Gravitational forces, negative pressure and facial structure in the genesis of airway dysfunction during sleep: a review of the paradigm

Sleep Medicine
Howard D Stupak, Steven Y Park

Abstract

The recent and distant literature has extensive discussion of how sleep apnea, adeno-tonsillar growth, and facial structural deformity are related. Conventionally, the order of cause and effect is as follows: (1) Inflammatory/infectious process→tonsillar/adenoid tissue growth→(2) airway obstruction and mouth breathing/Obstructive Sleep Apnea (OSA)→(3) altered facial structure (adenoid facies). Using this same reasoning, adenotonsillectomy is the first line of treatment in the prevention of structural abnormalities. However, through a lifetime of clinical research Christian Guilleminault and his colleagues have challenged this paradigm. Through multiple articles and studies, Guilleminault et al., teach that even slight (subclinical) facial structure/muscle tone variations may be the inciting event triggering mouth-breathing and the eventual adenotonsillar growth in most patients. Essentially, this is the reverse of the conventional paradigms. Initial treatments therefore shift from simplified removal of inflammatory tissue to limiting mouth-breathing via musculo-skeletal modification. The purpose of this paper is to synthesize and analyze the recent (and distant) relevant literature to provide support for, and provide a potentia...Continue Reading

Citations

Sep 26, 2020·Bioscience·Sandra KahnSimon Wong
Mar 1, 2021·American Journal of Otolaryngology·Sadia T AhmedHoward D Stupak
Apr 3, 2021·European Archives of Oto-rhino-laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery·Haiyan LiuJinxiu Zhang
Jun 3, 2021·Molecules : a Journal of Synthetic Chemistry and Natural Product Chemistry·Konstantinos AdamopoulosGeorge I Lambrou
Sep 1, 2021·Journal of Oral Rehabilitation·Martin SchimmelPeter Svensson

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