Floppy closing door epiglottis treated successfully with an mhealth application based on myofunctional therapy: a case report

We introduce the first case reported to date of a floppy closing door epiglottis in an OSA (obstructive sleep apnea) patient treated successfully with an Mhealth smartphone application based on myofunctional therapy

Orofacial myofunctional rehabilitation and multidisciplinary management of obstructive sleep-disordered breathing

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Optimizing Mandibular Advancement Maneuvers during Sleep Endoscopy with a Titratable Positioner: DISE-SAM Protocol

Mandibular advancement devices (MAD) are an effective alternative treatment to CPAP. Different maneuvers were performed during drug sleep-induced endoscopy (DISE) to mimic the effect of MAD. Using the Selector Avance Mandibular (SAM) device, we aimed to identify MAD candidates during DISE using a titratable, reproducible, and measurable maneuver. This DISE-SAM protocol may help to find the relationship between the severity of the respiratory disorder and the degree of response and determine the advancement required to improve the collapsibility of the upper airway. Explorations were performed in 161 patients (132 males; 29 females) with a mean age of 46.81 (SD = 11.42) years, BMI of 27.90 (SD = 4.19) kg/m2, and a mean AHI of 26.51 (SD = 21.23). The results showed no relationship between severity and MAD recommendation. Furthermore, there was a weak positive relationship between the advancement required to obtain a response and the disease severity. Using the DISE-SAM protocol, the response and the range of mandibular protrusion were assessed, avoiding the interexaminer bias of the jaw thrust maneuver. We suggest prescribing MAD as a single, alternative, or multiple treatment approaches following the SAM recommendations in a personalized design

Consensus statement on the orofacial myofunctional assessment and therapy in patients with OSA: proposal of an international Delphi Method process

La rééducation myofonctionnelle orofaciale a été montrée efficace dans la prise en charge multidisciplinaire du syndrome d’apnées obstructives du sommeil chez l’enfant, l’adolescent et l’adulte, et elle est prescrite à plusieurs étapes de ces prises en charge. Cependant, compte tenu du manque d’homogénéité des protocoles de traitement et de mesures des résultats, du manque de recherches sur le type, la fréquence et la durée des exercices myofonctionnels et sur les phénotypes spécifiques qui peuvent en bénéficier, il apparait nécessaire de définir des recommandations de bonne pratique. Un consensus de recommandations Delphi consacré à l’évaluation et au traitement myofonctionnel orofacial pour les patients atteints de SAOS, a été mis en oeuvre à l’initiative de Marc Richard Moeller. Les deux premières étapes du consensus de recommandations Delphi sont achevées. La troisième étape, consacrée à l’élaboration du questionnaire aura lieu lors de la réunion conjointe de la World Sleep Society et de l’Academy of Applied Myofunctional Sciences, en mars 2022 à Rome. Les conclusions du consensus de recommandations Delphi seront publiées l’année suivante et largement diffusées.info:eu-repo/semantics/publishedVersio

Improving Adherence to Myofunctional Therapy in the Treatment of Sleep-Disordered Breathing

Myofunctional therapy (MT) is used to treat sleep-disordered breathing. However, MT has low adherence—only ~10% in most studies. We describe our experiences with MT delivered through a mobile health app named Airway Gym®, which is used by patients who have rejected continuous positive airway pressure and other therapies. We compared ear, nose, and throat examination findings, Friedman stage, tongue-tie presence, tongue strength measured using the Iowa oral performance instrument (IOPI), and full polysomnography before and after the 3 months of therapy. Participants were taught how to perform the exercises using the app at the start. Telemedicine allowed physicians to record adherence to and accuracy of the exercise performance. Fifty-four patients were enrolled; 35 (64.8%) were adherent and performed exercises for 15 min/day on five days/week. We found significant changes (p < 0.05) in the apnoea–hypopnoea index (AHI; 32.97 ± 1.8 to 21.9 ± 14.5 events/h); IOPI score (44.4 ± 11.08 to 49.66 ± 10.2); and minimum O2 saturation (80.91% ± 6.1% to 85.09% ± 5.3%). IOPI scores correlated significantly with AHI after the therapy (Pearson r = 0.4; p = 0.01). The 19 patients who did not adhere to the protocol showed no changes. MT based on telemedicine had good adherence, and its effect on AHI correlated with IOPI and improvement in tongue-tie

