Updates in Airway Health: Why Early Intervention, Especially in Children, Changes Everything

Airway care is moving toward earlier screening, personalized treatment, and collaboration across disciplines.

Airway health is evolving quickly.

For decades, obstructive sleep apnea has often been viewed through an adult-centered lens, with CPAP positioned as the primary treatment option. While CPAP can be highly effective for many adults, it does not address every contributing factor behind airway dysfunction. It also may not be realistic, tolerated, or appropriate for every patient, especially children.

In an Airway Circle Thursday Night Live session, Dr. Joseph Zelk shared important updates in airway health, sleep medicine, pediatric screening, dental sleep medicine, CPAP alternatives, and the importance of early intervention.

Dr. Zelk is the Clinic Director and a Diplomate of the American Board of Sleep Medicine, with over 20 years of experience treating snoring and obstructive sleep apnea. He is a nationally recognized speaker in sleep disorders and dental sleep medicine, and he has helped pioneer Hybrid Positive Airway Pressure therapies.

As the leader of Sleep Medicine Group, Dr. Zelk has been providing home sleep testing since 2005, integrating advanced home sleep monitoring to improve diagnostic accuracy and patient outcomes. He is also deeply committed to educating dentists and healthcare providers on oral appliance therapy and comprehensive medical management in dental sleep medicine.

His message was clear: airway care must become earlier, more personalized, more preventive, and more collaborative.

The Hidden Epidemic of Undiagnosed Sleep Apnea

Obstructive sleep apnea is still widely underdiagnosed.

Dr. Zelk shared that nearly 80% of the estimated 30 million Americans with OSA remain undiagnosed. Even more concerning, many children with airway dysfunction are also being missed.

Snoring is often dismissed as normal, especially in children. But snoring is not normal breathing. It is a sign of resistance in the airway.

Dr. Zelk emphasized that obstructive sleep apnea is a suffocating process, even when it is labeled “mild.”

In children, untreated airway obstruction may affect oxygen delivery, sleep quality, brain development, growth, behavior, attention, learning, and long-term health. This is why Dr. Zelk strongly cautions against a “watchful waiting” approach in pediatric patients with airway red flags.

When children are struggling to breathe well during sleep, waiting may mean missing a critical window for development.

Why Pediatric Airway Screening Matters

Children with airway dysfunction may show signs through sleep, behavior, growth, dental development, and oral posture.

Children do not always present like adults with sleep apnea.

Adults may report daytime sleepiness, fatigue, hypertension, snoring, witnessed apneas, or poor sleep quality. Children, however, may present with behavioral, developmental, orthodontic, or facial growth changes.

Pediatric airway dysfunction may show up as:

• Mouth breathing
• Snoring
• Restless sleep
• ADHD-like behavior
• Poor sleep quality
• Decreased upper arch width
• Increased overjet
• Reduced mandibular growth
• High-arched palate
• Short hard palate
• Increased vertical facial growth
• Crowding
• Difficulty concentrating
• Behavioral dysregulation

These are not simply cosmetic or orthodontic issues. They may be developmental signs that the airway is not growing or functioning optimally.

For airway-focused providers, the message is simple: children should be screened early and often.

Early Intervention Changes the Trajectory

One of the most important themes from Dr. Zelk’s presentation was the power of early intervention.

When airway issues are identified in childhood, clinicians may have the opportunity to guide growth, support nasal breathing, improve oral posture, address habits, and reduce airway resistance before problems become more complex.

Early intervention may include:

• ENT evaluation
• Orthodontic evaluation
• Myofunctional therapy
• Sleep screening
• Home sleep testing when appropriate
• Tonsil and adenoid evaluation
• Nasal breathing support
• Habit correction
• Palatal expansion
• Growth guidance
• Medical management
• Parent education

Not every child needs the same intervention. But every child with airway signs deserves a deeper look.

As Dr. Zelk emphasized, an ounce of prevention is truly worth a pound of cure.

Airway Health Shows Up in the Dental Chair

Dental professionals are in a powerful position to identify airway dysfunction.

The mouth often reveals what is happening during sleep, breathing, growth, and function. Dentists and hygienists may be the first providers to notice patterns that suggest airway compromise.

Common dental and orofacial red flags may include:

• Sleep-related bruxism
• Worn teeth
• Narrow arches
• Crowding
• High palate
• Mouth breathing
• Open-mouth posture
• TMD symptoms
• Large overjet
• Retrognathia
• Poor lip seal
• Tongue posture concerns
• Signs of pediatric sleep-disordered breathing

This is why airway screening belongs in the dental chair.

