Adenotonsillectomy alone may not resolve sleep-disordered breathing—persistent mouth breathing continues to impair airway function, sleep quality, and neuro-energetic recovery.
A growing body of clinical research is reshaping how scientists understand sleep-disordered breathing (SDB) and its long-term impact on cognitive and physiological performance.
A new retrospective study on non-syndromic, non-overweight prepubertal children reveals a critical insight:
Removing the tonsils and adenoids (T&A) improves symptoms, but does not fully resolve the problem if mouth breathing continues during sleep.
Key Findings
The study followed 64 children undergoing T&A and evaluated them with detailed clinical and polysomnographic (PSG) assessments:
-
26 children continued to experience residual SDB
-
35 children displayed persistent mouth breathing during sleep
-
These children spent 44%–100% of total sleep time breathing through the mouth
-
Persistent mouth breathing increased upper airway resistance
-
This disrupted sleep quality and impacted orofacial development
-
Only children who underwent myofunctional therapy (MFT) showed full normalization of breathing and sleep metrics
By the 1-year follow-up, children who completed MFT demonstrated near-complete recovery, while those who did not participate showed worse outcomes.
Why It Matters
The research highlights a major blind spot in both pediatric sleep medicine and adult performance science:
Mouth breathing during sleep increases airway resistance, reduces neurological recovery, and can progressively worsen energy stability and cognitive functioning.
This aligns with emerging neuroscience on the role of nasal breathing in:
-
Vagal tone regulation
-
Prefrontal cortex activation
-
Emotional resilience
-
Sleep-driven memory consolidation
-
Daytime executive function
Leadership & Performance Insight (MAX ENERGY Lens)
Although the study focuses on children, its implications are universal:
Your breathing pattern during sleep may be one of the most underestimated performance variables in your life and career.
Poor nocturnal breathing can:
-
Reduce decision-making quality
-
Increase irritability and stress reactivity
-
Impair learning consolidation
-
Lower morning energy stability
Nasal-first breathing is emerging as a foundational pillar of high-performance physiology.
What’s Next
The study strongly recommends that mouth breathing be routinely assessed after T&A procedures and that myofunctional therapy be included for long-term recovery.
As the science evolves, breathing—especially during sleep—is becoming recognized as more than a wellness practice; it is a high-performance necessity.
Breathe Right. Lead Strong.
