Sleep Related Breathing Disorder

What are we studying and why?

Based on numerous other peer-reviewed research, we understand that the root cause of many chronic inflammatory symptoms is associated with a compromised airway, which can cause disturbances to breathing both during the day and at night while a patient is sleeping. While the presentation of these symptoms may be different in adults vs. children, our philosophical basis of therapy is similar in that we employ minimally invasive medical devices, myofunctional exercises, and lifestyle changes to address the root cause. By treating this root cause, we can eliminate the need fo many chronic pharmaceutical intervention that is limited to masking symptoms of this inflammation and never "heal" the true etiology. 

In a 2016 study of over 500 pediatric subjects published in the Journal of the American Orthodontic Society, researchers used this same therapeutic modality and demonstrated almost complete resolution (>90%) of symptoms including morning headaches, snoring, labored breathing. Additional symptoms that demonstrated improvement by 74-90% included teeth grinding, night sweats, daytime sleepiness and irritability, restless sleep, bedwetting, and throat infections. 

We are very enthusiastic about the promise this therapy shows to help a wide variety of conditions that have previously gone undiagnosed or misdiagnosed. This new round of research we are launching is focused on evaluating this same therapeutic modality to more niche patient segments. So while the actual therapeutic tools have been around for a long time, we are exploring uncharted territory in the application of this therapy to resolve or alleviate new symptoms and/or to gather credible data to prove this therapy in hopes of increasing access to care to these patients in need and potentially challenge current accepted standards of care. 

What is sleep-disordered breathing? What is its relation to compromised airway?

 

Sleep-disordered breathing is an umbrella term for several chronic conditions in which partial or complete cessation of breathing occurs many times throughout the night, resulting in daytime sleepiness or fatigue that interferes with a person's ability to function and reduces quality of life. SDB causes systemic inflammation and can manifest itself in a variety of symptoms that can be easily overlooked, misdiagnosed, and most unfortunately, left untreated.

Awareness related to sleep-disordered breathing in both adults and children has increased drastically over the past two decades. Traditionally seen in the field of sleep medicine, most patients diagnosed with "sleep issues" fit the stereotype of an older person, oftentimes overweight, who snores loudly. However, in more recent years, physicians, dentists, and research scientists have tested and proven that sleep and airway disturbances occur much more commonly, and the presentation of associated symptoms looks very different based on the patient type.

 

For example in a child, audible breathing at nighttime is indicative of an airway issue that would disturb sleep; if a child is actually snoring, then he or she has a further progression of the disorder, or is presenting with more severe symptoms. Additionally, "young fit females" has become a classification for high risk patients who's symptoms are not only different to identify from what is typically associated with this disorder, but oftentimes these patients get misdiagnosed or their symptoms are "excused away" based on lifestyle or other factors (more on this later)

Common Symptoms Associated with Pediatric Sleep-Disordered Breathing:

Poor Nighttime habits

  • Mouth breathing

  • Snoring

  • Sleep walking/ talking

  • Teeth grinding

  • Wakes up at night, restless sleep

  • Night sweats

  • Bedwetting

  • Nightmares

behavioral issues

  • Difficulty listening, interrupting often

  • Fidgets with hands

  • ADHD, hyperactivity, attention deficit

  • Difficulty in school (specifically math, science, spelling)

myofunstional, anatomical

  • Speech problems

  • Tongue thrust, dysfunctional swallow

  • Crowded teeth 

  • Delayed or stunted growth

immunological, hormonal

  • Frequent throat infections

  • More frequent upper respiratory infections

  • Allergies, asthma

  • Skin conditions, eczema

  • Morning headaches

  • Increased risk of type 2 diabetes, obesity

What is the root cause of this disorder? 

Research from the past 20 years has linked these outward signs and symptoms to the following root causes:

  • Mouth breathing

  • Narrow palette

  • Improper tongue placement

  • Improper jaw relationships &/or deficient mandible

Said another way, if the child has any of these conditions, then the mandible (or "lower jaw") will drift down and back towards the spinal cord, thus restricting the airway that sits posteriorly. 

Effects of Mouth Breathing

Pictured here are 2 different types of scans to show the effects of mouth breathing on the airway. Opening the mouth 1/2 inch causes the oropharynx (or the upper part of the airway) to be reduced by 6mm

As a frame of reference, the average 7 year old child should have an airway that is approximately 7mm anteroposteriorly. So when a child of that age is breathing through his or her mouth, it's comparable to having their airway reduced to the size of a coffee straw. 

For adults, a healthy airway can be measured within a range of 11-15mm. 

For more information, we recommend viewing the following video: "How improper breathing leads to TMJ  Disorder and Crowded Teeth"

How is this related to the patients' condition in this study? 

For children who present with other comorbidities (ie. those who experience seizures associated with a hypoxic birth, those with special needs, etc.), our team of experts has gathered preliminary clinical data that supports an improvement in various clinical indicators if the child is treated with head and neck myofunctional therapy, with specific attention on ensuring the airway is patent. 

To expedite these optimized clinical outcomes, our team is employing Healthy Start intra-oral appliances to accomplish the following:

  • Establish nasal breathing

  • Reinforce proper tongue placement and function

  • Advance the mandible downward and forward, thus opening up the airway 

  • Expanding the dental arches and promoting optimal growth and development and dental eruption in children, or more ideal arch relationships in adults

And how can the therapy being studied help patients enrolled in the study? 

The intra-oral device and its associated therapy has been used for over 50 years in over 4 million cases worldwide. So it is important to note that the system is safe. Additionally, it has been proven effective in the treatment of the aforementioned chronic inflammatory symptoms and associated orthopedic and orthodontic conditions.

The purpose of this new research project aims to evaluate the efficacy of this therapy to achieve the following:

  • Decreased moisture in the upper airway

  • Increase O2 saturation and improved sleep condition

    • For our seizure study, we hypothesize that this could facilitate a decrease in frequency, duration, &/or severity of seizures a patient experiences

    • For our special needs study, we hypothesize that this could improve airway potency sufficiently to avoid or decrease the recommended surgical intervention (tongue reduction, ear tubes, TNA) and prevent the need for a CPAP