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Saba ES, Kim H, Huynh P, Jiang N. Orofacial Myofunctional Therapy for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. Laryngoscope 2024; 134:480-495. [PMID: 37606313 DOI: 10.1002/lary.30974] [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: 04/18/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE Orofacial myofunctional therapy (OMT) is an alternative form of treatment of obstructive sleep apnea (OSA), that incorporates various exercises to optimize tongue placement and increase oropharyngeal tone. The objective of this systematic review and meta-analysis is to determine the efficacy of OMT in OSA patients. DATA SOURCES PubMed/Medline, EMBASE, Cochrane, Web of Science. REVIEW METHODS Using PRISMA guidelines, a directed search strategy was performed for randomized control trials (RCTs) published prior to March 24, 2023, featuring 10+ patients with OSA undergoing mono-therapeutic OMT. The primary outcome of interest was apnea-hypopnea index (AHI). Secondary outcomes included subjective sleepiness, sleep-related quality-of-life, and snoring frequency. RESULTS Of the 1244 abstracts that were identified, 7 RCTs involving 310 patients met inclusion criteria. Adult OMT patients had a statistically significant improvement in AHI (MD -10.2; 95% CI, -15.6, -4.8, p < 0.05), subjective sleepiness (Epworth Sleepiness Scale; MD -5.66; 95% CI, -6.82, -4.5, p < 0.05), sleep-related quality-of-life (Pittsburgh Sleep Quality Index; MD -3.00; 95% CI, -4.52, -1.49, p < 0.05), and minimum oxygen saturation (MD 2.71; 95% CI, 0.23, 5.18, p < 0.05) when compared with sham OMT or no therapy. Within the single RCT featuring pediatric OMT patients, patients had poor compliance (<50%) and did not show any improvements in AHI, minimum oxygen saturation, or snoring frequency. CONCLUSION OMT may provide a reasonable alternative for OSA patients who cannot tolerate CPAP or other more established treatment options. OMT benefits appear limited in children due to poor compliance. More studies are required to evaluate compliance and the long-term effects of OMT on OSA outcomes. LEVEL OF EVIDENCE 1 Laryngoscope, 134:480-495, 2024.
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Affiliation(s)
- Elias S Saba
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland Medical Center, Oakland, California, U.S.A
| | - Hannah Kim
- Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Pauline Huynh
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland Medical Center, Oakland, California, U.S.A
| | - Nancy Jiang
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland Medical Center, Oakland, California, U.S.A
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Yu M, Ma Y, Xu Y, Bai J, Lu Y, Han F, Gao X. Orthodontic appliances for the treatment of pediatric obstructive sleep apnea: A systematic review and network meta-analysis. Sleep Med Rev 2023; 72:101855. [PMID: 37820534 DOI: 10.1016/j.smrv.2023.101855] [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: 08/07/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
This systematic review and network meta-analysis aims to preliminarily investigate the efficacy of different orthodontic appliances for the treatment of pediatric obstructive sleep apnea (OSA). Electronic databases were systematically searched. Randomized and non-randomized controlled trials with patients <18 y treated with either mandibular advancement appliance (MAA), rapid maxillary expansion (RME), or myofunctional therapy (MFT) were included. A network meta-analysis using multivariate random effects was conducted to estimate pooled differences using the apnea-hypopnea index (AHI) as the main outcome. Eleven studies (595 patients) were included in the analysis. Compared with control, MAA was associated with significant reductions in AHI of -2.18/h (95%CI -3.48 to -0.89, p = 0.001). Combined treatment of RME + adenotonsillectomy (AT) and RME + MAA showed a significant decrease in AHI, with -5.13/h (95%CI -7.50 to -2.76, p < 0.0001) and -3.79 (95%CI -5.21 to -2.37, p < 0.0001), respectively. MFT was associated with a -2.45/h (95%CI -4.76 to -0.14, p = 0.038) decrease in AHI. However, RME alone was not associated with significant AHI reduction (0.02, 95%CI -1.72 to 1.75, p = 0.985). The heterogeneity of the network meta-analysis was I2 = 32.6%. Limited evidence indicated that MAA (alone or combined with RME) and RME + AT were associated with benefits for pediatric patients with OSA. This study could not find convincing evidence of a significant benefit of other orthodontic appliances over control.
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Affiliation(s)
- Min Yu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; National Center for Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China
| | - Yanyan Ma
- Department of Stomatology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, PR China
| | - Ying Xu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; National Center for Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China
| | - Jingxuan Bai
- Department of Orthodontics, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; National Center for Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China
| | - Yujia Lu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; National Center for Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China
| | - Fang Han
- Sleep Division, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, PR China.
| | - Xuemei Gao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; National Center for Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China.
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Yang X, Wen Y, Xie S, Chen J, Liu Y, Zhou J. Research trends and hotspots regarding treatment of obstructive sleep apnea. Front Neurol 2023; 14:1268639. [PMID: 37920837 PMCID: PMC10618364 DOI: 10.3389/fneur.2023.1268639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023] Open
Abstract
Background Obstructive sleep apnea (OSA) is a type of sleep-disordered breathing disease, with high prevalence and multiple complications. It seriously affects patients' quality of life and even threatens their lives. Early and effective treatment can significantly improve patients' health conditions. Objective In this study, the main treatment methods, research hotspots and trends of OSA were summarized through bibliometric and visualization analysis. Methods From the Web of Science Core Collection database, articles on the treatment of OSA from 1999 to 2022 were obtained. CiteSpace and VOSviewer were comprehensively used to visualization of journals, co-authorship of countries, institutions and authors, co-citation of references, keywords cluster and burst. Results A total of 2,874 publications were obtained, of which 2,584 were concerned adults and 290 about children. In adults' research, Sleep and Breathing is the most published journal (280, 10.84%), the largest number of publications come from the United States (636,24.61%) and the University of Sydney (88, 3.41%), and Pepin JL is the most published author (48, 18.58%). In children's studies, International Journal of Pediatric Otorhinolaryngology is the most published journal (41, 14.14%), the maximum number of publications were also from the United States (123, 42.41%), with the University of Pennsylvania (20, 6.90%) and Marcus CL (15, 5.17%) being the most published institutions and authors. High-frequency keywords for adults' researches include positive airway pressure, oral appliance, surgery and positional therapy. On these basis, children's studies also focus on myofunctional therapy, rapid maxillary expansion and hypoglossal nerve Stimulation. Conclusion Over the past two decades, research in the field of OSA therapeutics has experienced significant growth in depth and breadth. The author cooperation network has already established a solid foundation, while there is potential for further strengthening the cooperation network between countries and institutions. Currently, positive airway pressure and surgery are the primary treatments for OSA in adults and children. Future research will focus on multidisciplinary combination targeted therapy, which presents a key area of interest and challenge.
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Affiliation(s)
| | | | - Shiqi Xie
- College of Nursing, Chongqing Medical University, Chongqing, China
| | | | | | - Jianrong Zhou
- College of Nursing, Chongqing Medical University, Chongqing, China
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Hopper DE, Cramer G. Conservative Treatment Using Chiropractic Care and Orofacial Myofunctional Therapy for Obstructive Sleep Apnea: A Case Report. J Chiropr Med 2023; 22:234-238. [PMID: 37645002 PMCID: PMC10461150 DOI: 10.1016/j.jcm.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 08/31/2023] Open
Abstract
Objective The purpose of this case study was to describe the use of chiropractic care in the treatment of obstructive sleep apnea (OSA). Clinical Features A 42-year-old man with obesity presented for chiropractic care. He had OSA and was seeking a way to reduce snoring. The patient had a previous diagnosis of OSA and had been using a continuous positive airway pressure machine for over 5 years. The patient was a mouth breather, exhibiting poor oral and spinal posture. Intervention and Outcome The patient was treated for 90 days, which included chiropractic manipulation, orofacial myofunctional therapy exercises, nutritional modification, postural/ergonomic correction, and regular exercise. After a course of care, there was a drop in his apnea-hypopnea index from 55.4 events per hour to 3.4 events per hour. The patient lost 40 pounds, with an 8% reduction in body fat and an 8-point drop in his body mass index. Conclusion This patient's sleep apnea and other health outcomes improved under a course of a combination of chiropractic adjustments, orofacial myofunctional therapy, nutritional modification, postural/ergonomic correction, and exercise.
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Affiliation(s)
- David E. Hopper
- Department of Basic Sciences, National University of Health Sciences, Lombard, Illinois
| | - Gregory Cramer
- Department of Research, National University of Health Sciences, Lombard, Illinois
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Liu Y, Zhou JR, Xie SQ, Yang X, Chen JL. The Effects of Orofacial Myofunctional Therapy on Children with OSAHS’s Craniomaxillofacial Growth: A Systematic Review. CHILDREN 2023; 10:children10040670. [PMID: 37189919 DOI: 10.3390/children10040670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
Orofacial myofunctional therapy (OMT) is one of the therapeutic methods for neuromuscular re-education and has been considered as one of the auxiliary methods for obstructive sleep apnea hypopnea syndrome (OSAHS) and orthodontic treatment. There is a dearth of comprehensive analysis of OMT’s effects on muscle morphology and function. This systematic review examines the literature on the craniomaxillofacial effects of OMT in children with OSAHS. This systematic analysis was carried out using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards, and the research was scanned using PICO principles. A total of 1776 articles were retrieved within a limited time, with 146 papers accepted for full-text perusing following preliminary inspection and 9 of those ultimately included in the qualitative analysis. Three studies were rated as having a severe bias risk, and five studies were rated as having a moderate bias risk. Improvement in craniofacial function or morphology was observed in most of the 693 children. OMT can improve the function or morphology of the craniofacial surface of children with OSAHS, and its effect becomes more significant as the duration of the intervention increases and compliance improves. In the majority of the 693 infants, improvements in craniofacial function or morphology were seen. The function or morphology of a kid’s craniofacial surface can be improved with OMT, and as the duration of the intervention lengthens and compliance rises, the impact becomes more pronounced.
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Ersu R, Chen ML, Ehsan Z, Ishman SL, Redline S, Narang I. Persistent obstructive sleep apnoea in children: treatment options and management considerations. THE LANCET. RESPIRATORY MEDICINE 2023; 11:283-296. [PMID: 36162413 DOI: 10.1016/s2213-2600(22)00262-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/15/2022] [Accepted: 07/05/2022] [Indexed: 10/14/2022]
Abstract
Unresolved obstructive sleep apnoea (OSA) after an adenotonsillectomy, henceforth referred to as persistent OSA, is increasingly recognised in children (2-18 years). Although associated with obesity, underlying medical complexity, and craniofacial disorders, persistent OSA also occurs in otherwise healthy children. Inadequate treatment of persistent OSA can lead to long-term adverse health outcomes beyond childhood. Positive airway pressure, used as a one-size-fits-all primary management strategy for persistent childhood OSA, is highly efficacious but has unacceptably low adherence rates. A pressing need exists for a broader, more effective management approach for persistent OSA in children. In this Personal View, we discuss the use and the need for evaluation of current and novel therapeutics, the role of shared decision-making models that consider patient preferences, and the importance of considering the social determinants of health in research and clinical practice. A multipronged, comprehensive approach to persistent OSA might achieve better clinical outcomes in childhood and promote health equity for all children.
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Affiliation(s)
- Refika Ersu
- Division of Respiratory Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Maida L Chen
- Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Zarmina Ehsan
- Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, Kansas City, MO, USA; Department of Pediatrics, University of Missouri, Kansas City, KS, USA
| | - Stacey L Ishman
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of HealthVine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Indra Narang
- Division of Respiratory Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
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Barbosa DF, Bana LF, Michel MCB, Meira E Cruz M, Zancanella E, Machado Júnior AJ. Rapid maxillary expansion in pediatric patients with obstructive sleep apnea: an umbrella review. Braz J Otorhinolaryngol 2023; 89:494-502. [PMID: 36894478 DOI: 10.1016/j.bjorl.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/26/2022] [Accepted: 02/10/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE To compare polysomnographic parameters with others from the literature in order to provide more accurate information about Rapid Maxillary Expansion (RME) for treating Obstructive Sleep Apnea (OSA) in children, through raising the question: Is RME a good option for treating OSA in children? Prevention of mouth breathing during children's growth remains a challenge with significant clinical consequences. In addition, OSA induces anatomofunctional changes during the critical period of craniofacial growth and development. METHODS The Medline, PubMed, EMBASE, CINAHL, Web of Science, SciELO and Scopus electronic databases were searched up to February 2021 for systematic reviews with meta-analysis in the English language. Among 40 studies on RME for treating OSA in children, we selected seven in which polysomnographic measurements of the Apnea-Hypopnea Index (AHI) had been made. Data were extracted and examined in order to clarify whether any consistent evidence exists for indicating RME as a treatment for OSA in children. RESULTS We found no consistent evidence favoring RME for long-term treatment of OSA in children. All the studies presented considerable heterogeneity due to variability of age and length of follow-up. CONCLUSION Through this umbrella review, the need for methodologically better studies on RME is supported. Moreover, it can be considered that RME is not recommended for treating OSA in children. Further studies and more evidence identifying early signs of OSA are necessary in order to achieve consistent healthcare practice.
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Affiliation(s)
- Denise Fernandes Barbosa
- Universidade de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Laura Fernandes Bana
- Universidade de Campinas (FOP-UNICAMP), Faculdade de Odontologia, Departamento de Morfologia, Piracicaba, SP, Brazil
| | | | - Miguel Meira E Cruz
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Unidade de Sono, Lisboa, Portugal
| | - Edilson Zancanella
- Universidade de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
| | - Almiro José Machado Júnior
- Universidade de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
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Poncin W, Correvon N, Tam J, Borel J, Berger M, Liistro G, Mwenge B, Heinzer R, Contal O. The effect of tongue elevation muscle training in patients with obstructive sleep apnea: A randomised controlled trial. J Oral Rehabil 2022; 49:1049-1059. [PMID: 36081312 PMCID: PMC9826101 DOI: 10.1111/joor.13369] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/23/2022] [Accepted: 09/05/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Oropharyngeal myofunctional therapy is a multi-component therapy effective to reduce the severity of obstructive sleep apnoea (OSA). However, existing protocols are difficult to replicate in the clinical setting. There is a need to isolate the specific effectiveness of each component of the therapy. OBJECTIVE To assess the effects of a 6 weeks tongue elevation training programme in patients with OSA. METHODS We conducted a multicentre randomised controlled trial. Eligible participants were adults diagnosed with moderate OSA who presented low adherence to continuous positive airway pressure therapy (mean use <4 h per night). The intervention group completed a 6 weeks tongue elevation training protocol that consisted in anterior tongue elevation strength and endurance tasks with the Iowa Oral Performance Instrument. The control group completed a 6 weeks sham training protocol that involved expiratory muscle training at very low intensity. Polygraphy data, tongue force and endurance, and OSA symptoms were evaluated pre- and post-intervention. The primary outcome was apneoa-hypopnea index (AHI). RESULTS Twenty-seven patients (55 ± 11 years) were recruited. According to modified intention-to-treat analysis (n = 25), changes in AHI and c did not significantly differ between groups. Daytime sleepiness (Epworth Sleepiness Scale) and tongue endurance significantly improved in the intervention group compared to the control group (p = .015 and .022, respectively). In the intervention group, 75% of participants had a decrease in daytime sleepiness that exceeded the minimal clinically important difference. CONCLUSION Six weeks of tongue elevation muscle training had no effect on OSA severity.
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Affiliation(s)
- William Poncin
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland,Institute of Experimental and Clinical Research (IREC), pôle de Pneumologie, ORL et DermatologieUniversité Catholique de LouvainBrusselsBelgium,Service de Pneumologie, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Nils Correvon
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Jonathan Tam
- HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland,Service de Physiothérapie cardio‐respiratoire, département de chirurgie, cœur‐vaisseau et centre interdisciplinaireCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | | | - Mathieu Berger
- Center for Investigation and Research in SleepCentre Hospitalier Universitaire Vaudois and Université de LausanneLausanneSwitzerland
| | - Giuseppe Liistro
- Service de Pneumologie, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Benny Mwenge
- Service de Pneumologie, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Raphael Heinzer
- Center for Investigation and Research in SleepCentre Hospitalier Universitaire Vaudois and Université de LausanneLausanneSwitzerland
| | - Olivier Contal
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
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Prevalence of mouth breathing, with or without nasal obstruction, in children with moderate to severe obstructive sleep apnea. Sleep Med 2022; 98:98-105. [DOI: 10.1016/j.sleep.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 10/17/2022]
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Li WY, Jin H, Zou Y, Huang H, Wei Z, Kang J, Xue Y, Wang W. The Different Effect of Tongue Motor Task Training (TTT) and Strength Training (ST) on the Modulation of Genioglossus Corticomotor Excitability and upper airway stability in Rats. Sleep 2022; 45:6648555. [PMID: 35867628 DOI: 10.1093/sleep/zsac170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES the mechanical efficiency of upper airway (UA) muscles are pivotal in maintaining UA stability. We aimed to investigate if different tongue training approaches could differently induce signs of neuroplastic in the corticomotor pathways and upper airway stability changes. METHODS 36 Sprague-Dawley rats were trained daily for eight weeks to lick an isotonic force-sensing disc at targeting forces using 30-50% of maximal achieved lick force (MALF) for tongue task training (TTT) or targeting force set above 50%, 60% and 70% of MALF progressively for tongue strength training (TST). Corticomotor excitability was dynamically assessed by GG response to transcortical magnetic stimulation (TMS) at different sessions. GG EMG activity, GG ultrastructure and myosin heavy chain (MHC), UA dynamics were assessed after eight weeks. RESULTS After 4 weeks, GG TMS latencies decreased in both tongue training groups when compared with the control group (p<0.05) and this excitability was more stable in TTT group. After 8 weeks, both GG TMS response and EMG activity revealed increased excitability in TTT and TST groups. The apoptotic pathological morphology changes of GG ultrastructure were observed in TST group, but not TTT. Percentage of GG MHC type I fibers in TST group was higher than the control and TTT groups (p<0.05). The UA Pcrit decreased significantly in TTT group (p<0.05) and tend to decrease in TST group (p=0.09). CONCLUSION TTT could improve the UA stability and induce the neuroplastic changes more efficiently without training-induced muscle injury, while TST revealed a fatigue-resistance change in GG.
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Affiliation(s)
- Wen-Yang Li
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Hongyu Jin
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Ying Zou
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Hong Huang
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Zhijing Wei
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Jian Kang
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Yixue Xue
- Neurobiology department, College of Life Science, China Medical University, Shenyang, China
| | - Wei Wang
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
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Zhang F, Tian Z, Shu Y, Zou B, Yao H, Li S, Li Q. The Efficiency of Orofacial Myofunctional Therapy in Treating Obstructive Sleep Apnea: A Meta-Analysis of Observational Studies. J Oral Rehabil 2022; 49:734-745. [PMID: 35342989 DOI: 10.1111/joor.13325] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 02/22/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The literature on orofacial myofunctional therapy (OMT) in children and adults with obstructive sleep apnea (OSA) was systematically reviewed to investigate the effects of OMT on patients with OSA by age and disease severity to verify the effect of OMT on OSA. DATA SOURCES All the comparative literature was retrieved from the PubMed, Embase, and Cochrane libraries. METHOD We searched the articles published up to February 12, 2022 and followed the preferred reporting project for systematic review and meta-analysis of reports. The quality of the studies was evaluated using the Newcastle-Ottawa scale. RESULTS Of the primary indicators for evaluating OSA, 13 studies reported on the apnea index (AHI), showing a decrease in the mean standard deviation of AHI from before OMT to after OMT (P < 0.00001). The lowest oxygen saturation was reported in nine studies, and the mean standard deviation of the lowest oxygen saturation increased from before to after OMT (P = 0.0009). Ten studies reported the Epworth Sleepiness Scale (ESS), indicating that the mean standard deviation of the ESS decreased from before to after OMT (P < 0.00001). The subgroup analysis showed that the AHI scores indicating mild and moderate OSA were significantly reduced, and the AHI scores indicating severe OSA also decreased, but this was not statistically significant. The lowest oxygen saturation increased obviously in patients with both mild and moderate and severe OSA. Of the secondary indicators of OSA, there was a statistically significant improvement in snoring intensity (P = 0.0002). CONCLUSION Oral and facial muscular function therapy can be used as a simple and non-invasive new technique to improve the AHI, minimum oxygen saturation, ESS, and snoring intensity in patients with mild and moderate OSA and the lowest oxygen saturation in patients with severe OSA.
