apnea:ManagementDr. Paulose
By Dr.K.O.Paulose FRCS DLO
Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, South India.www.drpaulose.com
www.snorefreesleep.com
Presentation in Indian Medical Association meeting on 07102011, Trivandrum Chapter.
This document discusses dynamic hyperinflation and its relationship to dyspnea. Dynamic hyperinflation occurs when expiration is incomplete before the next breath is taken, leading to increased lung volumes. This can happen in COPD patients during exercise or periods of increased breathing. It causes dyspnea through several mechanisms, including impairing the inspiratory muscles, decreasing inspiratory capacity, and stimulating various receptors in the lungs and chest wall. Managing dynamic hyperinflation and the resulting dyspnea involves strategies like pharmacotherapy, pulmonary rehabilitation, breathing techniques, CPAP, and lung volume reduction.
Reading material on COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE) for Nursing students and teachers. It tells pathophysiology, clinical manifestations, diagnostic evaluations, medical and nursing management of COPD.
Human beings are normally nasal breathers. The nasal and oral cavities serve as pathways for respiratory airflow.
Ordinarily, the inspiratory and expiratory airstreams are channeled through the nose because the mouth is usually closed.
However, in some individuals, because of nasal airway inadequacy or habit, the oral cavity becomes the predominant route for the passage of respiratory airflow.
seminar on hfv - high frequency ventilation dr saimaDr. Habibur Rahim
This document summarizes a seminar on high frequency ventilation (HFV). It includes two case scenarios and outlines the history, types, mechanisms, settings, monitoring, and strategies for different lung diseases when using HFV. HFV uses small tidal volumes and high rates to prevent lung injury from mechanical ventilation. It aims to operate in the "safe window" between overdistension and collapse. Settings like mean airway pressure, amplitude, and frequency are adjusted based on goals of lung recruitment and avoidance of barotrauma. Complications can include irritation, hemodynamic effects, air trapping, and overinflation.
This document describes a study evaluating the effectiveness of different airway clearance therapies for patients with ALS. The study aims to compare the combination of mechanical insufflation/exsufflation (MIE) and high frequency chest wall oscillation (HFCWO) devices to using each device alone. 28 participants were randomized into three groups testing MIE alone, MIE+HFCWO, or HFCWO alone. The primary outcome is to evaluate respiratory complications severity using scales. Participants commit to daily device use and clinic visits at 3 months. Descriptive results found attrition with 10 completing the study. Discussion notes the difficulties conducting research in ALS and that patients may present at later disease stages.
This document discusses the use of non-invasive ventilation (NIV) as a physiotherapeutic approach. It defines NIV as the delivery of oxygen via a face mask without an endotracheal tube. NIV works by creating positive airway pressure to force air into the lungs, reducing respiratory effort. There are two main types of NIV: non-invasive positive pressure ventilation and negative pressure ventilation. The document then discusses specific NIV techniques like CPAP and BiPAP and their indications. It also covers contraindications and how NIV can be used to manage acute respiratory failure, improve secretion removal, exercise capacity, and treat chronic respiratory failure.
This document provides information on respiratory function and aging-related changes. It discusses how the lungs, airways, chest wall, and respiratory muscles undergo anatomical and physiological changes with normal aging. These include stiffening of lung tissue, decreased lung capacity and compliance, weaker respiratory muscles, and altered breathing patterns. Age-related changes in the immune system, cardiovascular system, and neurological function can also impact pulmonary status. Common respiratory conditions that affect older adults like COPD are then reviewed in terms of symptoms, diagnostic testing, treatment options, and nursing management.
This document discusses ARDS (acute respiratory distress syndrome), including its history, definitions, pathophysiology, and evidence-based treatment strategies. ARDS is characterized by diffuse pulmonary inflammation and reduced lung compliance. Traditional ventilator strategies have been shown to cause ventilator-induced lung injury, so current recommendations focus on lung-protective ventilation with low tidal volumes and high PEEP. Additional rescue therapies for refractory hypoxemia include recruitment maneuvers, proning, and ECMO. Proper diagnosis requires consideration of alternative conditions and use of diagnostic tools like echocardiogram, bronchoscopy, and chest CT scan.
