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Review
. 2021 Jan 26;10(3):471.
doi: 10.3390/jcm10030471.

Breathing Re-Education and Phenotypes of Sleep Apnea: A Review

Patrick McKeown  1 , Carlos O'Connor-Reina  2   3 , Guillermo Plaza  4   5
Affiliations
Review

Breathing Re-Education and Phenotypes of Sleep Apnea: A Review

Patrick McKeown et al. J Clin Med. .

Abstract

Four phenotypes of obstructive sleep apnea hypopnea syndrome (OSAHS) have been identified. Only one of these is anatomical. As such, anatomically based treatments for OSAHS may not fully resolve the condition. Equally, compliance and uptake of gold-standard treatments is inadequate. This has led to interest in novel therapies that provide the basis for personalized treatment protocols. This review examines each of the four phenotypes of OSAHS and explores how these could be targeted using breathing re-education from three dimensions of functional breathing: biochemical, biomechanical and resonant frequency. Breathing re-education and myofunctional therapy may be helpful for patients across all four phenotypes of OSAHS. More research is urgently needed to investigate the therapeutic benefits of restoring nasal breathing and functional breathing patterns across all three dimensions in order to provide a treatment approach that is tailored to the individual patient.

Keywords: breathing re-education; dysfunctional breathing; myofunctional therapy; obstructive sleep apnea; phenotypes.

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Conflict of interest statement

Patrick McKeown is a Buteyko Breathing Educator, the inventor of MyoTape® and the owner of https://myotape.com/ and The Oxygen Advantage®. Carlos O’Connor Reina is a Buteyko Breathing Educator and the creator of the APP Airway Gym®. Guillermo Plaza has no conflicts of interest.

Figures

Figure 1
Figure 1
Breathing re-education is based on three dimensions. The causes of dysfunctional breathing are biomechanical, biochemical and psychological. Breathing re-education (BRE) approaches these from three dimensions, each underpinned by full-time nasal breathing. (1) Biomechanical, breathe low to engage the diaphragm. (2) Biochemical, breathe light, reduce tidal volume and lessen chemosensitivity to CO2. (3) Resonant frequency—slow breathing at six breaths per minute.
Figure 2
Figure 2
Breathing re-education. A video demonstration of decongesting nose exercise is available as Supplementary Materials (Video S1).
Figure 3
Figure 3
Four phenotypes/endotypes in obstructive sleep apnea hypopnea syndrome (OSAHS), modified from Eckert et al. [34,35].
Figure 4
Figure 4
MyoTape®, a device to reinforce nasal breathing. A video demonstration is as Supplementary Materials (Video S2).
Figure 5
Figure 5
Normal breathing versus hyperventilation. Modified from www.RespiracionNormal.org [154].
See this image and copyright information in PMC

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