When dental providers recognize these signs, they can guide patients toward sleep evaluation, airway-focused orthodontics, ENT care, myofunctional therapy, and appropriate collaborative treatment.

Sleep-Related Bruxism and Airway

Dr. Zelk discussed sleep-related bruxism as an important clinical sign.

Nighttime grinding can generate significantly more force than daytime clenching, and in some patients, bruxism may be a response to airway instability or sleep disruption.

This does not mean every patient who grinds has sleep apnea. But it does mean bruxism should prompt airway screening.

A single-arch splint may protect the teeth, but if airway dysfunction is present and not addressed, the underlying problem may remain. In some cases, certain appliances may even worsen breathing if airway anatomy and sleep-disordered breathing are not considered.

For dental providers, bruxism should not be treated only as a tooth problem.

It may be a sleep and airway clue.

TMD, Sleep, and Airway

Temporomandibular disorders are also commonly seen in patients with poor sleep or sleep-disordered breathing.

Dr. Zelk noted that a significant percentage of adults report TMD symptoms, and many of those patients also experience poor sleep quality or breathing-related sleep concerns.

TMD is multifactorial. It may involve joint health, muscle tension, occlusion, stress, posture, airway, bruxism, and sleep quality.

For clinicians, this means patients with jaw pain, clenching, headaches, or TMD symptoms should be screened for sleep and airway issues, especially when symptoms are chronic, bilateral, or worse in the morning.

Narrow Arches, Crowding, and Airway Restriction

A narrow arch is more than an orthodontic concern.

Dr. Zelk discussed how reduced inter-arch width may correlate with airway restriction. A narrow maxilla can reduce tongue space, contribute to mouth breathing, increase nasal resistance, and affect craniofacial growth patterns.

A healthy airway-focused evaluation should consider:

• Arch width
• Palatal height
• Tongue space
• Nasal breathing
• Occlusion
• Mandibular development
• Facial growth direction
• Sleep symptoms
• Oral rest posture

When the dental arches are narrow, the tongue often does not have enough room to rest comfortably in the palate. This may contribute to low tongue posture, mouth breathing, crowding, poor lip seal, and sleep-disordered breathing risk.

Moving Beyond CPAP Alone

CPAP remains an important and effective therapy for many adults with obstructive sleep apnea. However, modern airway care should not be limited to CPAP alone.

Dr. Zelk emphasized that treatment should be individualized and multidisciplinary.

Patients may need support with structure, function, nasal breathing, sleep testing, orthodontics, medical management, oral appliance therapy, myofunctional therapy, weight management, or non-invasive airway technologies.

The goal is not to replace CPAP for every patient.

The goal is to expand the treatment toolkit so patients receive care that fits their anatomy, physiology, tolerance, lifestyle, and long-term goals.

Orthodontics and Jaw Development

Orthodontics can play a major role in airway health when treatment is planned with breathing, growth, and function in mind.

Dr. Zelk discussed several orthodontic and skeletal approaches that may be part of airway care, including:

• Aligner therapy
• Rapid maxillary expansion
• MARPE
• MMA
• Airway-centric restorative planning

Aligner therapy may help improve arch form and dental alignment in selected patients. Rapid maxillary expansion may support nasal breathing and improve pediatric snoring or sleep-disordered breathing in certain cases. MARPE and MMA may be considered in more severe or adult skeletal cases.

Airway-focused orthodontics is not simply about straight teeth. It is about creating a structure that supports nasal breathing, tongue space, lip seal, sleep quality, and long-term function.

Myofunctional Therapy and Airway Health

Myofunctional therapy helps patients support nasal breathing, tongue posture, lip seal, and functional carryover.

Myofunctional therapy is an essential part of the airway conversation.

Dr. Zelk emphasized the importance of addressing tongue posture, tethered oral tissues, lip competence, nasal breathing, and neck posture as part of comprehensive airway care.

Myofunctional therapy may support:

• Nasal breathing
• Tongue-to-palate rest posture
• Lip seal
• Swallowing function
• Chewing patterns
• Oral awareness
• Breathing patterns
• Postural awareness
• Oral appliance success
• Orthodontic stability
• Sleep-disordered breathing care

Structure matters, but function matters too.

If a patient receives expansion, oral appliance therapy, nasal treatment, or orthodontic care but continues to mouth breathe with low tongue posture and poor oral function, the result may be incomplete.

Myofunctional therapy helps patients learn how to use the airway they have been given.

Nasal Breathing Is Non-Negotiable

Nasal breathing is central to airway health.

Dr. Zelk emphasized that nasal breathing supports nitric oxide production, oxygen uptake, immune function, inflammation control, sleep quality, and overall airway physiology.

When patients cannot breathe well through the nose, they often compensate with mouth breathing. Over time, mouth breathing may contribute to dry mouth, altered tongue posture, poor sleep quality, snoring, orthodontic relapse, oral inflammation, and reduced airway stability.

Nasal breathing support may include:

• ENT evaluation
• Allergy management
• Nasal hygiene
• Nasal dilators
• Breathing retraining
• Myofunctional therapy
• Nasal sprays when appropriate
• Airway-focused orthodontic evaluation

The nose should never be ignored in airway care.

Nasal Hygiene and Airway Support

Nasal hygiene is one of the simplest and most overlooked parts of airway care.

Dr. Zelk discussed tools such as nasal dilators and hypochlorous acid sprays that may support airflow, reduce inflammation, and improve nasal comfort.

While nasal hygiene does not replace medical diagnosis or treatment, it can be a helpful part of a broader airway plan.

For many patients, improving nasal airflow may help support better sleep, better CPAP tolerance, better oral appliance outcomes, and better myofunctional therapy carryover.

Non-Invasive Technologies in Airway Care

Airway health is rapidly changing, and new tools are expanding the options available to patients.

Dr. Zelk discussed several non-invasive and emerging technologies, including:

• NightLase or DEKA QuietNite laser therapy
• ExciteOSA
• iNAP
• iBreath
• Bongo Rx

NightLase and DEKA QuietNite are laser-based approaches designed to help tighten and firm airway tissues in selected patients.

ExciteOSA is a neuromuscular stimulation device designed to strengthen the tongue with daytime use.

iNAP uses oral negative pressure to help pull the tongue and soft palate forward during sleep.

iBreath may be used as a gentle tool for teens and pre-teens to encourage nasal breathing and proper tongue posture.

Bongo Rx is an EPAP therapy that creates expiratory resistance and may support breathing mechanics in selected patients.

These tools are not one-size-fits-all solutions. They should be used within a proper diagnosis and comprehensive treatment plan.

Comprehensive Medical Management

Airway care is also connected to whole-body health.

Dr. Zelk discussed the role of weight management, including the use of GLP-1 medications in selected patients, as part of medical management for obstructive sleep apnea.

Weight changes can influence airway anatomy, soft tissue volume, tongue fat, inflammation, and OSA severity. For some patients, reducing tongue fat volume and improving metabolic health may significantly improve sleep apnea severity.

However, weight is only one part of the picture. Many thin patients also have airway dysfunction due to craniofacial anatomy, nasal obstruction, oral restrictions, narrow arches, or poor muscle tone.

A comprehensive plan should consider the whole patient.

Advanced Sleep Testing Matters

Accurate diagnosis is critical.

Dr. Zelk discussed advanced sleep testing technologies, including devices that provide EEG, sleep staging, body-position data, and more detailed physiologic information.

Home sleep testing has improved significantly over the years, and advanced home sleep monitoring may help identify sleep-disordered breathing more accurately in selected patients.

The more precise the diagnosis, the more personalized the treatment plan can be.

Important factors may include:

• AHI
• Oxygen desaturation
• Sleep staging
• Body position
• REM-related events
• Snoring
• Flow limitation
• Respiratory effort
• Arousals
• Patient symptoms
• Medical history
• Airway anatomy

Sleep testing should not be reduced to one number alone. The full clinical picture matters.

Why Collaboration Changes Outcomes

Airway health improves when providers work together across sleep, dentistry, orthodontics, ENT, myofunctional therapy, and whole-body care.

Airway health is not a solo sport.

Dentists, orthodontists, sleep physicians, ENTs, myofunctional therapists, pediatricians, physical therapists, and other allied providers each bring a valuable perspective.

A dentist may identify bruxism, narrow arches, and occlusal changes.

An orthodontist may guide jaw development and arch form.

An ENT may evaluate nasal obstruction, tonsils, adenoids, and airway anatomy.

A sleep physician may diagnose and monitor sleep-disordered breathing.

