Orofacial Myofunctional Therapy for Obstructive Sleep Apnea Syndrome in children

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Authors (including presenting author) :
Chan MPY(1), Fung BKY(1), Leung RWC(1), Chan YY(1), Lam KY(1), Lau MY(2), Leung SY(2), Li CM(1), Kwok KL(2)
Affiliation :
Physiotherapy Department(1), Department of Paediatrics(2), Kwong Wah Hospital, Hong Kong
Introduction :
Traditional management of obstructive sleep apnea syndrome (OSAS) includes life style modification, non-invasive ventilation such as Continuous Positive Airway Pressure (CPAP), surgery e.g. tonsillectomy, and mandibular advancement splint. Orofacial myofunctional therapy (OMT) improves proprioception, mobility and tone of oral facial muscles and neck muscles. Some studies demonstrated that OMT may be an effective adjunct therapy in improving OSAS in adults, however the evidence of OMT in treating children with OSAS is still limited.
Objectives :
To investigate the effectiveness of 12 week-OMT exercise program in children with OSAS in Hong Kong
Methodology :
It was a retrospective study to investigate the effectiveness of 12 week-OMT exercise program. Children with OSAS were referred for OMT. OMT exercises include training of the tongue muscles, cheek muscles, muscles around the lips and mouth, and postural muscles. Outcome measure included OSA-18, Sleep Related Breathing Disorder (SRBD), Modified Epworth Sleepiness Scales (mESS), tongue strength, tongue endurance and Nordic Orofacial Test – Screening (NOT-S). The tongue strength and tongue endurance were measured by the Iowa Oral Performance Instrument (IOPI). All outcome measures were captured at the beginning of the first session and immediate after the program.
Result & Outcome :
Thirty-eight children (median age: 11.7) had completed the program. Significant improvements were shown in quality of life: SRBD score decreased from 8.0 to 4.0 (p< 0.001) and OSA-18 improved from 56.0 to 41.5 (p< 0.001). mESS and NOT-s total score improved from 7.0 to 4.0 (p< 0.001) and from 3.0 to 2.0 (p< 0.001) respectively. Both tongue strength and tongue endurance increased from 38.0 to 49.0kPa (p< 0.001) and from 5 to 9s (p< 0.001) respectively. There were 84% of children with mouth breathing while awake before the OMT training then decreased to 39% after the training. There were 45% of children with drooling problem and decreased to 5% after the training. OMT exercise program demonstrate a positive effect in improving symptoms and quality of life of children with OSAS in Hong Kong.

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