Mouth Breathing: Effects, Sleep, Face

by Johanna McWeeney

Why Breathing Through an Open Mouth Is Bad News for Adults and Children, and How to Fix It

If you’ve read the other articles in our Science section, you will know by now that healthy, efficient breathing happens through the nose. But if your nose is blocked, or your tolerance to carbon dioxide is very low, it’s likely you habitually open your mouth to breathe. As many as 90% of us have a deviated nasal septum, where the cartilage between the nostrils is crooked. Children often experience swollen adenoids and tonsils that block the nasal airway.

A sedentary lifestyle, poor cardiovascular fitness, and misconceptions about breathing all play their part. But if you breathe through an open mouth, during exercise, in a protective face mask, when you sleep, or just by force of habit, you may be surprised by the damage your breathing can cause. If your child is a mouth breather, things are perhaps even more serious. Let’s look at the effects of mouth breathing and find out how to resolve it.

What Is Mouth Breathing?

Mouth breathing is a dysfunctional breathing pattern, related to stress and disease states. If you notice yourself breathing through your mouth almost all the time, or you’re a nighttime mouth breather, there are steps you can take to restore healthy breathing. While mouth breathing is “normal” if you have a heavy cold, or are exercising intensively, chronic mouth breathing indicates a problem. What’s more, whether mouth breathing is the cause or result of your symptoms, breathing re-education to restore nasal breathing will help you feel better and perform better. In children, it’s essential for healthy growth of the face, teeth, airways, and brain.

What Causes Mouth Breathing?

Mouth breathing can be caused by anything that puts your body, and your breathing, out of balance. Some of these mouth breathing causes may not be immediately obvious. Here are just a few reasons you may be breathing through your mouth:

  • Asthma
  • Allergies
  • A deviated nasal septum or other physical nasal obstruction
  • Chronic colds or airway infections
  • Swollen or enlarged tonsils and/or adenoids
  • Polyps in your sinuses
  • A history of thumb or finger-sucking
  • A history of childhood mouth breathing
  • A small nose
  • Birth abnormalities including cleft palate, tongue-tie, and lip-tie [1]
  • Down syndrome
  • Poor posture, especially if you sit in front of a computer all day or drive professionally
  • Emotional stress, panic disorder and/or anxiety
  • Extra resistance to breathing caused by your face mask
  • Bottle feeding or overuse of a pacifier in infancy [2,3]

Habitual mouth breathing will itself cause mouth breathing. If you’re already a mouth breather, it’s likely your nose is too bunged up to breathe through it.

At night, mouth breathing can happen as you get older. Once you reach the age of 40, you’re 60% more likely to spend at least half the night breathing through an open mouth [4]. In postmenopausal women, the risk of sleep apnea increases by 200% compared with women who are still menstruating [5].

If you carry a bit of extra weight, fat on your tongue, neck and belly can cause mouth breathing during sleep. So can sleeping on your back, an overheated, stuffy room, drinking alcohol before bed, and eating late.

Is Mouth Breathing Bad?

You know we wouldn’t have devoted an entire article to the negative effects of mouth breathing if it were healthy. So, let’s just cut to the chase and begin to answer some questions. First off, if so many of us are doing it, why is mouth breathing bad?

Businesswoman feeling stressed

Mouth breathing is often fast, hard, audible and involves visible movement of the upper chest. Sometimes it’s punctuated by heavy sighs. You’d expect to see this type of breathing in someone who is very stressed or breathless.

But for habitual mouth breathers, the negative side effects of mouth breathing become chronic, due, in part to over-breathing or hyperventilation. Hyperventilation is defined as breathing too much air, reducing levels of blood carbon dioxide below normal. Long term, mouth breathing has a serious negative impact on health and longevity, and even on the way your face looks.