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Affiliation(s)
- Feng Zhang
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, 400014, Chongqing, People's Republic of China.,National Clinical Research Center for Child Health and Disorders, 400014, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, 400014, Chongqing, People's Republic of China
| | - Zhuo Tian
- Department of Geratology, Chongqing General Hospital, 400014, Chongqing, People's Republic of China
| | - Yan Shu
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, 400014, Chongqing, People's Republic of China.,National Clinical Research Center for Child Health and Disorders, 400014, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, 400014, Chongqing, People's Republic of China
| | - Bin Zou
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, 400014, Chongqing, People's Republic of China.,National Clinical Research Center for Child Health and Disorders, 400014, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, 400014, Chongqing, People's Republic of China
| | - Hongbing Yao
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, 400014, Chongqing, People's Republic of China.,National Clinical Research Center for Child Health and Disorders, 400014, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, 400014, Chongqing, People's Republic of China
| | - Shaojun Li
- National Clinical Research Center for Child Health and Disorders, 400014, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, 400014, Chongqing, People's Republic of China.,Department of Emergency, Children's Hospital of Chongqing Medical University, 400014, Chongqing, People's Republic of China
| | - Qiu Li
- National Clinical Research Center for Child Health and Disorders, 400014, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, 400014, Chongqing, People's Republic of China.,Department of Nephrology, Children's Hospital, Chongqing Medical University, 400014, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, 400014, Chongqing, People's Republic of China
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12
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Update and Progress in Pediatric Sleep Disorders. J Pediatr 2021; 239:16-23. [PMID: 34450124 DOI: 10.1016/j.jpeds.2021.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 08/01/2021] [Accepted: 08/18/2021] [Indexed: 12/28/2022]
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13
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Moin Anwer HM, Albagieh HN, Kalladka M, Chiang HK, Malik S, McLaren SW, Khan J. The role of the dentist in the diagnosis and management of pediatric obstructive sleep apnea. Saudi Dent J 2021; 33:424-433. [PMID: 34803282 PMCID: PMC8589585 DOI: 10.1016/j.sdentj.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
The objective of this article is to review the role of the dentist in the early diagnosis of pediatric obstructive sleep apnea (OSA) and to provide an in-depth review of the best evidence-based practices available to treat and/or to refer these patients for intervention. Material and methods A narrative review was performed using indexed data bases (PubMed, Medline, EMBASE, OVID, Scopus and Cochrane) up to year 2020, and approximately 1000 articles were reviewed. The articles included were those with the best information provided. Results Detailed review of the literature suggests that the role of the dentist has been redefined owing to their expertise in the orofacial region. Every patient consulting a dental practice is not merely a dental patient; he/she also requires a comprehensive medical review. The role of the dentist is pivotal in pediatric patients once diagnosed with OSA; as the patients grow, growth modification can be achieved, and future management will be easier. Initiating dental treatments during growth can benefit patients two-fold, saving them from malocclusion, and intervening in orofacial structural growth can help to avoid cumbersome treatments, such as CPAP and various surgeries. Proper diagnosis and management of systemic illnesses can prevent compromised quality of life, delays in treatment, morbidity and, in some cases, mortality.
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Affiliation(s)
- Hafiz M Moin Anwer
- Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ 07103, USA
| | - Hamad N Albagieh
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Mythili Kalladka
- Eastman Institute for Oral Health, 625 Elmwood Ave, Rochester, NY 14620, USA
| | - Harmeet K Chiang
- Virginia Commonwealth University, 521 N. 11th Street, Richmond, VA 23298, USA
| | - Shaima Malik
- Eastman Institute for Oral Health, 625 Elmwood Ave, Rochester, NY 14620, USA
| | - Sean W McLaren
- Eastman Institute for Oral Health, 625 Elmwood Ave, Rochester, NY 14620, USA
| | - Junad Khan
- Eastman Institute for Oral Health, 625 Elmwood Ave, Rochester, NY 14620, USA
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14
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Xu ZF, Ni X. Debates in pediatric obstructive sleep apnea treatment. World J Otorhinolaryngol Head Neck Surg 2021; 7:194-200. [PMID: 34430827 PMCID: PMC8356119 DOI: 10.1016/j.wjorl.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/01/2022] Open
Abstract
Pediatric obstructive sleep apnea (OSA) is among the most common sleep-disordered breathing (SDB) diseases in children. Its high prevalence and multiple systemic complications lead to increasing numbers of children and families affected by OSA. Timely diagnosis and effective intervention in children with this condition is extremely important in improving their prognosis. The major approaches in the treatment of OSA in children are to eliminate the causes of upper airway obstruction and prevent and treat complications. Considering the specific individual differences in children's growth and development, as well as the diversity of etiologies in children's OSA, pediatric treatment strategies need to be precise, multidisciplinary, and individualized. First-line clinical treatment consists of surgical (adenotonsillectomy) and non-surgical therapies [including anti-inflammatory medications and non-invasive ventilation (NIV)]. However, a considerable controversy exists concerning the indications, treatment standards, and the evaluation of the efficacy of the aforementioned treatment methods. In this review, reviews and assessment of literature studies and multidisciplinary clinical experience were performed to analyze the application of each treatment and discuss controversial issues and future research directions. We suggest that the above interventions should be tailored to each child's needs, comorbidities, and the availability and expertise of the practitioner. The ideal case is when a multidisciplinary team of doctors together with the patients and their parents, or guardians, have a thorough discussion regarding the benefits and risks of all available treatment options and all agree on an effective treatment plan.
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Affiliation(s)
- Zhi-Fei Xu
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
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15
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Suzuki M, Okamoto T, Akagi Y, Matsui K, Sekiguchi H, Satoya N, Inoue Y, Tatsuta A, Hagiwara N. Efficacy of oral myofunctional therapy in middle-aged to elderly patients with obstructive sleep apnoea treated with continuous positive airway pressure. J Oral Rehabil 2020; 48:176-182. [PMID: 33080062 DOI: 10.1111/joor.13119] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/03/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Oral myofunctional therapy (MFT) is an effective treatment for mild-to-moderate obstructive sleep apnoea (OSA) in middle-aged patients. However, few reports have described its use in elderly patients with moderate and severe OSA. Moreover, no studies have examined the relationship between changes in tongue pressure with MFT and the severity of OSA. OBJECTIVE We conducted an interventional study using MFT to evaluate the effect of MFT on middle-to-senior-aged patients with moderate or severe OSA and compared changes in apnoea-hypopnea index (AHI) and tongue pressure. METHODS Thirty-two OSA patients (≥45 years) treated with continuous positive airway pressure (CPAP) were included. MFT was performed in parallel with CPAP. Three days after CPAP discontinuation, polysomnographies were performed and tongue pressures were measured before and after MFT. RESULTS Patients were 69.3 ± 1.5 years old. After 6 months of MFT, AHI decreased significantly from 34.7 to 29.0/h (P = .03), while tongue pressure significantly increased from 35.9 to 45.6 kPa (P < .01). Seven patients (22%), including 6 of the 12 patients with moderate OSA (50%), experienced successful CPAP discontinuation. CONCLUSIONS MFT can be a useful intervention even among middle-aged to elderly patients with OSA. Increased tongue pressure may have contributed to the AHI improvement. Clinical trials: Trial registration at www.umin.ac.jp UMIN000027547.
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Affiliation(s)
- Mayumi Suzuki
- Division of Comprehensive Sleep Medicine, Tokyo Women's Medical University, Tokyo, Japan.,Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshihiro Okamoto
- Department of Oral and Maxillofacial Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuichi Akagi
- Department of Oral and Maxillofacial Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kentaro Matsui
- Division of Comprehensive Sleep Medicine, Tokyo Women's Medical University, Tokyo, Japan.,Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.,Department of Clinical Laboratory, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan.,Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan
| | - Haruki Sekiguchi
- Division of Comprehensive Sleep Medicine, Tokyo Women's Medical University, Tokyo, Japan.,Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.,Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Fukakusa, Japan.,Clinical Research Institute, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - Natsumi Satoya
- Division of Comprehensive Sleep Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuji Inoue
- Division of Comprehensive Sleep Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Akihisa Tatsuta
- Division of Comprehensive Sleep Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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16
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Rueda JR, Mugueta-Aguinaga I, Vilaró J, Rueda-Etxebarria M. Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database Syst Rev 2020; 11:CD013449. [PMID: 33141943 PMCID: PMC8094400 DOI: 10.1002/14651858.cd013449.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a syndrome characterised by episodes of apnoea (complete cessation of breathing) or hypopnoea (insufficient breathing) during sleep. Classical symptoms of the disease - such as snoring, unsatisfactory rest and daytime sleepiness - are experienced mainly by men; women report more unspecific symptoms such as low energy or fatigue, tiredness, initial insomnia and morning headaches. OSA is associated with an increased risk of occupational injuries, metabolic diseases, cardiovascular diseases, mortality, and being involved in traffic accidents. Continuous positive airway pressure (CPAP) - delivered by a machine which uses a hose and mask or nosepiece to deliver constant and steady air pressure- is considered the first treatment option for most people with OSA. However, adherence to treatment is often suboptimal. Myofunctional therapy could be an alternative for many patients. Myofunctional therapy consists of combinations of oropharyngeal exercises - i.e. mouth and throat exercises. These combinations typically include both isotonic and isometric exercises involving several muscles and areas of the mouth, pharynx and upper respiratory tract, to work on functions such as speaking, breathing, blowing, sucking, chewing and swallowing. OBJECTIVES To evaluate the benefits and harms of myofunctional therapy (oropharyngeal exercises) for the treatment of obstructive sleep apnoea. SEARCH METHODS We identified randomised controlled trials (RCTs) from the Cochrane Airways Trials Register (date of last search 1 May 2020). We found other trials at web-based clinical trials registers. SELECTION CRITERIA We included RCTs that recruited adults and children with a diagnosis of OSA. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We assessed our confidence in the evidence by using GRADE recommendations. Primary outcomes were daytime sleepiness, morbidity and mortality. MAIN RESULTS We found nine studies eligible for inclusion in this review and nine ongoing studies. The nine included RCTs analysed a total of 347 participants, 69 of them women and 13 children. The adults' mean ages ranged from 46 to 51, daytime sleepiness scores from eight to 14, and severity of the condition from mild to severe OSA. The studies' duration ranged from two to four months. None of the studies assessed accidents, cardiovascular diseases or mortality outcomes. We sought data about adverse events, but none of the included studies reported these. In adults, compared to sham therapy, myofunctional therapy: probably reduces daytime sleepiness (Epworth Sleepiness Scale (ESS), MD (mean difference) -4.52 points, 95% Confidence Interval (CI) -6.67 to -2.36; two studies, 82 participants; moderate-certainty evidence); may increase sleep quality (MD -3.90 points, 95% CI -6.31 to -1.49; one study, 31 participants; low-certainty evidence); may result in a large reduction in Apnoea-Hypopnoea Index (AHI, MD -13.20 points, 95% CI -18.48 to -7.93; two studies, 82 participants; low-certainty evidence); may have little to no effect in reduction of snoring frequency but the evidence is very uncertain (Standardised Mean Difference (SMD) -0.53 points, 95% CI -1.03 to -0.03; two studies, 67 participants; very low-certainty evidence); and probably reduces subjective snoring intensity slightly (MD -1.9 points, 95% CI -3.69 to -0.11 one study, 51 participants; moderate-certainty evidence). Compared to waiting list, myofunctional therapy may: reduce daytime sleepiness (ESS, change from baseline MD -3.00 points, 95% CI -5.47 to -0.53; one study, 25 participants; low-certainty evidence); result in little to no difference in sleep quality (MD -0.70 points, 95% CI -2.01 to 0.61; one study, 25 participants; low-certainty evidence); and reduce AHI (MD -6.20 points, 95% CI -11.94 to -0.46; one study, 25 participants; low-certainty evidence). Compared to CPAP, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.30 points, 95% CI -1.65 to 2.25; one study, 54 participants; low-certainty evidence); and may increase AHI (MD 9.60 points, 95% CI 2.46 to 16.74; one study, 54 participants; low-certainty evidence). Compared to CPAP plus myofunctional therapy, myofunctional therapy alone may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.56 to 2.96; one study, 49 participants; low-certainty evidence) and may increase AHI (MD 10.50 points, 95% CI 3.43 to 17.57; one study, 49 participants; low-certainty evidence). Compared to respiratory exercises plus nasal dilator strip, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.46 to 2.86; one study, 58 participants; low-certainty evidence); probably increases sleep quality slightly (-1.94 points, 95% CI -3.17 to -0.72; two studies, 97 participants; moderate-certainty evidence); and may result in little to no difference in AHI (MD -3.80 points, 95% CI -9.05 to 1.45; one study, 58 participants; low-certainty evidence). Compared to standard medical treatment, myofunctional therapy may reduce daytime sleepiness (MD -6.40 points, 95% CI -9.82 to -2.98; one study, 26 participants; low-certainty evidence) and may increase sleep quality (MD -3.10 points, 95% CI -5.12 to -1.08; one study, 26 participants; low-certainty evidence). In children, compared to nasal washing alone, myofunctional therapy and nasal washing may result in little to no difference in AHI (MD 3.00, 95% CI -0.26 to 6.26; one study, 13 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Compared to sham therapy, myofunctional therapy probably reduces daytime sleepiness and may increase sleep quality in the short term. The certainty of the evidence for all comparisons ranges from moderate to very low, mainly due to lack of blinding of the assessors of subjective outcomes, incomplete outcome data and imprecision. More studies are needed. In future studies, outcome assessors should be blinded. New trials should recruit more participants, including more women and children, and have longer treatment and follow-up periods.
