Advertisement

Sleep and Breathing

, Volume 21, Issue 4, pp 1025–1032 | Cite as

Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing?

  • Maria Pia VillaEmail author
  • Melania Evangelisti
  • Susy Martella
  • Mario Barreto
  • Marco Del Pozzo
Pediatrics • Original Article

Abstract

Purpose

Data in the literature suggest that myofunctional therapy (MT) may be able to play a role in the treatment of children with sleep-disordered breathing (SDB). Our study investigated the effectiveness of MT in reducing respiratory symptoms in children with SDB by modifying tongue tone.

Methods

Polysomnographic recordings were performed at baseline to assess obstructive sleep apnea (OSA) severity in 54 children (mean age 7.1 ± 2.5 years, 29 male) with SDB. Patients were randomly assigned to either the MT or no-MT group. Myofunctional evaluation tests, an assessment of tongue strength, tongue peak pressure, and endurance using the Iowa Oral Performance Instrument (IOPI), and nocturnal pulse oximetry were performed before (T0) and after (T1) 2 months of treatment.

Results

MT reduced oral breathing (83.3 vs 16.6%, p < 0.0002) and lip hypotonia (78 vs 33.3%, p < 0.003), restored normal tongue resting position (5.6 vs 33.4%, p < 0.04), and significantly increased mean tongue strength (31.9 ± 10.8 vs 38.8 ± 8.3, p = 0.000), tongue peak pressure (34.2 ± 10.2 vs 38.1 ± 7.0, p = 0.000), and endurance (28.1 ± 8.9 vs 33.1 ± 8.7, p = 0.01) in children with SDB. Moreover, mean oxygen saturation increased (96.4 ± 0.6 vs 97.4 ± 0.7, p = 0.000) and the oxygen desaturation index decreased (5.9 ± 2.3 vs 3.6 ± 1.8, p = 0.001) after MT.

Conclusions

Oropharyngeal exercises appear to effectively modify tongue tone, reduce SDB symptoms and oral breathing, and increase oxygen saturation, and may thus play a role in the treatment of SDB.

Keywords

Children Obstructive sleep apnea Myofunctional therapy Oropharyngeal exercises 

Notes

Compliance with ethical standards

Funding source

There were no sources of funding or support for this research.

Conflict of interest

The authors declare that they have no conflict of interest. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.

None of the authors has any relevant financial activities outside the submitted manuscript (over the 3 years prior to submission).

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

This article does not contain any studies with animals performed by any of the authors.