Mouth Breathing Symptoms — Things to Look Out For

 

“Back in 1909, an article, “Habitual Mouth-Breathing and Consequent Malocclusion of the Teeth,” was published in The Dental Cosmos. In it, DeLong described how mouth-breathing can cause the sleeper to wake with a dry mouth and throat in the morning, often accompanied by headache:

A restless sleep, [and] much tossing in bed and snoring will be observed. The face is usually elongated, the bones of the face are underdeveloped, as the air spaces do not have the proper circulation, the nostrils are small.

DeLong goes on to list other detrimental effects of mouth breathing, including recession of the chin and a high narrow palate with crooked teeth. Children who breathe through their mouths are observed as looking dull and expressionless and may be accused by their teachers of being inattentive in class.” — The Breathing Cure, Patrick McKeown

For children, there are many side effects of mouth breathing. We’ll get to those in more detail later. For adults, you may notice you can hear your breathing. Maybe you make a lot of noise when you eat, because you struggle to eat and breathe at the same time. You’re likely to have bad breath [6]. Mouth breathing dries the saliva, creating a breeding ground for the bacteria that cause halitosis and tooth decay. You may frequently have a blocked, stuffy, or runny nose.

When you exercise, you’re more likely to experience exercise-induced asthma, as cold, dry air hits your airways. You’ll also get colds and respiratory infections more often. Mouth breathing and a sore throat can go hand in hand, due to irritation, inflammation, and dehydration of the airway.

Long-term, you’ll have high blood pressure, greater risk of cardiovascular disease, and stress-related problems including anxiety, panic attacks and insomnia. You’ll have a lower immunity to airborne viruses, allergens and bacteria, and less resilience in the face of day-to-day challenges. Mouth breathing and anxiety creates a vicious cycle. Fast, hard breathing can make you anxious, and anxiety can cause fast hard breathing. When breathing is fast and hard, blood carbon dioxide (CO2) levels drop. People prone to panic disorder are known to have lower-than-normal levels of blood CO2 [7].

When you sleep, it’s likely you snore or even experience sleep apnea, a serious disorder in which breathing stops periodically during the night, leading to oxygen desaturation, and contributing to daytime fatigue, road traffic accidents [8] and early mortality. If you treat your sleep apnea with CPAP, mouth breathing with CPAP is the leading cause of non-compliance as air meant to support the airway leaks out through the lips [9]. You may end up needing a CPAP mask that covers your mouth and nose. This can be uncomfortable and claustrophobic.

The Effects of Mouth Breathing on the Face, Chin and Jaw

If you’re a mouth breather, especially if you have been since childhood, you will have a particular mouth breathing face shape. Mouth breathing affects the development of the face, jaw, and teeth when you’re still growing. This is partly due to the downward pull of gravity on the face, and partly to the incorrect resting position of the tongue. The tongue plays an important role in facial growth, and it can only sit in its correct place when the mouth is closed.

As an adult you may notice your nose is bent, the lower part of your face is elongated, your chin is recessed, and your teeth and tongue don’t seem to fit in your mouth. It’s likely your teeth are crowded and/or crooked, and you probably have heavy bags under your eyes. You may also experience neck and back pain and poor posture because you constantly push your head forward to breathe.

Does mouth breathing change your face? Over time, yes, it does. Mouth breathing has undeniable effects on the shape of the face.

How to Fix Mouth Breather Face

If you breathed through an open mouth as a child, you may need dental surgery to expand your jaw, open your airway and give your teeth the space they should have had. But before you resort to surgery, which in adulthood will be significant, it’s worth trying a gentler approach. The first step in fixing the problem is to learn to breathe through your nose. Use breathing exercises and open your nose with a nasal dilator. You can also explore myofunctional therapy, which strengthens muscles in the tongue and throat, helping to restore proper function.

Breathing Exercises for Forward Head Posture

For most people, modern life dictates that we spend many hours sitting down, often peering at a screen. It’s easy to slump and allow the head to thrust forward. All the time we’re falling forward — giving in to gravity.