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Affiliation(s)
- José-Ramón Rueda
- Department of Preventive Medicine and Public Health, University of the Basque Country, Leioa, Spain
| | - Iranzu Mugueta-Aguinaga
- Respiratory Physiotherapy Unit, Rehabilitation Service, Pneumology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - Jordi Vilaró
- Department of Health Sciences, Ramon Lull University, Barcelona, Spain
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17
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Atilgan E, Kunter E, Algun ZC. Are oropharyngeal exercises effective in Obstructive Sleep Apnea Syndrome? J Back Musculoskelet Rehabil 2020; 33:209-216. [PMID: 31282395 DOI: 10.3233/bmr-171101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study has been conducted to examine the effects of posture, cervical region and oropharyngeal exercises in patients with Obstructive Sleep Apnea Syndrome (OSAS). METHOD Thirty patients with OSAS have been randomly divided into two groups. The first group received supervised exercise program including oropharyngeal, posture and cervical region exercises for 12 weeks. The patients in the control group have been informed about the posture but the exercise was not recommended. Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), Short Form 36 (SF-36), International Physical Activity Questionnaire-Short Form (IPAQ-SF) and 6 Minute Walk Test (6MWT) have been used in the evaluation of individuals participating in the study. Evaluations have been made at the beginning of the treatment and at the end of the 12-week exercise program. RESULTS Statistically significant improvements have been observed in the exercise group in PSQI total value, ESS score, SF-36 General Health Subscale and 6MWT (p< 0.05). Statistical significance could not be reached for other parameters. CONCLUSIONS Sleep quality, general health, and functional capacity have been found to improve in OSAS patients with oropharyngeal exercises.
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Affiliation(s)
- Esra Atilgan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medipol University, Turkey
| | - Erdoğan Kunter
- Department of Chest Diseases, Faculty of Medicine, Istanbul Medipol University, Turkey
| | - Z Candan Algun
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medipol University, Turkey
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18
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Bandyopadhyay A, Kaneshiro K, Camacho M. Effect of myofunctional therapy on children with obstructive sleep apnea: a meta-analysis. Sleep Med 2020; 75:210-217. [PMID: 32861058 DOI: 10.1016/j.sleep.2020.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To systematically review the current literature for articles describing the effect of myofunctional therapy on pediatric obstructive sleep apnea (OSA) and to perform a meta-analysis on the sleep study data. METHODS Three authors (A.B., K.K. and M.C.) independently searched from inception through April 20, 2020 in PubMed/MEDLINE, Scopus, Embase, Google Scholar and The Cochrane Library. Mean difference (MD), standard deviations and 95% confidence intervals were combined in the meta-analysis for apnea-hypopnea index (AHI), mean oxygen saturations, and lowest oxygen saturations (nadir O2). RESULTS 10 studies with 241 patients met study criteria and were further analyzed. The AHI reduced from 4.32 (5.2) to 2.48 (4.0) events/hr, a 43% reduction. Random effects modeling demonstrated a mean difference in AHI of -1.54 (95% CI -2.24,-0.85)/hr, z-score is 4.36 (p < 0.0001). Mean oxygen saturation increased by 0.37 (95% CI 0.06,0.69) percent, z-score is 2.32 (p = 0.02). There was no significant increase in nadir O2. CONCLUSIONS Despite heterogeneity in exercises, myofunctional therapy decreased AHI by 43% in children, and increased mean oxygen saturations in children with mild to moderate OSA and can serve as an adjunct OSA treatment.
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Affiliation(s)
- Anuja Bandyopadhyay
- Clinical Pediatrics Section of Pediatric Pulmonology, Allergy and Sleep Medicine Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, ROC 4270, Indianapolis, IN, 46202-5225, USA.
| | | | - Macario Camacho
- Otolaryngology, Sleep Surgery and Sleep Medicine, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859, USA.
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19
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Templier L, Rossi C, Miguez M, Pérez JDLC, Curto A, Albaladejo A, Vich ML. Combined Surgical and Orthodontic Treatments in Children with OSA: A Systematic Review. J Clin Med 2020; 9:E2387. [PMID: 32722638 PMCID: PMC7463535 DOI: 10.3390/jcm9082387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/29/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a sleeping breathing disorder. In children, adenotonsillar hypertrophy remains the main anatomical risk factor of OSA. The aim of this study was to assess the current scientific data and to systematically summarize the evidence for the efficiency of adenotonsillectomy (AT) and orthodontic treatment (i.e., rapid maxillary expansion (RME) and mandibular advancement (MA)) in the treatment of pediatric OSA. A literature search was conducted in several databases, including PubMed, Embase, Medline, Cochrane and LILACS up to 5th April 2020. The initial search yielded 509 articles, with 10 articles being identified as eligible after screening. AT and orthodontic treatment were more effective together than separately to cure OSA in pediatric patients. There was a greater decrease in apnea hypoapnea index (AHI) and respiratory disturbance index (RDI), and a major increase in the lowest oxygen saturation and the oxygen desaturation index (ODI) after undergoing both treatments. Nevertheless, the reappearance of OSA could occur several years after reporting adequate treatment. In order to avoid recurrence, myofunctional therapy (MT) could be recommended as a follow-up. However, further studies with good clinical evidence are required to confirm this finding.
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Affiliation(s)
- Laura Templier
- Division of Orthodontics, School of Dentistry, University of Alfonso X el Sabio, 28016 Madrid, Spain; Faculty of Medicine; (L.T.); (C.R.); (J.D.l.C.P.)
- Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain; (A.C.); (A.A.)
| | - Cecilia Rossi
- Division of Orthodontics, School of Dentistry, University of Alfonso X el Sabio, 28016 Madrid, Spain; Faculty of Medicine; (L.T.); (C.R.); (J.D.l.C.P.)
- Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain; (A.C.); (A.A.)
| | - Manuel Miguez
- Sleep Dental Medicine Spanish Society (SEMDeS), Dental Sleep Medicine Program, Catholic University of Murcia UCAM, 30107 Murcia, Spain;
| | - Javier De la Cruz Pérez
- Division of Orthodontics, School of Dentistry, University of Alfonso X el Sabio, 28016 Madrid, Spain; Faculty of Medicine; (L.T.); (C.R.); (J.D.l.C.P.)
| | - Adrián Curto
- Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain; (A.C.); (A.A.)
| | - Alberto Albaladejo
- Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain; (A.C.); (A.A.)
| | - Manuel Lagravère Vich
- Division of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
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20
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Amaral MS, Furlan RMMM, de Las Casas EB, Motta AR. The influence of tongue mobility on children's performance in computer games that depend on lingual movements. J Oral Rehabil 2020; 47:1233-1241. [PMID: 33464606 DOI: 10.1111/joor.13050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/01/2020] [Accepted: 06/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alteration in tongue mobility requires rehabilitation work through oral motor exercises. These exercises can be integrated with computer games to increase the patient's motivation during treatment. OBJECTIVE To investigate the influence of tongue mobility on children's motor performance in a computer game reliant on lingual movements. METHODS A cross-sectional descriptive observational study was carried out with 16 children with altered tongue mobility and 16 children with normal tongue mobility. The subjects were between 8 and 12 years of age. They underwent a clinical evaluation of the tongue and performed an activity using an intra-oral joystick controlled by the tongue to play a simple computer game. The game consisted of targets appearing on the screen that the participants had to reach by moving the joystick control rod. Afterward, the participants answered a feedback questionnaire. Motor performance in the game, measured by the number of reached targets and by the time to reach the targets, was compared between groups and across directions of tongue movement and order of appearance of the targets. RESULTS The group with altered tongue mobility presented a higher time to reach the target in the downward direction and in the first and last 12 targets and a lower number of targets reached in the left direction, upward direction, and in the first 12 targets than the control group. The direction of the movement influenced tongue performance in both groups. CONCLUSION Children with altered tongue mobility exhibited a worse performance than those with normal tongue mobility.
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Affiliation(s)
- Mariana S Amaral
- Graduate Program in Speech Language Pathology and Audiology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Renata M M M Furlan
- Department of Speech Language Pathology and Audiology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Estevam B de Las Casas
- Department of Structural Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Andréa R Motta
- Department of Speech Language Pathology and Audiology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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21
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Bae J, Kim DK. Risk factors for residual mouth breathing in children who had completely resolved obstructive sleep apnea after adenotonsillectomy. Eur Arch Otorhinolaryngol 2020; 277:2913-2919. [DOI: 10.1007/s00405-020-06122-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/08/2020] [Indexed: 11/28/2022]
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22
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Savini S, Ciorba A, Bianchini C, Stomeo F, Corazzi V, Vicini C, Pelucchi S. Assessment of obstructive sleep apnoea (OSA) in children: an update. ACTA ACUST UNITED AC 2020; 39:289-297. [PMID: 31708576 PMCID: PMC6843580 DOI: 10.14639/0392-100x-n0262] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/11/2019] [Indexed: 02/04/2023]
Abstract
OSA is a condition characterised by episodes of complete or partial obstruction of the upper airway, associated with blood-gas changes and atypical sleep patterns. Early diagnosis of OSA may reduce the occurrence of systemic complications over time, although the diagnosis of OSA is, unfortunately, often late. The aim of the work is to review the current concepts in evaluation of paediatric obstructive sleep apnoea (OSA), with an updated revision of the literature considering risk factors, clinical manifestations, and basic and advanced assessment in the paediatric population. For this narrative review, PubMed, Embase and Cinahl databases were searched for the last 10 years, according to PRISMA criteria/guidelines. Assessment of paediatric OSA remains challenging and paediatric patients should always be carefully evaluated; polysomnography is the gold standard for diagnosis of paediatric OSA.
