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Picinato-Pirola M, Lira ALE, Viana GR, Santos TLB, Corrêa CDC. Sleep habits and orofacial myofunctional self-assessment of children at risk for sleep breathing disorders. Codas 2023; 36:e20220187. [PMID: 38126423 PMCID: PMC10750857 DOI: 10.1590/2317-1782/20232022187pt] [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: 07/23/2022] [Accepted: 06/23/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To identify orofacial myofunctional complaints and sleep-disordered breathing and correlate them with sleep habits in childhood. METHODS The study included 71 parents/guardians of public school children aged 6 to 11 years. They answered a form with semi-structured medical history questions and the Nordic Orofacial Test-Screening - interview, the Pediatric Obstructive Sleep Apnea Screening Tool Questionnaire, and the Children's Sleep Habits Questionnaire - all of them in their Portuguese/Brazilian versions in an online format. Statistical analyses used Spearman's correlation, setting the significance level at 5%. RESULTS There were 29 female children (40.8%) and 42 male ones (59.2%), with a mean age of 8.52 years. The study found orofacial myofunctional complaints related to breathing functions (35.2%), chewing and swallowing (32.4%), and deleterious habits (33.8%). All children were at a low risk of sleep-disordered breathing. As for sleep habits, 23 children (32.39%) had a lower total score, whereas 48 children (67.61%) exceeded 41 points. CONCLUSION There was a correlation between the risk of sleep-disordered breathing in children with complaints of orofacial myofunctional disorders and poor sleep quality/habits.
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Affiliation(s)
| | - Amanda Lima e Lira
- Faculdade de Ceilândia, Universidade de Brasília - UnB - Brasília (DF), Brasil.
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Rodrigues R, Sassi FC, Silva APD, Andrade CRFD. Correlation between findings of the oral myofunctional clinical assessment, pressure and electromyographic activity of the tongue during swallowing in individuals with different orofacial myofunctional disorders. Codas 2023; 35:e20220053. [PMID: 37820097 DOI: 10.1590/2317-1782/20232022053pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 10/10/2022] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To correlate the findings regarding the myofunctional orofacial examination, tongue pressure and surface electromyography (sEMG) of deglutition in individuals with different orofacial myofunctional disorders. METHODS 44 patients (20 males and 24 females, aged between 17 and 63 years old) with different orofacial myofunctional changes were clinically assessed using the Expanded Protocol of Orofacial Myofunctional Evaluation with Scores (OMES-E). In addition, the range of mandibular movements and facial anthropometry were measured, along with the assessment of the tongue pressure (tip and dorsum) and of the electrical activity of the suprahyoid muscles during deglutition, using surface electromyography (sEMG). RESULTS The statistical analysis found weak correlations between tongue dorsum pressure values, suggesting that the greater the measurement of the lower third of the face, the lower the pressure of the tongue dorsum; the greater the measurement of the overlaps (vertical and horizontal), the higher the pressure of the tongue dorsum; the higher the score from the orofacial evaluation and orofacial functions assessment, the higher the pressure of the tongue dorsum; and the higher the pressure of the tongue dorsum, the higher the pressure of the tongue tip. CONCLUSION The present study results indicate that the orofacial myofunctional changes found in different groups of patients are more related to the maxillomandibular discrepancies than to the pathologies investigated herein.