This document provides an overview of ventilator settings and their clinical application. It begins with the objectives and provides background on pulmonary physiology including lung volumes, compliance, resistance, and time constants. It then covers types of respiratory failure and diseases that impact compliance and resistance. The remainder focuses on ventilator settings like FiO2, PIP, PEEP, rate, Ti/Te ratio, flow and their significance. Manipulations to optimize oxygenation and CO2 elimination are discussed along with the advantages and disadvantages of increasing various settings. The goal of assisted ventilation is to achieve adequate oxygenation and CO2 elimination while minimizing risks of barotrauma.
Ok, heres the story. I was teaching this otherwise sharp EMT-Basic class that bombed two respiratory emergency tests in a ROW!
So this is the remedial lecture I inflicted on them. I don\'t know if they passed because of this fine work, or just because they were afraid of another lecture fo they failed.
Hope its useful to you.
1. ARDS is a respiratory condition characterized by diffuse pulmonary edema and hypoxemia that develops rapidly within one week of a known clinical insult.
2. The Berlin Definition from 2011 revised the diagnostic criteria for ARDS, requiring an onset within 1 week of a known clinical insult, bilateral opacities on chest imaging not fully explained by cardiac failure or fluid overload, and a ratio of arterial oxygen partial pressure to fractional inspired oxygen of ≤300 mm Hg for mild ARDS or ≤200 mm Hg for moderate/severe ARDS.
3. Management of ARDS involves mechanical ventilation with low tidal volumes, conservative fluid management to avoid pulmonary edema, and treating the underlying cause of lung injury while minimizing additional lung injury from
The document discusses sleep apnea, its types, causes, symptoms, diagnosis and various treatment options. It defines sleep apnea as cessation of breath lasting at least 10 seconds during sleep. The main types are obstructive, central and mixed apnea. Common risk factors include obesity, retrognathia and tonsillar hypertrophy. Diagnosis involves polysomnography and questionnaires. Treatments include oral appliances, CPAP, surgery like maxillomandibular advancement and tracheostomy. The role of orthodontists is in diagnosis and oral appliance therapy.
The document discusses ventilation and different modes of noninvasive ventilation. It provides details on:
1) How ventilation works through pressure differences that cause air to flow into and out of the lungs. Different factors like resistance and Boyle's law impact this process.
2) The history and development of noninvasive ventilation, from early negative pressure devices to current use of positive pressure ventilation delivered noninvasively through masks.
3) Modes of noninvasive positive pressure ventilation including volume ventilation, pressure ventilation, bilevel PAP, and CPAP. The benefits and limitations of noninvasive ventilation are also summarized.
This document covers several topics related to respiratory pathophysiology:
1. It describes the anatomy and control of breathing, including the medullary respiratory center and pontine and apneustic areas.
2. Various types of breathing patterns are defined, such as Cheyne-Stokes respirations and Biot's respiration, along with the areas of brain injury that cause each pattern.
3. Common respiratory symptoms like cough, dyspnea, and hemoptysis are discussed alongside their typical causes.
4. Physical exam findings on chest auscultation and percussion are outlined, including vocal fremitus and lung sounds.
5. The calculation of the alveolar-arterial oxygen
This document discusses various ventilator settings including inspiratory pause, I:E ratio, and inspiratory rise time. It provides details on how each setting influences oxygenation, ventilation, and hemodynamics. The I:E ratio represents a balance between oxygenation and ventilation. An inspiratory pause can improve oxygenation in ARDS but decrease CO2 clearance in asthma. The inspiratory rise time is typically set to the default or shortest time to minimize work of breathing. Compliance, inspiratory time, and resistance all impact tidal volumes in pressure control ventilation.
This document provides an overview of COPD and emphysema pathogenesis. It discusses:
1. The case of a 55-year-old male smoker presenting with dyspnea and a history of 20 pack-years of smoking.
2. The pathogenesis of emphysema, which involves chronic smoke exposure leading to lung inflammation and damage, structural cell death, and ineffective repair of lung tissue.
