New and unconventional treatments for obstructive sleep apnea

Conservative Treatment Using Chiropractic Care and Orofacial Myofunctional Therapy for Obstructive Sleep Apnea: A Case Report

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.

Non-surgical treatment of obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS), a pervasive disease, is closely associated with complications such as cardiovascular diseases, neurocognitive diseases, and metabolic syndromes. Continuous positive airway pressure (CPAP) is the standard treatment for OSAS, with low compliance due to multifarious factors. The two other modes of ventilation, bi-level positive airway pressure (BPAP) and autotitrating positive airway pressure (APAP), which were developed from CPAP, are slightly different from CPAP in specific groups, as well as the corresponding treatment effect and compliance. The compliance of traditional positional therapy is not high, but with the emergence of the neck-based position treatment device, its compliance and indications have changed. Although CPAP is superior to mandibular advancement device (MAD) in improving AHI, MAD seems to be comparable to CPAP in improving other indicators. Corticosteroids and leukotriene receptor antagonists are effective treatments for mild OSAS children. Whether corticosteroids can be used in other OSAS groups and their adjunctive functions to CPAP remains unclear. The combination of these two kinds of drugs appears to be more effective than single drug. Researches on transcutaneous electrical stimulation are still not enough. Its effectiveness and stimulation settings still need further study. This review summarized the various OSAS non-surgical treatments from indications, treatment outcomes, compliance, adverse reactions, and recent progress.

Effect of Laparoscopic Roux-en-Y Gastric Bypass Surgery on Obstructive Sleep Apnea in a Chinese Population with Obesity and T2DM

Background

Bariatric surgery has been reported to be an effective treatment for obstructive sleep apnea (OSA). However, this evidence was not enough for different populations. Thus, we conducted a follow-up study to evaluate the effect of bariatric surgery on OSA in a Chinese population with obesity and type 2 diabetes mellitus (T2DM).

Methods

From May 2011 to March 2014, 72 consecutive subjects with obesity and T2DM were recruited for this study. Before and at least 6 months after the laparoscopic Roux-en-Y gastric bypass (LYGB) surgery, all subjects were asked to undergo a polysomnography test. During the sleep center visit, anthropometric characteristic data, blood samples, and sleep questionnaires were collected.

Results

In total, 44 Chinese participants with OSA were included in the study. Compared with baseline data, the postoperative anthropometric characteristics, blood measurements, and sleep recording data, such as weight, apnea hypopnea index (AHI), and insulin resistance index, differed significantly (p < 0.001). The change in AHI was correlated significantly with preoperative weight (r = 0.298, p < 0.05), preoperative AHI (r = 0.729, p < 0.001), preoperative waist circumference (r = 0.307, p < 0.05), and preoperative insulin resistance (IR) index (r = −0.301, p < 0.05). Postoperative AHI was correlated significantly with age (r = 0.039, p = 0.039) and preoperative AHI (r = 0.445, p = 0.002), and the following prediction model was generated: log₁₀ (postoperative AHI) = 0.626 × log₁₀ (preoperative AHI) +0.010 × age −0.581.

Conclusions

Our findings indicate that LYGB could be an effective therapeutic intervention in the management of OSA for patients with both obesity and T2DM, and the preoperative AHI and age might be important factors that influence the effort of LYGB.

Electronic supplementary material

The online version of this article (doi:10.1007/s11695-014-1510-9) contains supplementary material, which is available to authorized users.

Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis

OBJECTIVE

To systematically review the literature for articles evaluating myofunctional therapy (MT) as treatment for obstructive sleep apnea (OSA) in children and adults and to perform a meta-analysis on the polysomnographic, snoring, and sleepiness data.

DATA SOURCES

Web of Science, Scopus, MEDLINE, and The Cochrane Library.

REVIEW METHODS

The searches were performed through June 18, 2014. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed.

RESULTS

Nine adult studies (120 patients) reported polysomnography, snoring, and/or sleepiness outcomes. The pre- and post-MT apneahypopnea indices (AHI) decreased from a mean ± standard deviation (M ± SD) of 24.5 ± 14.3/h to 12.3 ± 11.8/h, mean difference (MD) -14.26 [95% confidence interval (CI) -20.98, -7.54], P < 0.0001. Lowest oxygen saturations improved from 83.9 ± 6.0% to 86.6 ± 7.3%, MD 4.19 (95% CI 1.85, 6.54), P = 0.0005. Polysomnography snoring decreased from 14.05 ± 4.89% to 3.87 ± 4.12% of total sleep time, P < 0.001, and snoring decreased in all three studies reporting subjective outcomes. Epworth Sleepiness Scale decreased from 14.8 ± 3.5 to 8.2 ± 4.1. Two pediatric studies (25 patients) reported outcomes. In the first study of 14 children, the AHI decreased from 4.87 ± 3.0/h to 1.84 ± 3.2/h, P = 0.004. The second study evaluated children who were cured of OSA after adenotonsillectomy and palatal expansion, and found that 11 patients who continued MT remained cured (AHI 0.5 ± 0.4/h), whereas 13 controls had recurrent OSA (AHI 5.3 ± 1.5/h) after 4 y.

CONCLUSION

Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 50% in adults and 62% in children. Lowest oxygen saturations, snoring, and sleepiness outcomes improve in adults. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments.