1
|
Preedeewong C, Chirakalwasan N, Kaboosaya B. Impact of frenectomy on the oral exercise in patients with ankyloglossia and obstructive sleep apnea: double-blind randomized controlled clinical trials. Clin Oral Investig 2024; 28:566. [PMID: 39365358 DOI: 10.1007/s00784-024-05932-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 09/14/2024] [Indexed: 10/05/2024]
Abstract
OBJECTIVE This study compares the efficacy of oral exercise alone to oral exercise with frenectomy in improving obstructive sleep apnea (OSA) symptoms and quality of life (QOL) in patients with ankyloglossia. MATERIALS AND METHODS A prospective, controlled, double-blind clinical study enrolled fifteen adults (20-60 years) newly diagnosed with mild to moderate OSA and ankyloglossia. Participants were randomly assigned to either oral exercise alone (control group; n = 8) or oral exercise with frenectomy (intervention group; n = 7). Outcomes were assessed after a 3-month therapy period using polysomnography, the Epworth Sleepiness Scale (ESS), tongue strength (measured in kPa), and QOL questionnaires. RESULTS Both control (-2.88 ± 1.73; p = 0.02) and intervention (-4.00 ± 3.65; p = 0.03) groups showed a significant reduction in ESS scores, indicating both improved sleepiness. Although the apnea-hypopnea index (AHI) increased in both groups after treatment, these changes were not statistically significant (control 4.73 ± 15.55; p = 0.48, intervention 10.42 ± 14.66; p = 0.12). Tongue strength significantly increased in both groups: control group (p = 0.04) and intervention group (p = 0.03). Satisfaction rates with the overall treatment process were 100% in the control group and 57.1% in the intervention group. Furthermore, 75.0% and 57.1% of participants in the respective groups reported an improvement in QOL. CONCLUSION Frenectomy improved tongue mobility and the ability to perform oral exercises in individuals with OSA and ankyloglossia. However, these exercises did not significantly improve OSA-related symptoms or QOL. CLINICAL RELEVANCE While frenectomy enhances tongue mobility, thereby enabling better engagement in oral exercises. These exercises alone did not significantly improve OSA-related symptoms or QOL. This suggests that oral exercises focusing solely on tongue mobility may not be sufficient for managing OSA. TRIAL REGISTRATION The Thai Clinical Trials Registry was TCTR20220429002.
Collapse
Affiliation(s)
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | |
Collapse
|
2
|
Rodríguez-Alcalá L, Benjumea F, Casado-Morente JC, Baptista PM, O’Connor-Reina C, Plaza G. Evaluation of the Muscle Strength of the Tongue with the Tongue Digital Spoon (TDS) in Patients with Obstructive Sleep Apnea. Life (Basel) 2022; 12:1841. [PMID: 36362996 PMCID: PMC9692766 DOI: 10.3390/life12111841] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 09/15/2024] Open
Abstract
Myofunctional therapy (MT) is a recent treatment option for obstructive sleep apnea (OSA). The Iowa Oral Performance Instrument (IOPI) is a useful but expensive tool for measuring tongue strength in patients with OSA. We validated the Tongue Digital Spoon (TDS) to monitor tongue hypotonia in patients with OSA. Measurements with the IOPI and TDS were compared in patients with OSA before and after MT for tongue hypotonia. Baseline mean tongue strength measured with the IOPI in patients with moderate and severe OSA were 35.36 ± 9.05 and 33.83 ± 12.05, respectively, and that with the TDS were 168.55 ± 42.8 and 129.61 ± 53.7, respectively. After MT, mean tongue strength significantly improved: measured with the IOPI in patients with moderate and severe OSA were 53.85 ± 10.09 and 55.50 ± 9.64 (p = 0.8), and that with the TDS were 402.36 ± 52.92 and 380.28 ± 100.75 (p = 0.01), respectively. The correlation between the IOPI and TDS was high (r = 0.74; p = 0.01 pre-treatment, and r = 0.25; p = 0.05 post-treatment). The TDS is a useful tool for monitoring the efficacy of MT in patients with short-term OSA. Future randomized studies will determine the effectiveness of MT for the treatment of OSA.
