Conventional Treatment
The discussion of prevention-based treatments has only come into popular discourse recently and was likely born out of the realization that current symptom-based treatments have shown to be largely ineffective at treating SRBDs.
In children, the majority of mouth breathing is related to allergies or an obstruction involving the nose or the adenoids and tonsils. Adenotonsillectomy has shown to be effective in immediate symptom improvement, however many children continue to mouth breathe afterwards and many of the children who subsequently are nose breathing relapse into mouth breathing a few years after their operation. Although surgical procedures have a definite place in the management of SRBDs, many parents are reluctant to undergo these procedures and it must be acknowledged that it is not a pragmatic answer to the hundreds of millions of people requiring treatment. Making the airway larger by surgical or pharmaceutical means is only one facet of the issue and rehabilitation must also focus on the behavior and muscles associated with the airway.
Positive airway pressure (PAP) is a widely used intervention for patients with OSA, however since its inception it has had some major disadvantages. The major issue with PAP is that patients either stop wearing their device or alternatively they only use it for a fraction of their sleep. Adjustment to the device has notoriously been difficult, many citing embarrassment or discomfort with using the device. PAP masks in children have been shown to apply an orthopedic force to the midface and retard the growth of the craniofacial bones, and a similar but less dramatic phenomenon may also happen in adults. At the end of the day, using air to stent open the airways is an emergency measure and doesn’t really rehabilitate the patient.
Mandibular advancement devices (MADs) are next in line after PAP to address mild to moderate OSA, and in some cases severe OSA. The same orthopedic issue arises when MADs apply a force which protrudes the mandible past its physiological rest position. In order to pull the lower jaw forward, a backward force must be applied to the upper jaw, and this often causes a change to the patient’s bite. Furthermore, MAD users have reported pain in the jaw, teeth, facial muscles and a dry mouth.
After exploring modern interventions, it seems clear to see that no single intervention is entirely effective at addressing the problem, mainly because they are centered around short-term control of patient symptoms. This is inevitably the outcome of mechanical interventions for biological problems, and why discussion is increasing turning to prevention and patient rehabilitation.