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Affiliation(s)
- Robson Rodrigues
- Divisão de Fonoaudiologia, Hospital das Clínicas - HC, Faculdade de Medicina - FM, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Fernanda Chiarion Sassi
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina - FM, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Amanda Pagliotto da Silva
- Divisão de Fonoaudiologia, Hospital das Clínicas - HC, Faculdade de Medicina - FM, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Claudia Regina Furquim de Andrade
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina - FM, Universidade de São Paulo - USP - São Paulo (SP), Brasil
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Craniofacial Sleep Medicine: The Important Role of Dental Providers in Detecting and Treating Sleep Disordered Breathing in Children. CHILDREN 2022; 9:children9071057. [PMID: 35884041 PMCID: PMC9323037 DOI: 10.3390/children9071057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) is a clinical disorder within the spectrum of sleep-related breathing disorders (SRDB) which is used to describe abnormal breathing during sleep resulting in gas exchange abnormalities and/or sleep disruption. OSA is a highly prevalent disorder with associated sequelae across multiple physical domains, overlapping with other chronic diseases, affecting development in children as well as increased health care utilization. More precise and personalized approaches are required to treat the complex constellation of symptoms with its associated comorbidities since not all children are cured by surgery (removal of the adenoids and tonsils). Given that dentists manage the teeth throughout the lifespan and have an important understanding of the anatomy and physiology involved with the airway from a dental perspective, it seems reasonable that better understanding and management from their field will give the opportunity to provide better integrated and optimized outcomes for children affected by OSA. With the emergence of therapies such as mandibular advancement devices and maxillary expansion, etc., dentists can be involved in providing care for OSA along with sleep medicine doctors. Furthermore, the evolving role of myofunctional therapy may also be indicated as adjunctive therapy in the management of children with OSA. The objective of this article is to discuss the important role of dentists and the collaborative approach between dentists, allied dental professionals such as myofunctional therapists, and sleep medicine specialists for identifying and managing children with OSA. Prevention and anticipatory guidance will also be addressed.
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Gozal D, Ismail M, Brockmann PE. Alternatives to surgery in children with mild OSA. World J Otorhinolaryngol Head Neck Surg 2021; 7:228-235. [PMID: 34430830 PMCID: PMC8356096 DOI: 10.1016/j.wjorl.2021.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/17/2021] [Accepted: 03/18/2021] [Indexed: 12/01/2022] Open
Abstract
Precision medicine requires coordinated and integrated evidence-based combinatorial approaches so that diagnosis and treatment can be tailored to the individual patient. In this context, the treatment approach to mild obstructive sleep apnea (OSA) is fraught with substantial debate as to what is mild OSA, and as to what constitutes appropriate treatment. As such, it is necessary to first establish a proposed consensus of what criteria need to be employed to reach the diagnosis of mild OSA, and then examine the circumstances under which treatment is indicated, and if so, whether and when anti-inflammatory therapy (AIT), rapid maxillary expansion (RME), and/or myofunctional therapy (MFT) may be indicated.
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Affiliation(s)
- David Gozal
- Department of Child Health and Child Health Research Institute, and MU Women and Children's Hospital, University of Missouri School of Medicine, Columbia, MO, USA
| | - Mahmoud Ismail
- Department of Neurology and Sleep Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Pablo E Brockmann
- Department of Pediatric Cardiology and Pulmonology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Pediatric Sleep Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Guo SW, Dai CF, Yu L, Zhao XF. Can respiratory muscle training therapy effectively manage obstructive sleep apnea syndrome after stroke?: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20589. [PMID: 32541492 PMCID: PMC7302676 DOI: 10.1097/md.0000000000020589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study will explore the effectiveness and safety of respiratory muscle training therapy (RMTT) for the treatment of patients with obstructive sleep apnea syndrome (OSAS) after stroke. METHODS In this study, we will systematically and comprehensively search Cochrane Library, PubMed, EMBASE, WANGFANG, VIP, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure for relevant literature from their inception to March 1, 2020 without any limitations to language and publication status. We will consider any randomized controlled trials focusing on the effectiveness and safety of RMTT for the treatment of patients with OSAS after stroke. The study quality will be checked using Cochrane risk of bias tool, and statistical analysis will be performed utilizing RevMan 5.3 software. RESULTS This study will summarize and synthesize the current evidence of RMTT for the treatment of patients with OSAS following stroke. CONCLUSION The findings of this study will assess the present evidence for the benefits and harms of RMTT for treating OSAS after stroke, and will inform clinical practice and future research. PROSPERO REGISTRATION NUMBER PROSPERO CRD42020170355.
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Affiliation(s)
- Shu-wen Guo
- Department of Neurology-Neuroelectrophysiology, Cardio-Crebrovascular Disease Hospital of Meishan, Meishan, Sichuan
| | - Chang-fei Dai
- Department of Neurology, Xianyang Hospital of Yan’an University, Xianyang
| | - Liang Yu
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Xiong-fei Zhao
- Department of Neurology, Xianyang Hospital of Yan’an University, Xianyang
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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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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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Oropharyngeal Exercises for Treatment of Pediatric Obstructive Sleep-Disordered Breathing. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00136-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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