Rééducation myofonctionnelle orofaciale et syndrome d’apnées obstructives du sommeil : l’apport de la santé connectée

La rééducation myofonctionnelle orofaciale (RMOF) a été montrée efficace dans le traitement multidisciplinaire des syndromes d’apnées obstructives du sommeil (SAOS) de l’enfant, de l’adolescent et de l’adulte et elle est prescrite à plusieurs étapes de ces prises en charge. La santé connectée fait appel à l’utilisation de messages électroniques, à une surveillance à distance, à des plateformes de télémédecine du sommeil et à des applications de santé mobile. Les objets connectés aident au diagnostic du SAOS, ils permettent la télésurveillance des patients traités par pression positive continue et facilitent la prise en charge des comorbidités liées au SAOS. La première application conçue pour réaliser une RMOF chez des patients souffrant de SAOS, nommée Airway Gym®, a été conçue par O’Connor-Reina et al. en 2017. Elle permet au patient d’interagir directement avec le smartphone sans avoir besoin d’un autre appareil et elle vise à améliorer la tonicité des différents muscles impliqués dans la pathogenèse du SAOS. Un essai clinique randomisé a évalué les effets de l’application Airway Gym® chez des patients atteints de SAOS sévère, et montré des améliorations significatives de l’IAH, du score de l’échelle de somnolence d’Epworth, de la saturation minimale en O2, du score maximal de la langue IOPI et du score maximal des lèvres IOPI

A systematic review of smartphone applications and devices for obstructive sleep apnea

Objective: Sleep is fundamental for both health and wellness. The advent of “on a chip” and “smartphone” technologies have created an explosion of inexpensive, at-home applications and devices specifically addressing sleep health and sleep disordered breathing. Sleep-related smartphone Applications and devices are offering diagnosis, management, and treatment of a variety of sleep disorders, mainly obstructive sleep apnea. New technology requires both a learning curve and a review of reliability. Our objective was to evaluate which app have scientific publications as well as their potential to help in the diagnosis, management, and follow-up of sleep disordered breathing. Methods: We search for relevant sleep apnea related apps on both the Google Play Store and the Apple App Store. In addition, an exhaustive literature search was carried out in MEDLINE, EMBase, web of science and Scopus for works of apps or devices that have published in the scientific literature and have been used in a clinical setting for diagnosis or treatment of sleep disordered breathing performing a systematic review. Results: We found 10 smartphone apps that met the inclusion criteria. Conclusions: The development of these apps and devices has a great future, but today are not as accurate as other traditional options. This new technology offers accessible, inexpensive, and continuous at home data monitoring of obstructive sleep apnea, but still does not count with proper testing and their validation may be unreliable

Evaluation of the Muscle Strength of the Tongue with the Tongue Digital Spoon (TDS) in Patients with Obstructive Sleep Apnea

Myofunctional therapy (MT) is a recent treatment option for obstructive sleep apnea (OSA). The Iowa Oral Performance Instrument (IOPI) is a useful but expensive tool for measuring tongue strength in patients with OSA. We validated the Tongue Digital Spoon (TDS) to monitor tongue hypotonia in patients with OSA. Measurements with the IOPI and TDS were compared in patients with OSA before and after MT for tongue hypotonia. Baseline mean tongue strength measured with the IOPI in patients with moderate and severe OSA were 35.36 ± 9.05 and 33.83 ± 12.05, respectively, and that with the TDS were 168.55 ± 42.8 and 129.61 ± 53.7, respectively. After MT, mean tongue strength significantly improved: measured with the IOPI in patients with moderate and severe OSA were 53.85 ± 10.09 and 55.50 ± 9.64 (p = 0.8), and that with the TDS were 402.36 ± 52.92 and 380.28 ± 100.75 (p = 0.01), respectively. The correlation between the IOPI and TDS was high (r = 0.74; p = 0.01 pre-treatment, and r = 0.25; p = 0.05 post-treatment). The TDS is a useful tool for monitoring the efficacy of MT in patients with short-term OSA. Future randomized studies will determine the effectiveness of MT for the treatment of OSA

