How is tongue-tie a known risk factor for obstructive sleep apnoea?
In obstructive sleep apneoa, the airway collapses repetitively during sleep. This blocks air flow into the lungs and threatens adequate oxygenation of the body’s organs and tissues. It leads to fragmented, unrefreshing sleep.
In children it can manifest as behavioural or social-emotional problems. It may impact their mental abilities, focus, concentration and school performance. Research now demonstrates the interruptions in oxygen are linked to structural changes in the developing brain.
Adults are more likely to present with tiredness, fatigue or excessive daytime sleepiness. It has been linked to neurocognitive deficits, poorer school performance, and increased risk of Alzheimer’s Disease later in life.
The collapse of the airway can occur in multiple areas. Often the most significant area is behind the base of the tongue. As the muscles relax during sleep, the tongue may fall back into the throat creating a blockage.
Tongue-tie’s prevent the tongue from developing the sufficient tone to sit lightly suctioned to the palate during sleep. A low tongue posture increases the chance of the base of the tongue obstructing the airway.
In childhood, the altered tongue function and resting posture leads to changes in the way the palate develops. This has been linked to increased collapsibility of the airway.
The latest evidence linking tongue-ties to poor sleep breathing
Research from Stanford Sleep Centre now identifies children with tongue-ties as a new group of children at risk of obstructive sleep apnoea. Compared to children who have enlarged adenoids and tonsils, children with restricted tongue-ties will present with breathing difficulties at a later age. This is because the changes in palate development are slowly progressive.
In another study, the same researcher emphasizes the importance of checking for tongue-ties in children with Sleep Disordered Breathing (SDB). Conversely, it suggests screening for the presence of SDB when tongue-ties are noted. The results highlight how mouth breathing often persists after the tongue-tie has been released, and myofunctional therapy to restore nasal breathing and normal breathing during sleep is often required.
Case Studies: The impact of tongue-tie release in managing obstructed sleep breathing in children
What about tongue-tie release for adults?
At present there are no published studies directly examining tongue-ties in adults and measures of obstructive sleep breathing.
We do know there are numerous quality studies to support myofunctional therapy as an adjunct to other treatments for obstructive sleep apnoea. This therapy consists of various exercises designed to improve tongue of the tongue and throat muscles. This ultimate aim is to reduce upper airway collapsibility.
This video demonstrates the exercises used in one of the first studies that compared patients that did myofunctional exercises, compared to a group that did a sham set of activities.
The group who did these exercises had significantly reduced obstructive sleep apnoea and less symptoms.
These exercises require optimal range of tongue movements. Through the restriction of full movements, tongue-ties prevent the development of the proper muscle tone required for airway stability.
Tongue-tie release in combination with myofunctional therapy to reduce collapsibility of the airway can be a rational option for some patients. It does require more systematic investigation. This may be considered for those who are interested in addressing root causes in addition to managing symptoms, or those who can’t tolerate any other management options for obstructed sleep breathing.