Collapse
Affiliation(s)
| | - Felipe Benjumea
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29603 Málaga, Spain
| | | | - Peter M. Baptista
- Otorhinolaryngology Department, Clínica Universidad de Navarra, 31007 Pamplona, Spain
| | | | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain
| |
Collapse
|
3
|
Torres-Castro R, Solis-Navarro L, Puppo H, Alcaraz-Serrano V, Vasconcello-Castillo L, Vilaró J, Vera-Uribe R. Respiratory Muscle Training in Patients with Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis. Clocks Sleep 2022; 4:219-229. [PMID: 35466271 PMCID: PMC9036269 DOI: 10.3390/clockssleep4020020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Effective treatments for obstructive sleep apnoea (OSA) include positive pressure, weight loss, oral appliances, surgery, and exercise. Although the involvement of the respiratory muscles in OSA is evident, the effect of training them to improve clinical outcomes is not clear. We aimed to determine the effects of respiratory muscle training in patients with OSA. Methods: A systematic review was conducted in seven databases. Studies that applied respiratory muscle training in OSA patients were reviewed. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence. Results: Of the 405 reports returned by the initial search, eight articles reporting on 210 patients were included in the data synthesis. Seven included inspiratory muscle training (IMT), and one included expiratory muscle training (EMT). Regarding IMT, we found significant improvement in Epworth sleepiness scale in −4.45 points (95%CI −7.64 to −1.27 points, p = 0.006), in Pittsburgh sleep quality index of −2.79 points (95%CI −4.19 to −1.39 points, p < 0.0001), and maximum inspiratory pressure of −29.56 cmH2O (95%CI −53.14 to −5.98 cmH2O, p = 0.01). However, the apnoea/hypopnea index and physical capacity did not show changes. We did not perform a meta-analysis of EMT due to insufficient studies. Conclusion: IMT improves sleepiness, sleep quality and inspiratory strength in patients with OSA.
Collapse
Affiliation(s)
- Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, 8380453 Santiago, Chile; (R.T.-C.); (L.S.-N.); (H.P.); (L.V.-C.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Lilian Solis-Navarro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, 8380453 Santiago, Chile; (R.T.-C.); (L.S.-N.); (H.P.); (L.V.-C.)
| | - Homero Puppo
- Department of Physical Therapy, Faculty of Medicine, University of Chile, 8380453 Santiago, Chile; (R.T.-C.); (L.S.-N.); (H.P.); (L.V.-C.)
| | - Victoria Alcaraz-Serrano
- Barcelona Institute for Global Health (ISGlobal), 08003 Barcelona, Spain;
- Blanquerna School of Health Sciences, Universitat Ramon Llull, 08025 Barcelona, Spain
| | - Luis Vasconcello-Castillo
- Department of Physical Therapy, Faculty of Medicine, University of Chile, 8380453 Santiago, Chile; (R.T.-C.); (L.S.-N.); (H.P.); (L.V.-C.)
| | - Jordi Vilaró
- Blanquerna School of Health Sciences, Global Research on Wellbeing (GRoW), Universitat Ramon Llull, 08025 Barcelona, Spain;
| | - Roberto Vera-Uribe
- Department of Physical Therapy, Faculty of Medicine, University of Chile, 8380453 Santiago, Chile; (R.T.-C.); (L.S.-N.); (H.P.); (L.V.-C.)
| |
Collapse
|
4
|
O’Connor-Reina C, Ignacio Garcia JM, Rodriguez Alcala L, Rodríguez Ruiz E, Garcia Iriarte MT, Casado Morente JC, Baptista P, Plaza G. Improving Adherence to Myofunctional Therapy in the Treatment of Sleep-Disordered Breathing. J Clin Med 2021; 10:5772. [PMID: 34945068 PMCID: PMC8707643 DOI: 10.3390/jcm10245772] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/04/2021] [Accepted: 12/08/2021] [Indexed: 12/31/2022] Open
Abstract
Myofunctional therapy (MT) is used to treat sleep-disordered breathing. However, MT has low adherence-only ~10% in most studies. We describe our experiences with MT delivered through a mobile health app named Airway Gym®, which is used by patients who have rejected continuous positive airway pressure and other therapies. We compared ear, nose, and throat examination findings, Friedman stage, tongue-tie presence, tongue strength measured using the Iowa oral performance instrument (IOPI), and full polysomnography before and after the 3 months of therapy. Participants were taught how to perform the exercises using the app at the start. Telemedicine allowed physicians to record adherence to and accuracy of the exercise performance. Fifty-four patients were enrolled; 35 (64.8%) were adherent and performed exercises for 15 min/day on five days/week. We found significant changes (p < 0.05) in the apnoea-hypopnoea index (AHI; 32.97 ± 1.8 to 21.9 ± 14.5 events/h); IOPI score (44.4 ± 11.08 to 49.66 ± 10.2); and minimum O2 saturation (80.91% ± 6.1% to 85.09% ± 5.3%). IOPI scores correlated significantly with AHI after the therapy (Pearson r = 0.4; p = 0.01). The 19 patients who did not adhere to the protocol showed no changes. MT based on telemedicine had good adherence, and its effect on AHI correlated with IOPI and improvement in tongue-tie.