3. Definitions and classifications of COPD, emphysema, and chronic bronchitis from leading health organizations.
Similar to Buteyko Method - Sleep Apnea by Patrick McKeown (20)
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
2. Increased inflammation of upper and lower airways
Increased stickiness of upper airways
Reduced lung volume
Reduced nasal NO
Reduced ventilation/perfusion
Reduced messages to upper dilator muscles
Decreased ETCO2
Increased ventilatory response to CO2
Lighter sleep
Oral Breathing
3. More moist upper and lower airway
Reduced stickiness of upper airways
Improved lung volume
Nasal NO
Improved ventilation/perfusion
Increased messages to upper dilator muscles
More normal ETCO2
Reduced ventilatory response to CO2
Deeper sleep
Nasal Breathing
4. Reduced negative pressure in upper airways
Enhanced concentrations of nasal NO
Improved ventilation/perfusion
More normal ETCO2
Improved functioning of nasal airways- starling resistor model
Easier to maintain nasal breathing as less feeling of ‘suffocation’
Reduced ventilatory response to CO2
Normal Breathing Volume
5. Four key traits
Four key traits of upper airway anatomy and neuromuscular control
interact to varying degrees within individuals to cause OSA.
(1) Pharyngeal critical closing pressure
(2) Stability of ventilator chemoreflex feedback control (loop gain)
(3) The negative intraesophageal pressure that triggers arousal
(arousal threshold)
(4) The level of stimulus required to activate upper airway dilator
muscles (upper airway recruitment threshold).
AnnalsATS Volume 13 Number 1| January 2016
6. Pcrit
• Air pressure at which the passive airway collapses
• Fat deposition both around the pharynx and within upper airway
dilator muscles such as the genioglossus (tongue) decreases
airway lumen size and causes detrimental changes to upper airway
muscle function.
AnnalsATS Volume 13 Number 1| January 2016
7. Pcrit
• Abdominal obesity compresses the abdomen and thoracic cavities,
reducing lung volume which reduces tracheal tension and thus
impairs pharyngeal mechanics.
AnnalsATS Volume 13 Number 1| January 2016
8. Pcrit
• Therefore, fat deposition around the pharynx and torso
both increase airway collapsibility
AnnalsATS Volume 13 Number 1| January 2016
9. Pcrit & Breathing Re-Education
Bernoulli Principle
• As fluid flows, a negative pressure develops at the periphery of the
flow and that as the flow velocity increases, so does the negative
pressure.
• (sucking through a paper straw)
Snoring and Obstructive Sleep Apnea. David N.F. Fairbanks and Samuel A. Mickelson
10. Pcrit & Breathing Re-Education
• 15 (±3) L/min (Twenty obese men with OSA and normal lung
function)
• 12.8 (±3.5 )11 obese men with overlap syndrome (OSA & COPD)
Radwan L, Maszczyk Z, Koziorowski A, Koziej M, Cieslicki J, Sliwinski P, Zielinski J.
Control of breathing in obstructive sleep apnea and in patients with the overlap
syndrome. Eur Respir J. 1995 Apr; 8(4): p.542-545.
11. Pcrit & Breathing Re-Education
• Minute ventilation mouth breathing (8.43)
• Nose breathing (9.37 )
Douglas NJ, White DP, Weil JV, Zwillich CW. Effect of breathing route on ventilation
and ventilatory drive. Respir Physiol. 1983 Feb;51(2):209-18.
12. Pcrit & Breathing Re-Education
Men
• Minute ventilation Wake: 10.6
• Minute ventilation sleep: 9.2
Women
• Minute ventilation Wake: 7.8
• Minute ventilation sleep: 7.2
Jordan AS, McEvoy RD, Edwards JK, et al. The influence of gender and upper airway
resistance on the ventilatory response to arousal in obstructive sleep apnoea in
humans. The Journal of Physiology. 2004;558(Pt 3):993-1004.
13. Pcrit & Breathing Re-Education
Minute Volume pre-trial: At three months follow up:
BBT 14 L BBT 9.6 L/min
Control Group 14.2 L/min Control Group 13.3 L/min
The relative reduction in beta2-agonist use in the BBT group was related to
the proportionate reduction in minute volume
Bowler SD, Green A, Mitchell CA, Buteyko breathing techniques in asthma: a blinded
randomised controlled trial. Med J of Australia 1998; 169: 575-578.