References

  1. 1.
    Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S (2016) Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. EurRespir J 47(1):69–94CrossRefGoogle Scholar
  2. 2.
    Kheirandish-Gozal L, Bhattacharjee R, Gozal D (2010) Autonomic alterations and endothelial dysfunction in pediatric obstructive sleep apnea. SleepMed 11(7):714–720Google Scholar
  3. 3.
    Chang SJ, Chae KY (2010) Obstructive sleep apnea syndrome in children: epidemiology, pathophysiology, diagnosis and sequelae. Korean J Pediatr 53(10):863–871CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Villa MP, Castaldo R, Miano S, Paolino MC, Vitelli O, Tabarrini A, Mazzotta AR, Cecili M, Barreto M (2014) Adenotonsillectomy and orthodontic therapy in pediatric obstructive sleep apnea. SleepBreath 18(3):533–539Google Scholar
  5. 5.
    Kaditis A, Kheirandish-Gozal L, Gozal D (2012) Algorithm for the diagnosis and treatment of pediatric OSA: a proposal of two pediatric sleep centers. SleepMed 13(3):217–227Google Scholar
  6. 6.
    Harvold EP, Tomer BS, Vargervik K, Chierici G (1981) Primate experiments on oral respiration. Am J Orthod 79:359–372CrossRefPubMedGoogle Scholar
  7. 7.
    Vargervik K, Miller AJ, Chierici G, Harvold E, Tomer BS (1984) Morphologic response to changes in neuromuscular patterns experimentally induced by altered modes of respiration. Am J Orthod 85:115–124CrossRefPubMedGoogle Scholar
  8. 8.
    Huang YS, Guilleminault C (2013) Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences. Front Neurol 3:184CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Guilleminault C1, Huang YS, Monteyrol PJ, Sato R, Quo S, Lin CH (2013) Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Med 14(6):518–525CrossRefPubMedGoogle Scholar
  10. 10.
    Villa MP, Brasili L, Ferretti A, Vitelli O, Rabasco J, Mazzotta AR, Pietropaoli N, Martella S (2015) Oropharyngeal exercises to reduce symptoms of OSA after AT. Sleep Breath 19(1):281–289CrossRefPubMedGoogle Scholar
  11. 11.
    Villa MP, Paolino MC, Castaldo R, Vanacore N, Rizzoli A, Miano S, Del Pozzo M, Montesano M (2013) Sleep clinical record: an aid to rapid and accurate diagnosis of paediatric sleep disordered breathing. Eur Respir J 41(6):1355–1361CrossRefPubMedGoogle Scholar
  12. 12.
    Liistro G, Rombaux P, Belge C, Dury M, Aubert G, Rodenstein DO (2003) High Mallampati score and nasal obstruction are associated risk factors for obstructive sleep apnoea. Eur Respir J 21(2):248–252CrossRefPubMedGoogle Scholar
  13. 13.
    Brouilette R, Hanson D, David R, Klemka L, Szatkowski A, Fernbach S, Hunt C (1984) A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr 105(1):10–14CrossRefPubMedGoogle Scholar
  14. 14.
    Marzocchi GM CC (2000) Una scala di facile uso per la rilevazione dei comportamenti problematici dei bambini con Deficit di Attenzione e Iperattività. [A scale to indentify behavioural problems in ADHD children.]. Psicologia Clinica dello Sviluppo.43–64Google Scholar
  15. 15.
    Iber C, Ancoli-Israel S, Chesson AL Jr, Quan SF, for the American Academy of Sleep Medicine (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, WestchesterGoogle Scholar
  16. 16.
    Brouillette RT, Morielli A, Leimanis A, Waters KA, Luciano R, Ducharme FM (2000) Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatrics 105(2):405–412CrossRefPubMedGoogle Scholar
  17. 17.
    Chauvois A, Fournier M, Girardin F (1991) Rééducation des fonctions dans la thérapeutique orthodontique. Editions Sid, VanvesGoogle Scholar
  18. 18.
    Levrini A (1997) Terapia miofunzionale. Rieducazione neuromuscolare integrata. Masson S.p.A, MilanGoogle Scholar
  19. 19.
    Potter NL, Short R (2009) Maximal tongue strength in typically developing children and adolescents. Dysphagia 24(4):391–397CrossRefPubMedGoogle Scholar
  20. 20.
    Rappai M, Collop N, Kemp S, de Shazo R (2003) The nose and sleep-disordered breathing: what we know and what we do not know. Chest 124(6):2309–2323 ReviewCrossRefPubMedGoogle Scholar
  21. 21.
    Van Dyck C, Dekeyser A, Vantricht E, Manders E, Goeleven A, Fieuws S, Willems G (2016) The effect of orofacial myofunctional treatment in children with anterior open bite and tongue dysfunction: a pilot study. Eur J Orthod 38(3):227–234CrossRefPubMedGoogle Scholar
  22. 22.
    Peat JH (1968) A cephalometric study of tongue position. Am J Orthod 54:339–351CrossRefPubMedGoogle Scholar
  23. 23.
    Raymond JL (2000) A functional approach to the relationship between nursing and malocclusion. Rev Orthop Dento Faciale 34:379–402CrossRefGoogle Scholar
  24. 24.
    Guilleminault C, Huseni S, Lo L (2016) A frequent phenotype for paediatric sleep apnoea: short lingual frenulum. ERJ Open Res Jul 29;2(3)Google Scholar
  25. 25.
    Guilleminault C, Akhtar F (2015) Pediatric sleep-disordered-breathing: new evidence on its development. Sleep Med Rev 24:46–56CrossRefPubMedGoogle Scholar
  26. 26.
    Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, Kushida CA (2015) Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep 38(5):669–675CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Lima MS, Nader CM, Franco LP, Meira ZM, Capanema FD, Guimarães RE, Becker HM (2016) Pulmonary hypertension evaluation by Doppler echocardiogram in children and adolescents with mouth breathing syndrome. Braz J Otorhinolaryngol Jun 8. pii: S1808–8694(16)30107–0Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Maria Pia Villa
    • 1
    Email author
  • Melania Evangelisti
    • 1
  • Susy Martella
    • 1
  • Mario Barreto
    • 1
  • Marco Del Pozzo
    • 1
  1. 1.Pediatric Unit Sant’Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology“Sapienza” UniversityRomeItaly

Personalised recommendations