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Affiliation(s)
- S Savini
- ENT Department, University Hospital of Ferrara, Italy
| | - A Ciorba
- ENT Department, University Hospital of Ferrara, Italy
| | - C Bianchini
- ENT Department, University Hospital of Ferrara, Italy
| | - F Stomeo
- ENT Department, University Hospital of Ferrara, Italy
| | - V Corazzi
- ENT Department, University Hospital of Ferrara, Italy
| | - C Vicini
- Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - S Pelucchi
- ENT Department, University Hospital of Ferrara, Italy
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Furlan RMMM, Santana GA, Amaral MS, Motta AR, de Las Casas EB. The influence of tongue strength on children's performance in computer games reliant on lingual force generation. J Oral Rehabil 2020; 47:872-879. [PMID: 32080882 DOI: 10.1111/joor.12951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/14/2020] [Accepted: 02/15/2020] [Indexed: 11/30/2022]
Abstract
Oral motor exercises, for recovering tongue strength, can be integrated with computer games to increase motivation, especially for treatments in children. The aim of this study was to investigate the influence of tongue strength on motor performance in computer games reliant on lingual force generation. An observational study was carried out at a speech-language pathology outpatient university clinic. Twenty participants (10 with normal tongue strength and 10 with reduced tongue strength) aged 8-13 years used an intra-oral joystick controlled by the tongue to play six computer games during which they had to reach targets that appeared on the screen. Motor performance was measured by the number of attempts to score and the time during which the target force was maintained. Tongue motor performance was compared between groups and across directions of tongue movement, resistance force levels, order of target appearance, continuous force application time on the target, age and sex. Children with normal tongue strength had a lower number of attempts to score (P = .014) and maintained the target force for longer periods (P = .002) than those with reduced tongue strength. The performance was better for both groups (a) in the downward direction compared with the performance in other directions, (b) in games with the lowest resistive force level (0.5 N) compared to those with other levels of resistive force and (c) in the second and third rounds compared with the first round. There were no gender-related differences in performance. Older participants performed better than younger participants. Tongue strength, direction of movement, force to reach the target, time of continuous force application, order of target appearance and age influenced tongue motor performance.
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Affiliation(s)
| | - Guilherme André Santana
- Graduate Program in Structural Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mariana Souza Amaral
- Graduate Program in Speech Language Pathology and Audiology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Andréa Rodrigues Motta
- Department of Speech Language Pathology and Audiology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Lin SY, Su YX, Wu YC, Chang JZC, Tu YK. Management of paediatric obstructive sleep apnoea: A systematic review and network meta-analysis. Int J Paediatr Dent 2020; 30:156-170. [PMID: 31680340 DOI: 10.1111/ipd.12593] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) affects many children, and adenotonsillar hypertrophy is the most common cause of paediatric OSA. AIM Despite the growing treatment options, there is no comprehensive comparison of all interventions. We aimed to compare and rank the effectiveness of various treatments in a network meta-analysis. DESIGN Literature was searched from inception to 13 May 2018 for paediatric OSA with adenotonsillar hypertrophy. The outcomes were the changes in apnoea-hypopnea index (AHI), oxyhaemoglobin desaturation index (ODI), and lowest arterial oxygen saturation (SaO2 ). Frequentist approach to network meta-analysis was used. Treatment hierarchy was summarized according to the surfaces under the cumulative ranking curves. RESULTS Fourteen trials comprising 1064 paediatric OSA participants evaluating ten interventions (adenotonsillectomy, adenotonsillectomy + pharyngoplasty, adenotonsillotomy, antimicrobial therapy, steroids, leukotriene receptor antagonists [LTRAs], steroids + LTRAs, rapid maxillary expansion [RME], placebo, and no treatment) were identified for network meta-analysis. In terms of effectiveness in AHI reduction, surgical approach was still the most effective intervention than no treatment. RME was one of the most effective interventions to improve lowest SaO2 . No comparisons showed statistical significance in reducing ODI. CONCLUSIONS Irrespective of the intervention used, complete resolution of OSA was not achieved in most trials.
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Affiliation(s)
- Shih-Ying Lin
- Department of Dentistry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Xuan Su
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Jenny Zwei-Chieng Chang
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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25
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Hsu B, Emperumal CP, Grbach VX, Padilla M, Enciso R. Effects of respiratory muscle therapy on obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med 2020; 16:785-801. [PMID: 32026802 DOI: 10.5664/jcsm.8318] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVES The purpose of this study is to conduct a systematic review and meta-analysis evaluating the effects of respiratory muscle therapy (ie, oropharyngeal exercises, speech therapy, breathing exercises, wind musical instruments) compared with control therapy or no treatment in improving apnea-hypopnea index ([AHI] primary outcome), sleepiness, and other polysomnographic outcomes for patients diagnosed with obstructive sleep apnea (OSA). METHODS Only randomized controlled trials with a placebo therapy or no treatment searched using PubMed, EMBASE, Cochrane, and Web of Science up to November 2018 were included, and assessment of risk of bias was completed using the Cochrane Handbook. RESULTS Nine studies with 394 adults and children diagnosed with mild to severe OSA were included, all assessed at high risk of bias. Eight of the 9 studies measured AHI and showed a weighted average overall AHI improvement of 39.5% versus baselines after respiratory muscle therapy. Based on our meta-analyses in adult studies, respiratory muscle therapy yielded an improvement in AHI of -7.6 events/h (95% confidence interval [CI] = -11.7 to -3.5; P ≤ .001), apnea index of -4.2 events/h (95% CI = -7.7 to -0.8; P ≤ .016), Epworth Sleepiness Scale of -2.5 of 24 (95% CI= -5.1 to -0.1; P ≤ .066), Pittsburgh Sleep Quality Index of -1.3 of 21 (95% CI= -2.4 to -0.2; P ≤ .026), snoring frequency (P = .044) in intervention groups compared with controls. CONCLUSIONS This systematic review highlights respiratory muscle therapy as an adjunct management for OSA but further studies are needed due to limitations including the nature and small number of studies, heterogeneity of the interventions, and high risk of bias with low quality of evidence.
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Affiliation(s)
- Brien Hsu
- Master of Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, California
| | - Chitra Priya Emperumal
- Master of Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, California
| | - Vincent X Grbach
- Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Mariela Padilla
- Division of Periodontology, Diagnostic Sciences and Dental Hygiene, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, California
| | - Reyes Enciso
- Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, California
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26
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Lin HY, Su PL, Lin CY, Hung CH. Models of anatomically based oropharyngeal rehabilitation with a multilevel approach for patients with obstructive sleep apnea: a meta-synthesis and meta-analysis. Sleep Breath 2019; 24:1279-1291. [PMID: 31836993 DOI: 10.1007/s11325-019-01971-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/17/2019] [Accepted: 11/02/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is a sleep-related breathing disorder associated with dysfunction of oropharyngeal muscles to maintain upper airway patency during sleep. Oropharyngeal rehabilitation (OPR) was developed to restore, reconstruct, and reeducate oropharyngeal muscle function, but current protocols and effectiveness of OPR have been inconsistent. The purpose of this study was to review (1) indications of OPR, (2) protocols of OPR, and (3) effectiveness of OPR. METHODS We searched MEDLINE, EMBASE, and the Cochrane Library and then conducted both meta-synthesis and meta-analysis according to the statement of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). RESULTS A total of eight studies with 203 patients were included. By means of meta-synthesis, the patients with middle age, BMI < 40 kg/m2, mild-to-moderate OSA, and non-severe upper airway anatomical abnormality were found to benefit from OPR. The protocol of OPR was summarized to be an anatomically based, multilevel approach, including the retropalatal, retroglossal, hypopharyngeal, TMJ, and facial levels. By using meta-analysis, overall outcomes were presented as apnea hypopnea index (AHI) with significant improvement from 25.2 ± 7.8/h to 16.1 ± 6.6/h (mean difference [MD] - 9.8 [95% CI - 11.0 to - 8.6], p < 0.0001); the lowest oxygen saturation (LSAT) improved from 80.2 ± 4.7 to 83.8 ± 2.9% (MD 3.0% [95% CI 2.0 to 4.0], p < 0.0001); Epworth sleepiness scale (ESS) improved from 11.8 ± 1.9 to 6.3 ± 1.6 (MD - 5.9 [95% CI - 7.5 to - 4.2], p < 0.001), neck circumference (NC) from 35.2 ± 1.1 to 34.7 ± 0.9 cm (MD - 0.6 [95% CI - 0.9 to - 0.2], p = 0.002), BMI from 24.8 ± 3.7 to 24.8 ± 4.1 kg/m2 (MD - 0.0; 95% CI - 0.5 to 0.5, p = 0.95). All outcomes except BMI demonstrated significant improvement from OPR. CONCLUSIONS Meta-analysis of previous OPR reports shows an improvement in AHI of 39%, compared with the usual surgical definition of success at 50%. Only mild and moderate cases of OSA were referred for OPR in the prior studies. In order to improve outcomes with OPR, a comprehensive approach to rehabilitation should be emphasized.
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Affiliation(s)
- Hsin-Yu Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, No. 1 Ta-Hsueh Road, East District, Tainan City, 701, Taiwan
| | - Po-Lan Su
- Department of Internal Medicine, Division of Pulmonary, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, North District, Tainan City, 704, Taiwan
| | - Cheng-Yu Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, North District, Tainan City, 704, Taiwan.,Department of Environmental and Occupational Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, North District, Tainan City, 704, Taiwan.,Sleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, North District, Tainan City, 704, Taiwan
| | - Ching-Hsia Hung
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, No. 1 Ta-Hsueh Road, East District, Tainan City, 701, Taiwan. .,Department of Physical Therapy, College of Medicine, National Cheng Kung University, No. 1 Ta-Hsueh Road, East District, Tainan City, 701, Taiwan.
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27
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Shafiek H, Evangelisti M, Abd-elwahab NH, Barreto M, Villa MP, Mahmoud MI. Obstructive Sleep Apnea in School-Aged Children Presented with Nocturnal Enuresis. Lung 2019; 198:187-194. [DOI: 10.1007/s00408-019-00304-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/02/2019] [Indexed: 11/29/2022]
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28
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Amat P, Tran Lu Y É. [The contribution of orofacial myofunctional reeducation to the treatment of obstructive sleep apnoea syndrome (OSA): a systematic review of the literature]. Orthod Fr 2019; 90:343-370. [PMID: 34643521 DOI: 10.1051/orthodfr/2019035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Obstructive sleep apnoea syndrome (OSA) is a widespread and under-diagnosed condition, making it a major public health and safety problem. Orofacial myofunctional reeducation (OMR) has been shown to be effective in the multidisciplinary treatment of OSA in children, adolescents and adults and is prescribed at several stages of OSA management. The main objective of this systematic literature review was to evaluate the effectiveness of active or passive orofacial myofunctional reeducation (OMR) in the treatment of obstructive sleep apnoea syndrome in children, adolescents and adults. The systematic literature review was undertaken from the three electronic databases: Medline (via PubMed), Cochrane Library, Web of Science Core Collection, and supplemented by a limited grey literature search (Google Scholar) in order to identify the studies evaluating the effectiveness of the OMR on OSA. The primary outcome of interest was a decrease in the Apnea-Hypopnea Index (AHI) of at least five episodes per hour compared to the baseline state. Secondary outcomes were an improvement in subjective sleep quality, sleep quality measured by night polysomnography and subjectively measured quality of life. Only ten studies met all the inclusion criteria. Eight were randomized controlled clinical trials, one was a prospective cohort study and another was a retrospective cohort study. Six studies were devoted to adult OSA and four to pediatric OSA. All included studies were assessed as "low risk of bias" based on the 12 bias risk criteria of the Cochrane Back Review Group. Based on the available evidence, RMO allows a significant reduction in AHI, up to 90.6% in children and up to 92.06% in adults. It significantly reduces the intensity and frequency of snoring, helps reduce daytime sleepiness, limits the recurrence of OSA symptoms after adenoamygdalectomy in children and improves adherence to PPC therapy. Passive RMO, with the assistance provided to the patient by wearing a custom orthosis, increases adherence to reeducation, significantly improves snoring intensity, AHI and significantly increases the upper airway. Published data show that orofacial myofunctional rééducation is effective in the multidisciplinary treatment of OSA in children, adolescents and adults and should be widely prescribed at several stages of OSA management. Passive RMO, with the pearl mandibular advancement orthosis designed by Michèle Hervy-Auboiron, helps to compensate for the frequent non-compliance observed during active RMO treatments.
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29
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Garrec P, Legris S, Soyer Y, Vi-Fane B, Jordan L. [Orthodontic management of obstructive sleep-disordered respiratory disorders]. Orthod Fr 2019; 90:321-335. [PMID: 34643519 DOI: 10.1051/orthodfr/2019029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Through his/her knowledge of cranio-facial growth, the orthodontist plays a leading role within the multidisciplinary team that tracks and treats sleep-disordered breathing (SDB) in children. Correction of craniofacial risk factors (maxillary deficiency and retrognathia) is commonly used by practitioners alongside orthodontic treatment such as OMA and RME in the optimal conditions afforded by childhood growth. Myofunctional therapies are performed to restore correct stomatognathic function and play a central role in the management of SDB in children. The orthodontist is therefore a key player in the medical treatment chain of these children.
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Affiliation(s)
- Pascal Garrec
- Université Paris Diderot-UFR Odontologie, 5 rue Garancière, 75006 Paris, France, Hôpital Pitié Salpêtrière, AP-HP, UF d'Orthodontie, 75013 Paris, France, AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Sylvie Legris
- AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Yves Soyer
- Hôpital Pitié Salpêtrière, AP-HP, UF d'Orthodontie, 75013 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Brigitte Vi-Fane
- Université Paris Diderot-UFR Odontologie, 5 rue Garancière, 75006 Paris, France, Hôpital Pitié Salpêtrière, AP-HP, UF d'Orthodontie, 75013 Paris, France, AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Laurence Jordan
- Université Paris Diderot-UFR Odontologie, 5 rue Garancière, 75006 Paris, France, AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, PSL Research University, Institut de Recherche de Chimie Paris, UMR 8247-Chimie ParisTech, 75005 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
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30
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Obstructive Sleep Apnea: Emerging Treatments Targeting the Genioglossus Muscle. J Clin Med 2019; 8:jcm8101754. [PMID: 31652594 PMCID: PMC6832267 DOI: 10.3390/jcm8101754] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/11/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by repetitive episodes of upper airway obstruction caused by a loss of upper airway dilator muscle tone during sleep and an inadequate compensatory response by these muscles in the context of an anatomically compromised airway. The genioglossus (GG) is the main upper airway dilator muscle. Currently, continuous positive airway pressure is the first-line treatment for OSA. Nevertheless, problems related to poor adherence have been described in some groups of patients. In recent years, new OSA treatment strategies have been developed to improve GG function. (A) Hypoglossal nerve electrical stimulation leads to significant improvements in objective (apnea-hypopnea index, or AHI) and subjective measurements of OSA severity, but its invasive nature limits its application. (B) A recently introduced combination of drugs administered orally before bedtime reduces AHI and improves the responsiveness of the GG. (C) Finally, myofunctional therapy also decreases AHI, and it might be considered in combination with other treatments. Our objective is to review these therapies in order to advance current understanding of the prospects for alternative OSA treatments.
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31
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Zaghi S, Valcu‐Pinkerton S, Jabara M, Norouz‐Knutsen L, Govardhan C, Moeller J, Sinkus V, Thorsen RS, Downing V, Camacho M, Yoon A, Hang WM, Hockel B, Guilleminault C, Liu SY. Lingual frenuloplasty with myofunctional therapy: Exploring safety and efficacy in 348 cases. Laryngoscope Investig Otolaryngol 2019; 4:489-496. [PMID: 31637291 PMCID: PMC6793603 DOI: 10.1002/lio2.297] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/02/2019] [Accepted: 07/09/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Ankyloglossia is a condition of altered tongue mobility due to the presence of restrictive tissue between the undersurface of the tongue and the floor of mouth. Potential implications of restricted tongue mobility (such as mouth breathing, snoring, dental clenching, and myofascial tension) remain underappreciated due to limited peer-reviewed evidence. Here, we explore the safety and efficacy of lingual frenuloplasty and myofunctional therapy for the treatment of these conditions in a large and diverse cohort of patients with restricted tongue mobility. METHODS Four hundred twenty consecutive patients (ages 29 months to 79 years) treated with myofunctional therapy and lingual frenuloplasty for indications of mouth breathing, snoring, dental clenching, and/or myofascial tension were surveyed. All procedures were performed by a single surgeon using a scissors and suture technique. Safety and efficacy was assessed >2 months postoperatively by means of patient-reported outcome measures. RESULTS In all, 348 surveys (83% response rate) were completed showing 91% satisfaction rate and 87% rate of improvement in quality of life through amelioration of mouth breathing (78.4%), snoring (72.9%), clenching (91.0%), and/or myofascial tension (77.5%). Minor complications occurred in <5% of cases including complaints of prolonged pain or bleeding, temporary numbness of the tongue-tip, salivary gland issues, minor wound infection or inflammation, and need for revision to excise scar tissue. There were no major complications. CONCLUSION Lingual frenuloplasty with myofunctional therapy is safe and potentially effective for the treatment of mouth breathing, snoring, clenching, and myofascial tension in appropriately selected patient candidates. Further studies with objective measures are merited. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Soroush Zaghi
- The Breathe InstituteLos AngelesCaliforniaU.S.A.
- UCLA HealthSanta MonicaCaliforniaU.S.A.
| | | | - Mia Jabara
- The Breathe InstituteLos AngelesCaliforniaU.S.A.
| | | | | | - Joy Moeller
- The Breathe InstituteLos AngelesCaliforniaU.S.A.
- Academy of Orofacial Myofunctional TherapyPacific PalisadesCaliforniaU.S.A.
| | | | - Rebecca S. Thorsen
- The Breathe InstituteLos AngelesCaliforniaU.S.A.
- Long Beach Speech PathologyLong BeachCaliforniaU.S.A.
| | - Virginia Downing
- The Breathe InstituteLos AngelesCaliforniaU.S.A.
- Orofacial IntegrityOaklandCaliforniaU.S.A.
| | | | - Audrey Yoon
- Section of Pediatric Dentistry, Division of Growth and DevelopmentUCLA School of DentistryLos AngelesCaliforniaU.S.A.
- Division of Sleep Surgery, Department of Otolaryngology‐Head & Neck SurgeryStanford University School of MedicineStanfordCaliforniaU.S.A.
| | - William M. Hang
- William M Hang, DDS, MSD ‐ A Prof CorpAgoura HillsCaliforniaU.S.A.
| | - Brian Hockel
- Life Dental and OrthodonticsWalnut CreekCaliforniaU.S.A.
| | - Christian Guilleminault
- Department of Psychiatry, Sleep Medicine DivisionStanford Hospital and ClinicsRedwood CityCaliforniaU.S.A.
| | - Stanley Yung‐Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology‐Head & Neck SurgeryStanford University School of MedicineStanfordCaliforniaU.S.A.
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32
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Chuang LC, Hwang YJ, Lian YC, Hervy-Auboiron M, Pirelli P, Huang YS, Guilleminault C. Changes in craniofacial and airway morphology as well as quality of life after passive myofunctional therapy in children with obstructive sleep apnea: a comparative cohort study. Sleep Breath 2019; 23:1359-1369. [DOI: 10.1007/s11325-019-01929-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/05/2019] [Accepted: 08/21/2019] [Indexed: 11/28/2022]
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33
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Katila M, Saarenpää‐Heikkilä O, Saha M, Vuorela N, Paavonen EJ. Parental reports showed that snoring in infants at three and eight months associated with snoring parents and smoking mothers. Acta Paediatr 2019; 108:1686-1694. [PMID: 30791132 DOI: 10.1111/apa.14758] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 01/06/2023]
Abstract
AIM This prospective study examined the prevalence of snoring during infancy and the prenatal and postnatal risk factors for this condition. METHODS The study population comprised 1388 infants from the CHILD-SLEEP birth cohort, who were recruited in the Pirkanmaa Hospital District, Finland, between 2011 and 2013. Sleep and background factor questionnaires were filled out prenatally by parents and when the infant was three and eight months old. RESULTS The prevalence of habitual snoring was 3.2% at the age of three months and 3.0% at eight months, and snoring infants had more sleeping difficulties at those ages, with odds ratios (ORs) of 3.11 and 4.63, respectively. At three months, snoring infants slept for a shorter length of time (p = 0.001) and their sleep was more restless (p = 0.004). In ordinal logistic regression models, parental snoring (adjusted OR = 1.65 and 2.60) and maternal smoking (adjusted OR = 2.21 and 2.17) were significantly associated with infant snoring at three and eight months, while formula feeding and dummy use (adjusted OR = 1.48 and 1.56) were only associated with infant snoring at three months. CONCLUSION Parental snoring and maternal smoking increased the risk of snoring. Infants who snored also seemed to suffer more from other sleep difficulties.