Collapse
Affiliation(s)
- Carlos O’Connor-Reina
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain; (C.O.-R.); (L.R.A.); (J.C.C.M.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | | | - Laura Rodriguez Alcala
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain; (C.O.-R.); (L.R.A.); (J.C.C.M.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | - Elisa Rodríguez Ruiz
- Pulmonology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain; (J.M.I.G.); (E.R.R.)
| | | | - Juan Carlos Casado Morente
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain; (C.O.-R.); (L.R.A.); (J.C.C.M.)
| | - Peter Baptista
- Otorhinolaryngology Department, Clínica Universitaria de Navarra, 31008 Pamplona, Spain;
| | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28942 Madrid, Spain
- Otorhinolaryngology Department, Hospital Sanitas la Zarzuela, 28942 Madrid, Spain
| |
Collapse
|
5
|
Maghsoudipour M, Nokes B, Bosompra NO, Jen R, Li Y, Moore S, DeYoung PN, Fine J, Edwards BA, Gilbertson D, Owens R, Morgan T, Malhotra A. A Pilot Randomized Controlled Trial of Effect of Genioglossus Muscle Strengthening on Obstructive Sleep Apnea Outcomes. J Clin Med 2021; 10:jcm10194554. [PMID: 34640575 PMCID: PMC8509668 DOI: 10.3390/jcm10194554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/19/2022] Open
Abstract
The genioglossus is a major upper airway dilator muscle. Our goal was to assess the efficacy of upper airway muscle training on Obstructive Sleep Apnea (OSA) as an adjunct treatment. Sixty-eight participants with OSA (AHI > 10/h) were recruited from our clinic. They fall into the following categories: (a) Treated with Automatic Positive Airway Pressure (APAP), (n = 21), (b) Previously failed APAP therapy (Untreated), (n = 25), (c) Treated with Mandibular Advancement Splint (MAS), (n = 22). All subjects were given a custom-made tongue strengthening device. We conducted a prospective, randomized, controlled study examining the effect of upper airway muscle training. In each subgroup, subjects were randomized to muscle training (volitional protrusion against resistance) or sham group (negligible resistance), with a 1:1 ratio over 3 months of treatment. In the baseline and the final visit, subjects completed home sleep apnea testing, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), SF-36 (36-Item Short Form Survey), and Psychomotor Vigilance Test (PVT). Intervention (muscle training) did not affect the AHI (Apnea-Hypopnea Index), (p-values > 0.05). Based on PSQI, ESS, SF-36 scores, and PVT parameters, the changes between the intervention and sham groups were not significant, and the changes were not associated with the type of treatment (p-value > 0.05). The effectiveness of upper airway muscle training exercise as an adjunct treatment requires further study.
Collapse
Affiliation(s)
- Maryam Maghsoudipour
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Brandon Nokes
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Naa-Oye Bosompra
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Rachel Jen
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Yanru Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China;
| | - Stacie Moore
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Pamela N. DeYoung
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Janelle Fine
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Bradley A. Edwards
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery Institute, Monash University, Melbourne, VIC 3800, Australia;
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC 3800, Australia
| | - Dillon Gilbertson
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Robert Owens
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Todd Morgan
- Department of Dentistry, Scripps Encinitas Hospital, Encinitas, CA 92024, USA;
| | - Atul Malhotra
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
- Correspondence:
| |
Collapse
|
6
|
Torres-Castro R, Vasconcello-Castillo L, Puppo H, Cabrera-Aguilera I, Otto-Yáñez M, Rosales-Fuentes J, Vilaró J. Effects of Exercise in Patients with Obstructive Sleep Apnoea. Clocks Sleep 2021; 3:227-235. [PMID: 33802403 PMCID: PMC7931110 DOI: 10.3390/clockssleep3010013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnoea (OSA) constitutes a public health problem, with various systemic consequences that can increase cardiovascular morbidity and mortality as well as increase healthcare expenditure. This review discusses the rationale and effects of using general physical exercise, oropharyngeal exercises, and respiratory muscle training as an adjunctive treatment for patients with sleep apnoea. The recommended treatment for OSA is the use of continuous positive airway pressure, which is a therapy that prevents apnoea events by keeping the airways open. In the last decade, coadjuvant treatments that aim to support weight loss (including diet and physical exercise) and oropharyngeal exercises have been proposed to lower the apnoea/hypopnoea index among patients with OSA. Based on the available evidence, health professionals could decide to incorporate these therapeutic strategies to manage patients with sleep apnoea.
Collapse
Affiliation(s)
- Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile; (L.V.-C.); (H.P.); (J.R.-F.)
- Correspondence: ; Tel.: +56-229-786-513
| | - Luis Vasconcello-Castillo
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile; (L.V.-C.); (H.P.); (J.R.-F.)
| | - Homero Puppo
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile; (L.V.-C.); (H.P.); (J.R.-F.)
| | | | - Matías Otto-Yáñez
- Kinesiology School, Universidad Autónoma de Chile, Santiago 7500912, Chile;
| | - Javiera Rosales-Fuentes
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile; (L.V.-C.); (H.P.); (J.R.-F.)
| | - Jordi Vilaró
- Grupo de Investigación Global Research on Wellbeing (GRoW), Facultad de Ciencias de la Salud Blanquerna, Universitat Ramón Llull, 08025 Barcelona, Spain;
| |
Collapse
|