A systematic review of 10 studies and 233 patients found that mouth taping for obstructive sleep apnea and mouth breathing during sleep provided limited clinical benefit and may pose safety risks, particularly for patients with nasal obstruction.
The review included randomized controlled trials, prospective studies, and observational studies that were published between 1999 and 2024. Most interventions involved adhesive tape, oral seals, or chin straps to keep the mouth closed during sleep. Participants had varying severities of sleep-disordered breathing. Their ages ranged from 38 to 64 years, and body mass index (BMI) ranged from 24 to 35.
Findings
Six studies measured changes in apnea-hypopnea index (AHI), a common metric of obstructive sleep apnea (OSA) severity. Only 2 studies reported statistically significant reductions: One showed a median AHI decrease from 8.3 to 4.7 events per hour while the reduction shown in the other was from 12 to 7.8 events. Both studies included patients with mild OSA (AHI <15) and excluded those with nasal obstruction.
Three other studies found no significant AHI change with mouth taping. In one study, combining a mandibular advancement device (MAD) with mouth tape did not improve AHI more than using MAD alone. Another trial that compared a novel nasal spray with and without taping found no added benefit from taping.
Three studies that assessed snoring index reported reduced snoring after taping or using a chin strap. Of the four studies that measured oxygen desaturation index (ODI), two showed significant improvements. However, mean oxygen saturation and carbon dioxide levels did not significantly change in the individual studies that assessed them.
Mouth leak, which reduces the effectiveness of nasal continuous positive airway pressure (CPAP), was evaluated in four studies. All reported reduced air leak with mouth taping or sealing. One study found lower CPAP pressure requirements when nasal CPAP was used with mouth taping compared with oronasal CPAP.
One study used accelerometers to detect “mouth puffing,” a movement that can be observed when patients exhale forcefully against tape. Patients with puffing had higher AHI and ODI than those without. Another study that used bronchoscopy showed increased airway space during sleep with mouth closure.
Safety concerns were raised in four studies. The potential risks included asphyxiation in patients who are unable to breathe nasally.
Limitations
All 10 studies were rated low quality using the Newcastle-Ottawa Scale due to small sample sizes and risk of bias. Four studies excluded patients with nasal obstruction, which limited generalizability. Others used imaging in awake patients, which may not reflect sleep conditions.
Conclusions
Overall, the researchers found inconsistent outcomes from their review. While some studies showed minor improvements in sleep metrics among patients with mild OSA, there was insufficient evidence to support mouth taping as an effective or safe intervention for the broader population with sleep-disordered breathing. The authors wrote that further high-quality studies are needed to evaluate safety and efficacy across patient subgroups.
Lead author Jess Rhee, MD, of the Department of Otolaryngology – Head and Neck Surgery at Western University in London, Ontario, concluded with colleagues: “There is a potentially serious risk of harm for individuals indiscriminately practicing this trend.”
The authors reported no conflicts of interest.
Source: PLOS One