Tired man looking at the computer screen.
To fix your posture, you must first correct your mouth breathing.

When you mouth breathe, it is impossible for the tongue to rest in its proper position. Your airway becomes dry and inflamed and your nose blocks. Habitual mouth breathers push their heads forward to compensate for restricted airways. They gasp for air like fish out of water.

Over time, this forward thrust of the head causes pain and muscle fatigue. It’s hardly surprising given the average weight of the head is about 11 pounds. In fact, every inch of forward head posture increases the weight on the spine by around 10 pounds.

Mouth breathing is also self-perpetuating. It tends to be shallow — into the upper chest instead of from the diaphragm. When posture is poor, the diaphragm becomes squashed. If the diaphragm can’t move properly, you can’t breathe deeply.

The diaphragm is integral to core and spinal stabilization. It’s closely linked with balance. If it can’t move well, neither can you. And, if you don’t use your diaphragm, it will become weaker. Poor diaphragm function contributes to back pain and injury.

When the diaphragm can’t move freely, we breathe into the chest. Chest breathing is linked with activation of the fight or flight stress response. Fast, upper chest breathing also causes changes to levels of blood CO2. This changes the acidity of the blood. Combined with stress, this contributes to the formation of painful myofascial trigger points, and to muscle aches.

During chest breathing, smaller breathing muscles mobilize to help get air into the body. These include muscles in the neck called the scalenes. The scalene muscles lift the ribs during normal inhalation. But if the diaphragm isn’t doing its job, they have to work too hard. Compensatory use of the scalene muscles causes neck pain and compromises the cervical range of movement.

Stop mouth breathing

Take a moment to notice… Are you slumped at your desk now, or are you sitting up straight? Whatever you’re doing, try pushing your head forward and opening your mouth. Notice your breathing. Can you breathe comfortably from your diaphragm, or is your breathing forced. Can you relax your tongue in the roof of your mouth?

Now gently line up your spine so your head, heart and pelvis are balanced over each other. Close your lips and let your tongue rest in the roof of your mouth. Feel your neck relax and your mind calm. Imagine taking this quiet, poised breathing into your everyday life.

Patrick explains the role of mouth breathing in forward head posture, and why it’s important to address children’s mouth breathing early

What the Scientists Say about Mouth Breathing

Let’s look at some of the clinical studies around mouth breathing, forward head posture and impaired lung function…

Mouth breathing and forward head posture: effects on respiratory biomechanics and exercise capacity

Sabatucci, A., Raffaeli, F., Mastrovincenzo, M., Luchetta, A., Giannone, A. and Ciavarella, D., 2015. Minerva stomatologica, 64(2), pp.59-74.

“Our study confirms that oral breathing modifies head position. The significant increase of the craniocervical angles NSL/OPT and NSL/CVT in patients with this altered breathing pattern suggests an elevation of the head and a greater extension of the head compared with the cervical spine.”

What does it mean?

Breathing through the mouth causes changes to head position.

Relationship between mouth breathing and postural alterations of children

Krakauer, L.H. and Guilherme, A., 2000. The International journal of orofacial myology: official publication of the International Association of Orofacial Myology, 26, pp.13-23.

This article explores the consequences of mouth breathing vs nose breathing and examines supposed postural alterations in children within specific age groups.

The review demonstrates that children aged 8 and over, with nasal respiration, have better posture than those who continue oral breathing beyond the age of 8 years.

What does it mean?

Mouth breathing in children should be corrected as soon as possible to avoid detrimental postural changes.

Exercise capacity, respiratory mechanics, and posture in mouth breathers

Okuro RT, Morcillo AM, Sakano E, Schivinski CI, Ribeiro MÂ, Ribeiro JD. Braz J Otorhinolaryngol. 2011 Sep-Oct;77(5):656-62..