A myofunctional therapist may support tongue posture, nasal breathing, lip seal, and functional carryover.

A medical provider may address metabolic health, inflammation, and comorbidities.

Through Sleep Balance Academy, Dr. Zelk supports clinicians by providing consultations, ordering sleep tests, and offering patient counseling, helping bridge gaps across disciplines.

This type of collaboration is exactly what airway care needs.

A Real-Life Airway Transformation

Dr. Zelk shared a case of a patient who began with a severe AHI of 88.

Through a personalized, multidisciplinary plan that included aligners, NightLase, ExciteOSA, nasal hygiene, and a mild mandibular advancement device, the patient’s AHI dropped to 2.9.

This type of transformation shows what may be possible when care is individualized rather than limited to one modality.

It also highlights an important lesson:

Airway success often comes from combining the right tools in the right order for the right patient.

Clinical Questions for Healthcare Professionals

When evaluating patients for airway dysfunction, clinicians may consider asking:

• Does the patient snore?
• Does the child mouth breathe?
• Are there signs of narrow arches or crowding?
• Is there sleep-related bruxism?
• Does the patient have TMD symptoms?
• Is nasal breathing comfortable?
• Does the patient wake with dry mouth?
• Is there ADHD-like behavior or poor focus in a child?
• Is there increased overjet or reduced mandibular growth?
• Is the palate high and narrow?
• Does the patient tolerate CPAP?
• Would oral appliance therapy be appropriate?
• Would myofunctional therapy improve function or treatment stability?
• Is sleep testing needed?
• Does this patient need an interdisciplinary team?

These questions can help clinicians identify airway dysfunction earlier and guide patients toward appropriate care.

Key Takeaways for Healthcare Professionals

• Screen early and often, especially in children.
• Do not normalize snoring, mouth breathing, restless sleep, or sleep-related bruxism.
• Pediatric airway dysfunction may show up as behavior, learning, growth, posture, or dental changes.
• Nasal breathing is essential for airway health.
• CPAP is valuable, but it is not the only tool in airway care.
• Orthodontics, myofunctional therapy, nasal health, medical management, oral appliances, laser therapy, and non-invasive technologies may all play a role.
• Sleep testing should be interpreted in the context of symptoms, anatomy, physiology, and patient goals.
• Collaboration improves outcomes.
• Airway science is evolving rapidly, and providers must stay current.

The Airway Circle Perspective

At Airway Circle, we believe airway health must be preventive, personalized, interdisciplinary, and rooted in function.

Dr. Joseph Zelk’s presentation reminds us that airway care is not only about treating disease after it becomes severe. It is about identifying risk early, especially in children, and creating a plan that supports breathing, growth, sleep, learning, and long-term health.

The future of airway care requires providers to work together.

Dentists, hygienists, orthodontists, ENTs, sleep physicians, myofunctional therapists, and allied professionals all have a role in helping patients breathe, sleep, grow, and function better.

Final Thoughts

Airway health is entering a new era.

The old model asked, “Does this patient need CPAP?”

The new model asks:

• Why is this patient struggling to breathe?
• Is this child developing with enough airway support?
• Can this patient breathe through the nose?
• Does the tongue have space?
• Is the jaw growing forward?
• Is the sleep test telling the whole story?
• Are we treating the root contributors or only managing symptoms?
• What team does this patient need?

By identifying airway dysfunction earlier and offering comprehensive solutions for both children and adults, healthcare professionals can help improve quality of life, sleep, development, and long-term health outcomes.

The future of airway care is preventive, personalized, collaborative, and bright.

Learn More From Dr. Joseph Zelk

To continue learning from Dr. Zelk and explore advanced airway education, visit Sleep Balance Academy for professional education, consultations, and comprehensive airway-focused resources.

Sleep Balance Academy: http://www.sleepbalanceacademy.com

Need Guidance With Airway, Sleep, or Myofunctional Therapy?

Finding the right support for airway health, breathing, sleep, tongue function, orthodontic concerns, or oral restrictions does not have to feel overwhelming. With the right guidance, patients and providers can better understand the clinical picture and explore the next best steps.

Whether care involves myofunctional therapy, airway-focused dentistry, sleep evaluation, tongue-tie assessment, nasal breathing support, orthodontic care, oral appliance therapy, or referrals to the right provider, the goal is to improve function and quality of life.

Your journey to better breathing, better sleep, and better oral function starts here.