14. • The presence of a further upstream obstructive factor (nose) will
generate a suction force, that is, a negative intraluminal pressure
downstream (oropharynx), resulting in pharyngeal collapse in
predisposed individuals
De Sousa Michels Daniel et al. International Journal of Otolaryngology.
Volume 2014 (2014), Article ID 717419
Pcrit & Breathing Re-Education
15.
16. • A closed jaw and proper dental occlusion stabilize the flow in the
upper airways .
• When nasal resistance exceeds a certain level, an air bypass occurs
and leads to mouth breathing, resulting in a decrease in the
retroglossal dimension, due to the subsequent retraction of the
tongue, narrowing of the pharyngeal lumen, and increased
oscillation and vibration of the soft palate and redundant tissue of
the pharynx .
De Sousa Michels Daniel et al. International Journal of Otolaryngology.
Volume 2014 (2014), Article ID 717419
Pcrit & Breathing Re-Education
17. 10 normal men had full night recordings before and during nasal
obstruction.
During nasal obstruction, time spent in the deep sleep stages decreased
from 90 to 71 min, whereas significantly more time was spent in Stage
1 sleep.
Twofold increase in sleep arousals and awakening resulting from an
increased number of apneas (34 during control sleep versus 86 during
obstructed sleep).
Zwillich CW, Pickett C, Hanson FN, Weil JV Disturbed sleep and prolonged apnea during nasal
obstruction in normal men. J Pediatr (Rio J). 2011 Jul-Aug;87(4):357-63. Epub 2011 Jul 18.
Pcrit & Breathing Re-Education
18. • Apneas of 20 to 39s in duration became 2.5 times more frequent
during obstruction.
• De-saturation (SaO2 less than 90%) occurred 27 times during
control sleep compared with 255 times during obstructed sleep.
Disturbed sleep and prolonged apnea during nasal obstruction in normal men. Am
Rev Respir Dis. 1981 Aug;124(2):158-60.
Pcrit & Breathing Re-Education
20. Loop Gain
• During sleep, ventilatory control is dominated by the level of CO2
and O2 in the blood. Arterial CO2 has the greater influence, with
increasing CO2 stimulating an increase in ventilatory drive.
Annals ATS Volume 13 Number 1| January 2016
21. Loop Gain
• Ventilatory drive determines not only the level of activity of the
thoracic pump muscles but also the upper airway dilator muscles.
• Consequently, the upper airway is susceptible to collapse when
CO2, and therefore neural drive to the upper airway muscles, is
low.
AnnalsATS Volume 13 Number 1| January 2016
22. Loop Gain
• When the central respiratory output waxes and wanes, the activity
of the upper airway dilator muscles varies accordingly so that
periods of low central respiratory drive are associated with low
upper airway dilator muscle activity, high airway resistance, and a
predisposition to airway collapse.
• Thus, respiratory control instability (also known as high loop gain)
is probably a causative factor of obstructive sleep apnoea in some
patients.
Lancet. 2014 February 22; 383(9918): 736–747.
24. Loop Gain
• After arousal, most people hyperventilate briefly and if large
enough, CO2 concentration in blood can fall below the chemical
apnoea threshold, resulting in a central apnoea.
Lancet. 2014 February 22; 383(9918): 736–747.
25. • After a switch to oral breathing during sleep, there is greater
CO2 elimination during expiration, caused by an increase in
respiratory stimulus. The increase in central apneas suggests that
the nose plays an important role in the regulation of respiration
and not only in the maintenance of airway patency.
De Sousa Michels Daniel et al. International Journal of Otolaryngology.
Volume 2014 (2014), Article ID 717419
Loop Gain
26. Loop Gain
• Ventilatory responses were greater with mouth than nose
breathing both for hypercapnia (mouth 2.29, nose 1.58 L/min/mm
Hg CO2; ) and for hypoxia (mouth 1.08 nose 0.91 +/- 0.21 L/min/%
SaO2;).