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Affiliation(s)
- Maija Katila
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | - Outi Saarenpää‐Heikkilä
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | - Marja‐Terttu Saha
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | | | - E. Juulia Paavonen
- Pediatric Research Center Child Psychiatry University of Helsinki and Helsinki University Hospital Helsinki Finland
- National Institute for Health and Welfare Helsinki Finland
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Sánchez-Súcar AM, Sánchez-Súcar FDB, Almerich-Silla JM, Paredes-Gallardo V, Montiel-Company JM, García-Sanz V, Bellot-Arcís C. Effect of rapid maxillary expansion on sleep apnea-hypopnea syndrome in growing patients. A meta-analysis. J Clin Exp Dent 2019; 11:e759-e767. [PMID: 31598206 PMCID: PMC6776408 DOI: 10.4317/jced.55974] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 06/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background Changes produced in the upper airway after rapid maxillary expansion makes this procedure a therapeutic option for treating sleep apnea-hypopnea syndrome (SAHS) in children. The objective of this systematic review and meta-analysis was to analyze the evidence available for the effects of rapid maxillary expansion (RME) on SAHS, analyzing changes produced in oximetric variables: apnea-hypopnea index (AHI); oxygen saturation (SO2); sleep efficiency (SE), total sleep time (TST), percentage of rapid eye movement (REM) phase; and arousal index (AI). Material and Methods An electronic search was conducted in the PubMed, Scopus, Embase, and Cochrane databases, and in grey literature (Opengrey). No limit was placed on publication date or language. Inclusion criteria were: patients in growth with sleep apnea who underwent rapid maxillary expansion with oximetric values registered before and after treatment. Articles with patient sample sizes <10 were excluded. Ten articles were included for qualitative synthesis and nine for meta-analysis (eliminating one observational study). Results AHI values underwent a mean reduction of 5.79 events/hour (CI -95% 9.06 to 2.5); an increase in mean oxygen saturation of 2.54 % (CI-95% -0.28 to 4.80, 6.7 %); a reduction in AI of 2.17 events/hour (CI-95% -5.25 to -0.582); an increase in REM phase of 1.20 % (CI-95% 1.02 to 1.38); and an increase in SE of 0.961% (CI-95% -1.574 to 3.495). Conclusions RME would appear efficient for treating slight or moderate SAHS, as indicated by improvement in oximetric parameters; it may be effective as coadjuvant therapy to adenotonsillectomy in severe cases of children with maxillary compression. Key words:Rapid maxillary expansion, obstructive sleep apnea.
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Affiliation(s)
- Ana-Matilde Sánchez-Súcar
- Doctorate student, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia
| | | | | | - Vanessa Paredes-Gallardo
- Teaching Assistant, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia
| | - José-María Montiel-Company
- Teaching Assistant, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia
| | - Verónica García-Sanz
- Associate Professor, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia
| | - Carlos Bellot-Arcís
- Assistant Professor, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia
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Bluher AE, Ishman SL, Baldassari CM. Managing the Child with Persistent Sleep Apnea. Otolaryngol Clin North Am 2019; 52:891-901. [PMID: 31301824 DOI: 10.1016/j.otc.2019.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pediatric obstructive sleep apnea (OSA) affects 2% to 4% of American children, and is associated with metabolic, cardiovascular, and neurocognitive sequelae. The primary treatment for pediatric OSA is adenotonsillectomy. Children with obesity, craniofacial syndromes, and severe baseline OSA are at risk for persistent disease. Evaluation of persistent OSA should focus on identifying the causes of upper airway obstruction. Interventions should be tailored to address the patient's symptomatology, sites of obstruction, and preference for surgical versus medical management. Further research is needed to identify management protocols that result in improved outcomes for children with persistent OSA.
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Affiliation(s)
- Andrew E Bluher
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507, USA
| | - Stacey L Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC# 2018, Cincinnati, OH 45229-2018, USA; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC# 2018, Cincinnati, OH 45229-2018, USA
| | - Cristina M Baldassari
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507, USA; Departments of Pediatric Otolaryngology and Pediatric Sleep Medicine, Children's Hospital of the King's Daughters, 601 Children's Lane, 2nd Floor, Norfolk, VA 23507, USA.
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Nguyen XL, Briffod J, Couloigner V, Darqué F, Kerbrat JB, Vecchierini MF. [Adolescent obstructive sleep apnoea syndrome: Characteristics and treatment]. Rev Mal Respir 2019; 36:697-706. [PMID: 31255317 DOI: 10.1016/j.rmr.2018.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/29/2018] [Indexed: 12/28/2022]
Abstract
Although the prevalence of the obstructive sleep apnoea syndrome (OSAS) is high in adolescents, studies pertaining to adolescent OSAS are less numerous than childhood studies. Cases of adolescent OSAS may consist of residual OSAS after adenotonsillectomy, but most often are de novo cases. Major pathophysiological factors are weight excess or even high-grade obesity, and the association of upper airway narrowing and tonsillar hypertrophy (pharyngeal, palatal or even lingual). ENT and systematic orthodontic assessments are the main points. In case of predisposing factors such as dental, occlusal or dento-facial abnormalities, a specific orthodontic treatment can be discussed. First line treatment is surgical adenotonsillectomy; surgical reduction of the lingual tonsils is seldom required. CPAP treatment may be indicated in the case of severe comorbidities (craniofacial malformations, neuromuscular diseases…) or in obese adolescents with severe residual OSAS. Treatment of adolescent OSAS has to be comprehensive and multidisciplinary, taking into account the specific treatments of obesity and abnormal sleep/wake rhythms.
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Affiliation(s)
- X-L Nguyen
- Unité somnologie et fonction respiratoire, hôpital St-Antoine, 75012 Paris, France
| | - J Briffod
- Centre médical spécialisé de l'enfant et de l'adolescent, 17, rue Froment, 75011 Paris, France
| | - V Couloigner
- Service d'ORL pédiatrique, hôpital Necker-Enfants Malades, université Paris Descartes, AP-HP, 75015 Paris, France
| | - F Darqué
- Unité d'orthopédie dento-faciale, hôpital Pellegrin, place Amélie Raba-Léon, 33000 Bordeaux, France
| | - J-B Kerbrat
- Pathologies du sommeil, groupe hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, 75013 Paris, France
| | - M-F Vecchierini
- Centre du sommeil et de la vigilance, Hôtel-Dieu, 1, place du Parvis Notre-Dame, 75181 Paris cedex 04, France.
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Li HY, Lee LA, Hsin LJ, Fang TJ, Lin WN, Chen HC, Lu YA, Lee YC, Tsai MS, Tsai YT. Intrapharyngeal surgery with integrated treatment for obstructive sleep apnea. Biomed J 2019; 42:84-92. [PMID: 31130252 PMCID: PMC6541889 DOI: 10.1016/j.bj.2019.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/28/2019] [Accepted: 02/19/2019] [Indexed: 11/25/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common disease in adults, which influences human relations, quality of life and associates with major complications. Continuous positive airway pressure (CPAP) is the gold standard treatment modality in OSA patients. For patients incompliant or unwilling to CPAP therapy, surgery is an alternative treatment. Sleep surgery for OSA include intrapharyngeal surgery, extrapharyngeal surgery and bariatric surgery addressing upper airway soft tissue, maxillofacial bone, and obesity, respectively. Among sleep surgeries, intrapharyngeal surgery (soft tissue surgery) is widespread used and serves overwhelming majority in OSA surgical patients. Despite the popularity of intrapharyngeal surgery, its outcomes can be influenced by multiple factors and consequently need conjunctive remedy to enhance at the short-term and sustain in the long-term. In this article, we introduce updated indications for treating OSA, practical principle in decision-making between CPAP and surgery, hybrid procedures in treating obstruction at the nose, palate, tongue and epiglottis, and postoperative integrated treatment including oropharyngeal myofunctional therapy (local), positional therapy (regional), and body weight reduction (systemic), and circadian rhythm (central). In summary, intrapharyngeal surgery is a target-oriented procedure that needs to be performed precisely and combines with integrated treatment as a holistic care for OSA patients.
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Affiliation(s)
- Hsueh-Yu Li
- Department of Otolaryngology - Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Li-Ang Lee
- Department of Otolaryngology - Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Jen Hsin
- Department of Otolaryngology - Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Department of Otolaryngology - Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Ni Lin
- Department of Otolaryngology - Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hung-Chin Chen
- Department of Otolaryngology - Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yi-An Lu
- Department of Otolaryngology - Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yi-Chan Lee
- Department of Otolaryngology - Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Ming-Shao Tsai
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
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Wishney M, Darendeliler MA, Dalci O. Myofunctional therapy and prefabricated functional appliances: an overview of the history and evidence. Aust Dent J 2019; 64:135-144. [DOI: 10.1111/adj.12690] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
- M Wishney
- Discipline of Orthodontics Faculty of Dentistry University of Sydney Sydney New South Wales Australia
- Dental Hospital Sydney Local Health District Surry Hills New South Wales Australia
| | - MA Darendeliler
- Discipline of Orthodontics Faculty of Dentistry University of Sydney Sydney New South Wales Australia
- Dental Hospital Sydney Local Health District Surry Hills New South Wales Australia
| | - O Dalci
- Discipline of Orthodontics Faculty of Dentistry University of Sydney Sydney New South Wales Australia
- Dental Hospital Sydney Local Health District Surry Hills New South Wales Australia
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von Lukowicz M, Herzog N, Ruthardt S, Quante M, Iven G, Poets CF. Effect of a 1-week intense myofunctional training on obstructive sleep apnoea in children with Down syndrome. Arch Dis Child 2019; 104:275-279. [PMID: 30072363 DOI: 10.1136/archdischild-2018-315064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/05/2018] [Accepted: 07/22/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is common in children with Down syndrome (DS), yet difficult to treat. As muscular hypotonia of the upper airway may cause OSA and is also common in DS, we tested whether intense myofunctional therapy improves OSA in children with DS. PATIENTS AND METHODS Forty-two children underwent cardiorespiratory sleep studies immediately before and after a 1-week intensive training camp consisting of three daily 45 min sessions of myofunctional exercises according to Padovan. Primary outcome was the mixed-obstructive-apnoea/hypopnoea index (MOAHI), secondary outcomes the ≤3% oxygen desaturation index (DI3), the ≤90% desaturation index (DI90) and the lowest pulse oximeter saturation (SpO2nadir). RESULTS Eighteen recordings had ≥3 hours of artefact-free recording in both the pretreatment and post-treatment sleep study and were therefore included in the analysis. Mean age was 6.3 years (SD 2.5); 83% had OSA prior to intervention. Mean MOAHI was 6.4 (SD 8.6) before and 6.4 (SD 10.8) after the intervention (p>0.05); the DI3 and SpO2nadir also did not change. Only the DI90 decreased significantly from 2.7 (SD 4.5) to 2.1 (SD 3.7) (p<0.05). CONCLUSION The 1-week intense myofunctional training camp evaluated here in children with DS had only a marginal effect on OSA. Whether a longer follow-up period or duration of intervention would yield stronger effects remains to be determined.
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Affiliation(s)
- Magnus von Lukowicz
- Sleep Medicine, Department of Neonatology, University of Tuebingen, Tuebingen, Germany
| | - Nina Herzog
- Sleep Medicine, Department of Neonatology, University of Tuebingen, Tuebingen, Germany
| | | | - Mirja Quante
- Sleep Medicine, Department of Neonatology, University of Tuebingen, Tuebingen, Germany
| | | | - Christian F Poets
- Sleep Medicine, Department of Neonatology, University of Tuebingen, Tuebingen, Germany
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Oh SM, Kim JH, Kim SH. Upper airway myofunctional exercise: a systematic review. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2019. [DOI: 10.5124/jkma.2019.62.4.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Su-mi Oh
- Division for New Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jin-Hyeong Kim
- Division for New Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Seok-Hyun Kim
- Division for New Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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Abstract
PURPOSE Orofacial myofunctional therapy (OMT) is a modality of treatment for children and adults with obstructive sleep apnea (OSA) to promote changes in the musculature of the upper airways. This review summarizes and discusses the effects of OMT on OSA, the therapeutic programs employed, and their possible mechanisms of action. METHODS We conducted an online literature search using the databases MEDLINE/PubMed, EMBASE, and Web of Science. Search terms were "obstructive sleep apnea" in combination with "myofunctional therapy" OR "oropharyngeal exercises" OR "speech therapy". We considered original articles in English and Portuguese containing a diagnosis of OSA based on polysomnography (PSG). The primary outcomes of interest for this review were objective measurement derived from PSG and subjective sleep symptoms. The secondary outcome was the evaluation of orofacial myofunctional status. RESULTS Eleven studies were included in this review. The studies reviewed reveal that several benefits of OMT were demonstrated in adults, which include significant decrease of apnea-hypopnea index (AHI), reduced arousal index, improvement in subjective symptoms of daytime sleepiness, sleep quality, and life quality. In children with residual apnea, OMT promoted a decrease of AHI, increase in oxygen saturation, and improvement of orofacial myofunctional status. Few of the studies reviewed reported the effects of OMT on the musculature. CONCLUSION The present review showed that OMT is effective for the treatment of adults in reducing the severity of OSA and snoring, and improving the quality of life. OMT is also successful for the treatment of children with residual apnea. In addition, OMT favors the adherence to continuous positive airway pressure. However, randomized and high-quality studies are still rare, and the effects of treatment should also be analyzed on a long-term basis, including measures showing if changes occurred in the musculature.
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Affiliation(s)
- Cláudia Maria de Felício
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil,
- Craniofacial Research Support Center, University of São Paulo (USP), Ribeirão Preto, Brazil,
| | - Franciele Voltarelli da Silva Dias
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil,
- Craniofacial Research Support Center, University of São Paulo (USP), Ribeirão Preto, Brazil,
| | - Luciana Vitaliano Voi Trawitzki
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil,
- Craniofacial Research Support Center, University of São Paulo (USP), Ribeirão Preto, Brazil,
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Tan HL, Kheirandish-Gozal L, Gozal D. Adenotonsillectomy in Pediatric OSA: Time to Look Elsewhere. CURRENT SLEEP MEDICINE REPORTS 2018. [DOI: 10.1007/s40675-018-0122-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Bellussi LM, Villa MP, Degiorgi G, Passali FM, Evangelisti M, Paganelli II, Montesano M, Passali D. Preventive nasal bacteriotherapy for the treatment of upper respiratory tract infections and sleep disordered breathing in children. Int J Pediatr Otorhinolaryngol 2018; 110:43-47. [PMID: 29859585 DOI: 10.1016/j.ijporl.2018.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The purpose of this prospective study was to assess the effectiveness and safety of Streptococcus salivarius 24SMBc administered as a nasal spray in children affected by recurring infections of the upper airways, adenotonsillar hypertrophy, and sleep disordered breathing (SDB). METHODS Prospective study on 42 children with SDB. Anamnestic and general examination data were collected using the 'Sleep Clinical Record' (SCR) questionnaire during the first inspection and after three months of treatment with Streptococcus salivarius 24SMBc nasal spray. Quantitative variables were statistically compared. RESULTS After three months, the enrolled patients showed lower SCR scores than during the first inspection (6.0 vs 7.5 p < 0.000), with a significant reduction of nasal obstruction (p = 0.001) and oral breathing (p = 0.04), and a positive Brouillette Score (p = 0.001). The children and parents did not declare any adverse reactions during the three months of treatment. CONCLUSIONS This series confirms the effectiveness and safety of Streptococcus salivarius 24SMBc treatment in children affected by recurring upper respiratory tract infections, adenotonsillar hypertrophy, and sleep disordered breathing.
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Affiliation(s)
- Luisa Maria Bellussi
- Department of Medical-Surgical Sciences and Neurosciences, ENT Clinic University of Siena, Italy.
| | - Maria Pia Villa
- Pediatric Unit, Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Giulia Degiorgi
- Department of Medical-Surgical Sciences and Neurosciences, ENT Clinic University of Siena, Italy
| | | | - Melania Evangelisti
- Pediatric Unit, Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | | | - Marilisa Montesano
- Pediatric Unit, Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Desiderio Passali
- Department of Medical-Surgical Sciences and Neurosciences, ENT Clinic University of Siena, Italy
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Keefe KR, Byrne KJ, Levi JR. Treating pediatric post-tonsillectomy pain and nausea with complementary and alternative medicine. Laryngoscope 2018; 128:2625-2634. [PMID: 29729030 DOI: 10.1002/lary.27231] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/15/2018] [Accepted: 03/21/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Although tonsillectomy is a common and largely safe procedure, pain management in children remains a controversial topic. In addition to the challenge of choosing appropriate analgesia, there is often low parent and child adherence. This article presents a review, and evaluates the potential role, of a range of complementary and alternative therapies that may be sought out by parents. METHODS A literature review of complementary and alternative interventions performed using PubMed, Cochrane Library, and EMBASE, supplemented by searches from Google and hand searches of cross-references of selected articles, yielded 32 studies for qualitative analysis. RESULTS The studies included for analysis investigated a wide variety of alternative treatment modalities: acupuncture and related therapies, aromatherapy, homeopathy, honey, intravenous fluid, speech therapy, hyaluronic acid, behavioral therapies, ice/cold, hydrogen peroxide rinse, and chewing gum. CONCLUSION At this time, stronger conclusions cannot be made about the therapies investigated because there are many methodology limitations of the studies analyzed. However, our results suggest merit for these treatments as adjuvant therapies that can enhance analgesia and decrease requirements of controversial medications. Honey and acupuncture have the greatest amount of evidence for postoperative pain and nausea; however, all interventions examined were cost-effective and safe. We recommend against hydrogen peroxide rinses and chewing gum. Laryngoscope, 2625-2634, 2018.
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Affiliation(s)
| | - Kevin J Byrne
- Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Jessica R Levi
- Boston University School of Medicine, Boston, Massachusetts, U.S.A.,Boston Medical Center, Boston, Massachusetts, U.S.A
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Kayamori F, Bianchini EMG. Effects of orofacial myofunctional therapy on the symptoms and physiological parameters of sleep breathing disorders in adults: a systematic review. REVISTA CEFAC 2017. [DOI: 10.1590/1982-0216201719613317] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Recently, the orofacial myofunctional therapy (OMT) has appeared as a possible alternative treatment for obstructive sleep apnea (OSA). Systematic reviews are required to achieve scientific evidence, seeking to direct the decision on therapeutic issues. The aim of this study was to systematically review the literature about the OMT proposals in adults with OSA related to symptoms and physiological parameters. Data sources were Lilacs, MEDLINE, Pubmed, Cochrane and Scielo using the descriptors: obstructive sleep apnea; myofunctional therapy; oropharyngeal exercises; breathing exercises; upper airway exercises; speech therapy. Studies published from 2000 to 2017 that evaluated the treatment with isolated OMT in subjects with OSA were included, obligatorily with polysomnographic data, pre and post therapy. Eight studies, out of 124 articles, were eligible according to the criteria adopted. Two systematic reviews, one clinical trial, three randomized clinical trials, and two case reports were included. Six studies showed a decrease in the Apnea and Hypopnea Index (AHI), five studies showed improvement in the minimum SpO2, decrease in the Epworth Sleepiness Scale (ESS) and in snoring. OMT proposals refer to a three-month program changing the parameters related to partial reduction of AHI, ESS index, snoring, and partial increase of SpO2. There are few randomized studies.
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Guilleminault C, Huang YS. From oral facial dysfunction to dysmorphism and the onset of pediatric OSA. Sleep Med Rev 2017; 40:203-214. [PMID: 29103943 DOI: 10.1016/j.smrv.2017.06.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/21/2017] [Accepted: 06/26/2017] [Indexed: 01/01/2023]
Abstract
The upper airway is a collapsible tube, and its collapsibility increases during sleep. Extrinsic factors such as atypical craniofacial features may increase the risks of airway collapse. We review early development of oral-facial structures and the anatomical variants that may be present at birth and can impact nasal breathing. After birth, there is a continuous interaction between orofacial functions and growth of anatomic features. We review the dysfunctions identified to date that may impact orofacial development leading to sleep-disordered-breathing through changes in the orofacial growth. The identification of risk-factors, ultimately leading to full-blown obstructive sleep apnea, may allow early recognition of these factors and the development of treatments to eliminate early problems or at least decrease their impact.
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Affiliation(s)
- Christian Guilleminault
- Stanford University Sleep Medicine Division, CA, USA; Pediatric Sleep Laboratory Division of Child Psychiatry Chang Gung Memorial Hospital and Medical College, Linkou, Taiwan.
| | - Yu-Shu Huang
- Stanford University Sleep Medicine Division, CA, USA; Pediatric Sleep Laboratory Division of Child Psychiatry Chang Gung Memorial Hospital and Medical College, Linkou, Taiwan
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Chuang LC, Lian YC, Hervy-Auboiron M, Guilleminault C, Huang YS. Passive myofunctional therapy applied on children with obstructive sleep apnea: A 6-month follow-up. J Formos Med Assoc 2017; 116:536-541. [DOI: 10.1016/j.jfma.2016.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/07/2016] [Accepted: 08/29/2016] [Indexed: 10/20/2022] Open
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Boudewyns A, Abel F, Alexopoulos E, Evangelisti M, Kaditis A, Miano S, Villa MP, Verhulst SL. Adenotonsillectomy to treat obstructive sleep apnea: Is it enough? Pediatr Pulmonol 2017; 52:699-709. [PMID: 28052557 DOI: 10.1002/ppul.23641] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/07/2016] [Accepted: 11/03/2016] [Indexed: 01/01/2023]
Abstract
Although adenotonsillectomy is the first line treatment for children with obstructive sleep apnea syndrome (0SAS),1 improvement in objectively documented outcomes is often inadequate and a substantial number of children have residual disease. Early recognition and treatment of children with persistent OSAS is required to prevent long-term morbidity. The management of these children is frequently complex and a multidisciplinary approach is required as most of them have additional risk factors for OSAS and comorbidities. In this paper, we first provide an overview of children at risk for persistent disease following adenotonsillectomy. Thereafter, we discuss different diagnostic modalities to evaluate the sites of persistent upper airway obstruction and the currently available treatment options. Pediatr Pulmonol. 2017;52:699-709. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- A Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Belgium
| | - F Abel
- Department of Paediatric Respiratory and Sleep Medicine, Great Ormond Street Hospital for Children, London, United Kingdom
| | - E Alexopoulos
- Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece
| | - M Evangelisti
- University of Rome "La Sapienza" School of Medicine, Rome, Italy.,Regional Sleep Disorders Center, Sant' Andrea Hospital, Rome, Italy
| | - A Kaditis
- First Department of Paediatrics, Pediatric Pulmonology Unit, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - S Miano
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - M P Villa
- University of Rome "La Sapienza" School of Medicine, Rome, Italy.,Regional Sleep Disorders Center, Sant' Andrea Hospital, Rome, Italy
| | - S L Verhulst
- Department of Pediatric Pulmonology, Antwerp University Hospital, University of Antwerp, Belgium
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