Obstructive sleep apnea: focus on myofunctional therapy

Cláudia Maria de Felício,1,2 Franciele Voltarelli da Silva Dias,1,2 Luciana Vitaliano Voi Trawitzki1,2 1Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; 2Craniofacial Research Support Center, University of São Paulo (USP), Ribeirão Preto, Brazil 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. Keywords: sleep-disordered breathing, myofunctional therapy, oropharyngeal exercises, speech therapy, oral motor exercise

Mastigação e atividade eletromiográfica em crianças com mordida cruzada posterior Mastication and electromyographic activity in children with posterior crossbite

OBJETIVO: investigar a preferência mastigatória e o comportamento dos músculos mastigatórios, em crianças de 6 a 9 anos, com mordida cruzada posterior. MÉTODOS: 30 crianças foram selecionadas num serviço de Ortodontia de uma universidade pública. Após a concordância na participação no trabalho, foi realizada entrevista com a criança e seu responsável, para investigação de disfunção temporomandibular; análise da preferência mastigatória, por meio de registros em vídeo e avaliação eletromiográfica (EMG) dos músculos masseter e temporal anterior, durante a mastigação solicitada, direita e esquerda, de uma goma de marcar. RESULTADOS: houve diferença significante na atividade EMG dos músculos masseter e temporal anterior entre os lados de trabalho e balanceio, porém não houve diferença estatística quando foram comparadas as atividades EMG entre os lados de mordida cruzada e não cruzada, tampouco entre os lados de preferência e não preferência mastigatória. CONCLUSÃO: na amostra estudada não se verificou assimetria funcional muscular estabelecida.<br>PURPOSE: to investigate the masticatory preference and the behavior of masticatory muscles, in children between6 to 9-year old, with posterior crossbite. METHODS: 30 children were selected from the Orthodontical service of a public university. After consenting to take part in the study, there was an interview with the children and the parent, in order to investigate temporomandibular disorders; masticatory was analyzed through video recording and electromyographic (EMG) evaluation of the masseter and anterior temporal, during the solicited mastication, on right and left, using chewing gum. RESULTS: there was a significant difference in the EMG activity of the masseter and temporal between work and balance sides, however there was no statistical differences in the comparison between crossbite side and no crossbite side, but neither between preference side and non the preference side. CONCLUSION: in the studied population there was no functional muscular asymmetry established

Estudo eletromiográfico do músculo masseter durante o apertamento dentário e mastigação habitual em adultos com oclusão dentária normal Electromyographic study of the masseter muscle during maximal voluntary clenching and habitual chewing in adults with normal occlusion

OBJETIVO: Analisar a diferença entre os lados na atividade eletromiográfica do masseter em indivíduos adultos com oclusão dentária normal. MÉTODOS: Foram avaliados 30 indivíduos saudáveis entre 21 e 30 anos e realizou-se eletromiografia de superfície nos músculos masseteres direito e esquerdo, durante apertamento em máxima intercuspidação e mastigação habitual com uva passa. Foram computados os valores médios dos três apertamentos dentários e dos 15 segundos da mastigação habitual para cada indivíduo. Foram considerados para a análise: o lado de maior valor e o de menor valor eletromiográfico. RESULTADOS: Durante o apertamento dentário, a diferença média entre os dois lados foi de 20,0 microvolts (&#956;V) com intervalo de confiança (95%) entre 14,0 e 26,0 &#956;V e durante a mastigação habitual, a diferença média entre os dois lados foi de 10,3 &#956;V com intervalo de confiança (95%) entre 6,7 e 13,8 &#956;V. CONCLUSÃO: Houve diferença estatisticamente significante entre os lados, com relação entre eles de 24% para o apertamento dentário e de 27% para a mastigação habitual, em indiv duos adultos saudáveis.<br>PURPOSE: To analyze the difference between both sides of the face during the electromyographic activity of the masseter muscle in adults with normal occlusion. METHODS: Thirty healthy individuals with ages ranging from 21 to 30 years old were selected. Surface electromyography was performed on right and left masseter muscles during maximal voluntary clenching and habitual chewing with raisins. The mean values of three teeth clenching and fifteen seconds of habitual chewing were calculated for each subject. The analysis considered the sides with higher and lower electromyographic activity. RESULTS: During maximal voluntary clenching, the mean difference between sides was 20.0 microvolts (&#956;V), with confidence interval (95%) between 14.0 and 26.0 &#956;V. During habitual chewing, the mean difference between sides was 10.3 &#956;V, with confidence interval (95%) between 6.7 and 13.8 &#956;V. CONCLUSION: There was a statistically significant difference between both sides of the face in healthy adult subjects, with a relation between sides of 24% for maximal voluntary clenching and 27% during habitual chewing