• (lowers loop gain. More stable)
Douglas NJ, White DP, Weil JV, Zwillich CW. Effect of breathing route on ventilation
and ventilatory drive. Respir Physiol. 1983 Feb;51(2):209-18.
27. Loop Gain
• Higher loop gain defines less-stable control, as a
disproportionately large ventilatory response will result in a
greater degree of hypocapnia and subsequent reduction in
ventilatory drive.
Annals ATS Volume 13 Number 1| January 2016
28. Loop Gain
• Thus, high loop gain contributes to perpetuating apneas.
Supporting this concept is evidence that patients with OSA have
higher loop gain than patients without OSA and that loop gain
predicts AHI.
Annals ATS Volume 13 Number 1| January 2016
29. • Mouth breathing increase the ‘dryness’ of the upper airway
mucosal surface.
• Increased wall ‘stickiness’ may then make the upper airway more
difficult to reopen after closure.
Manisha Verma, Margaret Seto-Poon, John R Wheatley, Terence C Amis, Jason P
Kirkness. Influence of breathing route on upper airway lining liquid surface tension in
humans. J Physiol. 2006 Aug 1; 574(Pt 3): 859–866.
Loop Gain
30. • Increased lung volume also probably stabilises the respiratory
control system by increasing the stores of O2 and CO2 and thus,
buffering the blood gases from changes in ventilation.
Lancet. 2014 Feb 22; 383(9918): 736–747
Loop Gain
32. Arousal Threshold
• Another potentially important factor is the propensity to arouse
from sleep (the arousal threshold).
Lancet. 2014 February 22; 383(9918)
• Increasing negative intraesophageal pressure during airway
obstruction triggers arousal, and the change from sleep to wake
increases basal chemoreflex drive and sensitivity.
Annals ATS Volume 13 Number 1| January 2016
33. Arousal Threshold
• Individuals with low arousal thresholds might arouse before the
dilator muscles are able to reopen the airway.
• Delay of arousal with sedatives might help to treat the condition if
the upper airway muscles are sufficiently responsive to respiratory
stimuli to stabilise the airway before arousal.
Amy S. Jordan, PhD, David G. McSharry, MB, and Prof. Atul Malhotra, Adult
obstructive sleep apnoea Lancet. 2014 Feb 22; 383(9918): 736–747
34. Arousal Threshold
• Obstructive events terminated by arousal result in a greater
degree of hyperventilation and consequent hypocapnia and
reduction in ventilatory drive, including drive to upper airway
muscles.
Annals ATS Volume 13 Number 1| January 2016
35. Upper Airway Recruitment Threshold
• If the upper airway muscle responsiveness is sufficiently
poor, then arousal is necessary to initiate airway opening .
Annals ATS Volume 13 Number 1| January 2016
36. Arousal Threshold
• Thus, arousals may perpetuate successive obstructions.
• A high arousal threshold (aroused by more negative pressures)
appears to develop in many patients with OSA as an adaptive
mechanism, as a greater magnitude of both negative pressure
stimuli and chemostimulation can accumulate to recruit upper
airway dilator muscles to terminate the event before arousal.
Annals ATS Volume 13 Number 1| January 2016
38. Upper Airway Recruitment Threshold
• The magnitude of stimuli (both negative pressure stimuli and
chemostimulation) required to recruit upper airway dilator
muscles adequately to overcome negative intrapharyngeal closing
pressures is called the upper airway recruitment threshold.
Annals ATS Volume 13 Number 1| January 2016
39. Upper Airway Recruitment Threshold
• Poor upper airway muscle responsiveness increases the duration
of obstructive events, as greater stimuli are required to activate
the muscles to terminate the obstruction.
Annals ATS Volume 13 Number 1| January 2016
40. Upper Airway Recruitment Threshold
• Increased chemoreflex drive due to both prolonged obstruction
and arousal increases the ventilatory response after airway
opening. Thus, poor upper airway recruitment interacts with
arousal threshold and loop gain to contribute to repetitive apnea.
Annals ATS Volume 13 Number 1| January 2016
41. • NO appears to play a role in maintaining the patency of the upper
airways, as a transmitter between the nose, pharyngeal muscles,
and lungs. NO is produced in significant quantities in the nose and
in the paranasal sinuses .
De Sousa Michels Daniel et al. International Journal of Otolaryngology.
Volume 2014 (2014), Article ID 717419
Upper Airway Recruitment Threshold
42. • Nitric oxide and carbon dioxide may also act as aerocrine
messengers. Physiological, epidemiological, and clinical evidence
support a “unified airway” model.
James Bartley, Conroy Wong. Nasal Physiology and Pathophysiology of Nasal Disorders
pp 559-566. Date: 27 June 2013
Upper Airway Recruitment Threshold
43. • NO also plays a role in the maintenance of muscle tone, regulation
of neuromuscular pathways in the pharyngeal muscles,
spontaneous respiration, and sleep regulation. In general, the role
of NO in the regulation of nasal OSAS, although probably
significant, is still not completely understood.
De Sousa Michels Daniel et al. International Journal of Otolaryngology.
Volume 2014 (2014), Article ID 717419
Upper Airway Recruitment Threshold
44. • As the total amount of inspired NO varies according to the nasal
flow, it appears logical that a decrease in nasal breathing would
result in reduction of NO delivery to the lungs.
• Ventilation-perfusion ratio.
De Sousa Michels Daniel et al. International Journal of Otolaryngology.
Volume 2014 (2014), Article ID 717419
Upper Airway Recruitment Threshold
45. • Prevalence between asthma and OSA ranges from 38% up to as
high as 70%.
• Based on the current concepts of bidirectional relationship
of OSA and asthma, it is sensible to assume that treating one
disorder will result in the other's better control and vice versa.
Abdul Razak MR, Chirakalwasan N .Obstructive sleep apnea and asthma. Asian Pac J
Allergy Immunol. 2016 Dec;34(4):265-271.
Upper Airway Recruitment Threshold
46. • The lower and upper airways are mechanically linked, so that with
increased lung volumes, resulting in stiffening and dilation of the
pharyngeal airway.
Amy S. Jordan, PhD, David G. McSharry, MB, and Prof. Atul Malhotra, MD
Adult obstructive sleep apnoea Lancet. 2014 Feb 22; 383(9918): 736–747.
Upper Airway Recruitment Threshold
47. Research to determine
• Controlled, randomized, single-blind study. Breathing reeducation
on asthmatic mouth breathing children. 35 children with mild or
moderate asthma in the age group between 7 and 12 years.
• Karla M.P.P. Mendonca , Thalita M.F. Macedo , Diana A. Freitas , Ada C.J.S. Silva , Cleia T.
Amaral , Thayla A. Santino , Patrick McKeown . American Journal of Respiratory and Critical Care
Medicine 2017;195:A2204 . Buteyko Method for Children with Asthma and Mouth Breathing: A
Randomized Controlled Trial
48. Research to determine
• Breathing re-education group significantly improved the scores on
sleep disturbances, wakefulness disorders, sleep wake transition
disorders (DTSV), the number of days off school, total sleep
disturbance scores, forced vital capacity (FVC), peak Expiratory
flow and forced expiratory flow between 25% and 75% of FVC
(FEF25-75%).
• Karla M.P.P. Mendonca , Thalita M.F. Macedo , Diana A. Freitas , Ada C.J.S. Silva , Cleia T.
Amaral , Thayla A. Santino , Patrick McKeown . American Journal of Respiratory and Critical Care
Medicine 2017;195:A2204 . Buteyko Method for Children with Asthma and Mouth Breathing: A
Randomized Controlled Trial
49. 26 volunteers with a diagnosis of asthma
and chronic rhinitis, ranging in age from
23 – 60 years were recruited from the
general population.
Adelola O.A., Oosthuiven J.C., Fenton J.E. Role of Buteyko
breathing technique in asthmatics with nasal symptoms.
Clinical Otolaryngology.2013, April;38(2):190-191
Research to determine
52. Research to determine
• Relationship between minute volume and OSA
• Breathing pattern during wakefulness and sleep
• Normalisation of breathing pattern during wakefulness carries into
sleep
• Can breathing re-education prove to be an effective adjunctive
measure for patients with CPAP or treated with surgery?