In 2011, Brazilian researchers at Campinas State University conducted a study to assess exercise tolerance, breathing muscle strength and body posture in mouth breathing compared to nasal breathing children. Children with asthma, obesity, chronic respiratory diseases, neurological and orthopedic disorders, and cardiac conditions were excluded.

Of the 107 children, 45 were mouth breathers and 62 were nasal breathers. Examination revealed that 80% of mouth breathing and 48.4% of nasal breathing children had abnormal cervical posture and breathing pattern.

Researchers concluded that, “mouth breathing children had cervical spine postural changes and decreased respiratory muscle strength compared with nasal breathing.”

What does it mean?

Habitual mouth breathing is associated with postural changes resulting in decreased muscle strength, reduced chest expansion and impaired breathing.

Mouth breathing and forward head posture: effects on respiratory biomechanics and exercise capacity in children

J Bras Pneumol. 2011 Jul-Aug;37(4):471-9.

Scientists evaluated submaximal exercise tolerance and respiratory muscle strength in mouth breathing and nasal breathing children. A total of 92 children aged between 8 and 12 years were studied, of whom 30 were mouth breathers and 6 were nasal breathers.

The study concluded that respiratory biomechanics and exercise capacity were negatively affected by mouth breathing.

What does it mean?

Mouth breathing causes the breathing muscles (primarily the diaphragm) to become weak, so they do not work so well. When breathing is inefficient, you will become exhausted more quickly during exercise.

Assessment of the body posture of mouth-breathing children and adolescents

J Pediatr (Rio J). 2011 Jul-Aug;87(4):357-63. Epub 2011 Jul 18. Conti PB, Sakano E, Ribeiro MA, Schivinski CI, Ribeiro JD.

A study of 306 mouth breathing and 124 nasal breathing children showed that, “postural problems were significantly more common among children in the group with mouth breathing syndrome, highlighting the need for early interdisciplinary treatment of this syndrome.” In this study, researchers noted that boys are more likely to be mouth breathers than girls.

What does it mean?

Mouth breathing is present in around 50% of children, with a 60/40 split between boys and girls [6]. Children who are mouth breathers are likely to experience postural problems that can persist into adulthood.

Orientation and position of head posture, scapula, and thoracic spine in mouth-breathing children

Int J Neiva PD, Kirkwood RN, Godinho R. Pediatr Otorhinolaryngol. 2009 Feb;73(2):227-36. Epub 2008 Dec 3.

Mouth-breathing is a common clinical condition in school-age children. Some studies link this condition with poor quality of life and postural alterations.

This study investigates the orientation and position of the scapula (shoulder blade), thoracic spine (the long region of the spine between the neck and abdomen) and head posture among mouth breathing children compared with nasal breathing children.

“Mouth breathing children increased scapular superior position in comparison to nasal breathing children due probably to the position of forward head, leading to an alteration in the positioning of the mandible. The absence of significantly difference in posture pattern between groups in the present study could attributed to height-weight development in this age, as the posture of children changes in order to adapt to new body proportions, regardless of health status.”

What does it mean?

It is important to use reliable measurements when assessing postural changes in children with oral breathing routes. This will help physical therapists focus their strategies during rehabilitation.

Why do I Sleep with My Mouth Open?

Age, extra weight, “lazy” airway muscles, sleeping on your back, having one too many glasses of wine before bed… there are many reasons why your mouth may fall open during sleep. When you’re unconscious, it’s difficult to maintain control over your muscles, and if your breathing is a little hard and fast during the day, it’s likely you will mouth-breathe at night. Daytime mouth breathing may even prevent you from getting to sleep at all, as it causes hyperarousal of the sympathetic nervous system that contributes to insomnia [10].

Is it Bad to Sleep with Your Mouth Open?

It’s obvious that sleeping with your mouth open leads to mouth breathing during sleep. And if daytime mouth breathing is bad, nocturnal mouth breathing can be perhaps even more dangerous. Mouth breathing while sleeping leads to loud snoring, and it makes symptoms of sleep apnea much worse [11].