New mHealth application software based on myofunctional therapy applied to sleep-disordered breathing in non-compliant subjects

Abstract Background Myofunctional therapy (MT) is a therapeutic option with demonstrated efficacy for treating sleep-disordered breathing. We assessed the clinical application of a newly developed m-Health App, which aimed to allow patients with OSAHS (obstructive sleep apnea/hypopnea syndrome) to perform oropharyngeal exercises only by interacting with their smartphone without no other devices. Methods We offered to treat the OSAHS of 20 patients with the App for 90 sessions. Inclusion criteria were adult patients diagnosed with OSAHS who rejected, or could not tolerate or afford treatment for their OSAHS with other modalities. The App was used by 15 patients, while 5 were noncompliant and then were used as a control group. Polygraphy was performed at the beginning of the study, and after 90 sessions in the App group or after 3 months in the control group. Data for adherence to treatment, sex, body mass index (BMI), age, O2MIN (oxygen minimal saturation) and apnea–hypopnea index (AHI) were collected for both groups. Results 15 (75%) patients showed adherence to the treatment as measured as performing the exercises daily 5 days a week. In patients who performed the exercises, AHI decreased from 25.78 ± 12.6 to 14.1 ± 7,7 (p = 0.002), Epworth changed from 18,2 ± 1,98 to 14,2 ± 7,7(p = 0,002) and (O2MIN) changed from 84,87 ± 7.02 to 89,27 ± 3,77 (p = 0.0189). In the control group, there was no significant change. Conclusions To our knowledge, this is the first study reported where a mHealth App based on MT could be by itself a therapeutic option in selected patients with OSAHS

Tongue peak pressure: a tool to aid in the identification of obstruction sites in patients with obstructive sleep apnea/hypopnea syndrome

Purpose of this study was to evaluate whether tongue peak pressure measured using the Iowa Oral Performance Instrument is correlated with the topographic site of obstruction in patients with obstructive sleep apnea/hypopnea syndrome observed during drug-induced sleep endoscopy. Thirty-five consecutive adult patients (29 men, 6 women) were prospectively enrolled after having been diagnosed with severe obstructive sleep apnea/hypopnea syndrome by polysomnography. An apnea–hypopnea index > 30 was confirmed, and age, gender, and body mass index were recorded by Epworth Sleepiness Scale questionnaire, and a thorough evaluation of the upper airway by video-flexible endoscopy. Twenty healthy controls according to age and ex were chosen for IOPI measurements. After drug-induced sleep endoscopy, a topographic diagnosis was done using the VOTE classification. Tongue and lip peak pressures were both measured using the Iowa Oral Performance Instrument in all patients and in 20 healthy controls. Main outcomes and measures: the correlations between office findings, Iowa Oral Performance Instrument measures, and the VOTE tongue classification during drug-induced sleep endoscopy (T0, T1, T2) were then investigated. Results The average Iowa Oral Performance Instrument tongue and lip pressure were 44.02 ± 12.29 and 15.03 ± 3.71 kPa, respectively. The Iowa Oral Performance Instrument scores were both significantly lower than values in healthy controls (P < 0.001). The VOTE classification referring to the tongue position was T0 in 13 cases (37.1%), T1 in 12 cases (34.3%), and T2 in 10 cases (28.6%). A significant correlation was found between the Iowa Oral Performance Instrument tongue pressure and the T size during drug-induced sleep endoscopy (Kruskal–Wallis χ2 25.82; P ≤ 0.001). Conclusions In our experience, the Iowa Oral Performance Instrument is a useful tool for evaluating tongue collapse for the topographic diagnosis of patients with obstructive sleep apnea/hypopnea syndrome