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Obstructive sleep apnea: focus on myofunctional therapy

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.

Source: https://www.ncbi.nlm.nih.gov/pubmed/30233265

Nonadherence to CPAP Associated With Increased 30-Day Hospital Readmissions

Effective CPAP therapy is associated with improved cardiovascular and pulmonary-related morbidity and mortality. Nonadherence to CPAP leads to worsened health outcomes, but it is unclear whether this translates into increased 30-day hospital readmissions. A recent study published in the Journal of Clinical Sleep Medicine (JCSM) showed that Nonadherence to CPAP is associated with increased 30-day all-cause and cardiovascular-cause readmission in patients with OSA. Thirty-day all-cause and cardiovascular-cause readmission rate was significantly higher in the nonadherent group, with an adjusted odds ratio (OR) of 3.52 and 2.31 respectively. This study suggests that ensuring CPAP adherence is crucial in addressing general and cardiovascular-related healthcare utilization and morbidity in patients with OSA.

Source: Truong KK, De Jardin R, Massoudi N, Hashemzadeh M, Jafari B. Nonadherence to CPAP associated with increased 30-day hospital readmissions. J Clin Sleep Med. 2018;14(2):183–189.