Sleep apnea is linked with depression, death by road traffic accident, sudden cardiac death, cardiac arrhythmias, and erectile dysfunction in men.

How to Stop Mouth Breathing While Sleeping

A man struggling with poor sleep

To stop mouth breathing at night, you need to stop sleeping with your mouth open. Mouth breathing is caused when the mouth falls open during sleep. To keep your mouth closed, you can practice breathing exercises that reduce the speed and flow of air you breathe. You can also try myofunctional therapy to strengthen the muscles of your tongue and throat. Some people use a chin strap, but this can cause pain in the temporomandibular joint in your jaw. If you want to keep your mouth closed while sleeping, without discomfort, use a lip tape like MYOTAPE.

To find out more about the benefits of breathing re-education for sleep apnea, read Patrick McKeown’s review in the Journal of Clinical Medicine.

Night-day mouth breathing and quality of sleep

Should I Tape my Mouth Shut at Night?

Yes. It’s the best way to ensure nasal breathing when you’re asleep. However, before you try taping, it’s important to follow some simple guidelines.

  • Never tape your mouth if you feel nauseous or may vomit.
  • Don’t tape your mouth at night if you’ve been drinking alcohol or taken recreational drugs.
  • Only tape your mouth using a specialist lip tape, or Micropore paper tape. Never use any tape with strong adhesive, or glue not designed for the skin.
  • If you are anxious about taping, try Patrick’s patented sleep tape, MYOTAPE. It goes around the mouth rather than over the mouth, so you can still open your mouth if you need to. This makes it incredibly safe.
  • Always read the instructions on the packet before applying lip tape.
  • If you have any concerns or a serious medical condition, consult your medical doctor before taping your mouth to sleep. The advice in these articles is not a substitute for that of a qualified doctor. If in doubt you can also find a certified breathing instructor to help.
  • Always listen to your body.
Nose breathing and better sleep - illustration

How to Stop Mouth Breathing in my Child

As we’ve already seen, mouth breathing in children is a serious matter. Left unchecked, it can cause irreversible changes in facial growth and cognitive ability [12], and it contributes to behavioral disorders including ADHD [13]. In small babies, mouth breathing has been linked with sudden infant death syndrome [14].

Here are a few signs that mouth breathing may be impacting facial development for your child…

They have dental problems

Does your child have crowded teeth, dental pain, smelly breath, jaw pain, or an irregular bite? Mouth breathing causes changes in the growth of the teeth and jaws. It also causes crowding. When the tongue sits in its correct resting position (in the roof of the mouth just behind the front teeth), it helps the jaw and palate to grow wide, with nice straight teeth. During mouth breathing, the tongue cannot fulfil this function.

They constantly have a blocked nose

Little girl performing nose unblocking exercise

When a child has swollen adenoids and/or tonsils, they may resort to mouth breathing because they cannot breathe through the nose. Many parents resort to surgery to remove the adenoids or tonsils, but sometimes this is not necessary. Swollen adenoids and tonsils are aggravated during mouth breathing and may resolve when nasal breathing is restored. Equally, if your child does have surgery, it is vital to teach them to breathe through the nose after the procedure.

Removing the adenoids and tonsils can significantly reduce symptoms of sleep apnea, but one study found it only completely resolved the problem in 27% of cases [15]. This indicates there are other causative factors alongside the swollen adenoids and tonsils. Another study found that if nasal breathing is not restored, sleep apnea will recur within 3 years of surgery [16].

They have sleep-disordered breathing, snoring or sleep apnea (no child should ever snore)

“Studies have defined the risk factors of obstructive sleep apnea in children as a narrow palate, long face, enlarged tonsils and/or adenoids, and minor malocclusions (misaligned teeth), and not, as some might expect, obesity.” — The Breathing Cure, by Patrick McKeown

In his 2021 bestseller, The Breathing Cure, Oxygen Advantage founder, Patrick McKeown argues that dentists should be involved in identifying sleep-disordered breathing in children. Between 1 and 5% of children have sleep-disordered breathing, and the condition has been linked with sudden infant death syndrome [17].

They have speech changes and auditory processing disorders

Mouth breathing can cause speech disorders. If your child lisps or is slower developing speech and language than you would expect, it may be down to mouth breathing [18,19,20]. Mouth breathing can also cause a hoarse-sounding voice due to dry airways.

You may notice a difference in the shape of the jaw and chin

Children who are mouth breathers will display changes in the jaw. The face and lower jaw are likely to become longer. The child may develop an overbite and a receding chin.

Your child may struggle to focus as school or display behavioral issues

Practicing focused attention with nasal breathing

If your child habitually breathes through his or her mouth, less oxygen will get to the brain, and sleep will be disturbed. Studies have linked mouth breathing and sleep-disordered breathing with a permanent reduction in cognitive ability, special educational needs, and ADHD.

To read more about the dangers of mouth breathing in children, visit our sister site ButeykoClinic.com.

How to Stop My Child Mouth Breathing

Little girl wearing mouth tape - MyoTape

The good news is, Patrick’s mouth breathing tape, MYOTAPE, is available in a small size that’s ideal for children and teens. It can be worn by any child aged 4 years and older, who is able to easily remove the tape by themselves.

Treatment for mouth breathing is largely a matter of retraining the habit of nose breathing. To do this, observe when your child breathes through their mouth. Notice how they breathe when watching TV or concentrating on homework.

You can use MYOTAPE for short periods during the day as well as at night. You may like to work with a breathing instructor to help. Or try the free program of children’s breathing exercises over on the Buteyko Clinic website.

A Final Word

Breathing is fundamental to life. When it’s in balance, it supports all the body’s systems. It’s time to fix your habitual mouth breathing and give yourself the best chance of wellness.

References:

  1. Guilleminault, Christian, Shehlanoor Huseni, and Lauren Lo. “A frequent phenotype for paediatric sleep apnoea: short lingual frenulum.” ERJ open research 2, no. 3 (2016): 00043-2016.
  2. Milanesi, Jovana de Moura, Luana Cristina Berwig, Mariana Marquezan, Luiz Henrique Schuch, Anaelena Bragança de Moraes, Ana Maria Toniolo da Silva, and Eliane Castilhos Rodrigues Corrêa. “Variables associated with mouth breathing diagnosis in children based on a multidisciplinary assessment.” In CoDAS, vol. 30, no. 4. 2018.
  3. Palmer, Brian G. “Prevention-The Key to Treating OSA/SDB-Part II.”
  4. Madronio, M. R., Emily Di Somma, Rosie Stavrinou, J. P. Kirkness, Erica Goldfinch, J. R. Wheatley, and Terence C. Amis. “Older individuals have increased oro-nasal breathing during sleep.” European Respiratory Journal 24, no. 1 (2004): 71-77.
  5. Gargaglioni, Luciane H., Danuzia A. Marques, and Luis Gustavo A. Patrone. “Sex differences in breathing.” Comparative Biochemistry and Physiology Part A: Molecular & Integrative Physiology (2019): 110543.
  6. Alqutami, J., W. Elger, N. Grafe, A. Hiemisch, W. Kiess, and C. Hirsch. “Dental health, halitosis and mouth breathing in 10-to-15 year old children: A potential connection.” European journal of paediatric dentistry 20, no. 4 (2019): 274.
  7. Meuret, Alicia E., David Rosenfield, Anke Seidel, Lavanya Bhaskara, and Stefan G. Hofmann. “Respiratory and cognitive mediators of treatment change in panic disorder: Evidence for intervention specificity.” Journal of consulting and clinical psychology 78, no. 5 (2010): 691.
  8. Tefft, Brian C. Prevalence of motor vehicle crashes involving drowsy drivers, United States, 2009-2013. Washington, DC: AAA Foundation for Traffic Safety, 2014.
  9. Bachour, Adel, and Paula Maasilta. “Mouth breathing compromises adherence to nasal continuous positive airway pressure therapy.” Chest126, no. 4 (2004): 1248-1254.
  10. Gleeson, Kevin, and Clifford W. Zwillich. “Adenosine stimulation, ventilation, and arousal from sleep.” American Review of Respiratory Disease145, no. 2_pt_1 (1992): 453-457.
  11. Hsu, Yen‐Bin, Ming‐Ying Lan, Yun‐Chen Huang, Ming‐Chang Kao, and Ming‐Chin Lan. “Association Between Breathing Route, Oxygen Desaturation, and Upper Airway Morphology.” The Laryngoscope(2020).
  12. Boyd, Andy, Jean Golding, John Macleod, Debbie A. Lawlor, Abigail Fraser, John Henderson, Lynn Molloy, Andy Ness, Susan Ring, and George Davey Smith. “Cohort profile: the ‘children of the 90s’—the index offspring of the Avon Longitudinal Study of Parents and Children.” International journal of epidemiology 42, no. 1 (2013): 111-127.
  13. Bonuck, Karen, Katherine Freeman, Ronald D. Chervin, and Linzhi Xu. “Sleep-disordered breathing in a population-based cohort: behavioral outcomes at 4 and 7 years.” Pediatrics 129, no. 4 (2012): e857-e865.
  14. Rambaud, Caroline, and Christian Guilleminault. “Death, nasomaxillary complex, and sleep in young children.” European journal of pediatrics 171, no. 9 (2012): 1349-1358.
  15. Bhattacharjee, Rakesh, Leila Kheirandish-Gozal, Karen Spruyt, Ron B. Mitchell, Jungrak Promchiarak, Narong Simakajornboon, Athanasios G. Kaditis et al. “Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study.” American journal of respiratory and critical care medicine 182, no. 5 (2010): 676-683.
  16. Lee, Seo-Young, Christian Guilleminault, Hsiao-Yean Chiu, and Shannon S. Sullivan. “Mouth breathing,“nasal disuse,” and pediatric sleep-disordered breathing.” Sleep and Breathing 19, no. 4 (2015): 1257-1264.
  17. Durdik, Peter, Anna Sujanska, Stanislava Suroviakova, Melania Evangelisti, Peter Banovcin, and Maria Pia Villa. “Sleep architecture in children with common phenotype of obstructive sleep apnea.” Journal of Clinical Sleep Medicine 14, no. 01 (2018): 9-14.
  18. de Lábio, Roberto Badra, Elaine Lara Mendes Tavares, Rafael Ceranto Alvarado, and Regina Helen Garcia Martins. “Consequences of chronic nasal obstruction on the laryngeal mucosa and voice quality of 4-to 12-year-old children.” Journal of Voice 26, no. 4 (2012): 488-492.
  19. Eom, Tae-Hoon, Eun-Sil Jang, Young-Hoon Kim, Seung-Yun Chung, and In-Goo Lee. “Articulation error of children with adenoid hypertrophy.” Korean journal of pediatrics 57, no. 7 (2014): 323.
  20. Ziliotto, Karin Neves, Maria Francisca Colella dos Santos, Valeria G. Monteiro, Márcia Pradella-Hallinan, Gustavo A. Moreira, Liliane Desgualdo Pereira, Luc LM Weckx, Reginaldo Raimundo Fujita, and Gilberto Ulson Pizarro. “Auditory processing assessment in children with obstructive sleep apnea syndrome.” Brazilian journal of otorhinolaryngology 72, no. 3 (2006): 321-327.
  21. International Journal of Psychophysiology91, no. 3 (2014): 206-211.
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