Changes in craniofacial and airway morphology as well as quality of life after passive myofunctional therapy in children with obstructive sleep apnea: a comparative cohort study
- 190 Downloads
Abstract
Purpose
To examine the craniofacial and airway morphology as well as the quality of life before and after passive myofunctional therapy (PMFT) for 1 year in children with obstructive sleep apnea (OSA).
Methods
Forty children with OSA wearing an oral device nightly (treatment group) and seventeen without the device (control group) were followed up for 1 year. Lateral cephalometric radiography, polysomnography (without participants wearing the oral device), and quality of life survey (OSA-18) were performed before and after the study period.
Results
The apnea-hypopnea index (AHI) during sleep, REM AHI, hypopnea count, and desaturation count in the treatment group dropped significantly, compared with the control group. The craniofacial linear measurements increased significantly in both groups, while the length of mandible (Co-Gn) and anterior facial height (N-Me) became significantly larger in the treatment group. For the airway morphology, the intergroup comparison showed that OPha-Ophp (distance between anterior and posterior sides of oropharynx) increased significantly in the treatment group. For quality of life, the intergroup comparison found statistically significant improvements in the following in the treatment group, based on the OSA-18 survey: loud snoring, dysphagia, mood swings, discipline problems, difficulty awakening, total score for the emotional distress portion, and total survey score.
Conclusions
Preliminary evidence is substantiated for the benefits of 1-year PMFT using an oral device with a built-in tongue bead, including improvements in nasal breathing during sleep, mandible linear growth (Co-Gn and N-Me), airway morphology (OPha-Ophp), and patients’ quality of life.
Keywords
Pediatric obstructive sleep apnea syndrome Passive myofunctional therapy Oral appliance Craniofacial morphology Airway morphologyNotes
Funding
This study was supported by the Chang Gung Memorial Hospital (CMRPG3G1951 and CMRPG3H1591; Grant Recipient: Li-Chuan Chuang). The data of the study were first presented at the 5th International Pediatric Sleep Association Congress, Paris, April, 2018.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board of the Human Investigation Committee of Chang Gung Memorial Hospital and Chang Gung University (IRB 104-9308A3), as well as the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent from the legal guardian of each participant was obtained prior to the investigation.
References
- 1.Capua M, Ahmadi N, Shapiro C (2009) Overview of obstructive sleep apnea in children: exploring the role of dentists in diagnosis and treatment. J Can Dent Assoc 75(4):285–289PubMedGoogle Scholar
- 2.Bahammam A (2011) Obstructive sleep apnea: from simple upper airway obstruction to systemic inflammation. Ann Saudi Med 31(1):1–2CrossRefGoogle Scholar
- 3.Lal C, Strange C, Bachman D (2012) Neurocognitive impairment in obstructive sleep apnea. Chest. 141(6):1601–1610CrossRefGoogle Scholar
- 4.Katz ES, D’Ambrosio CM (2008) Pathophysiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc 5(2):253–262CrossRefGoogle Scholar
- 5.Huang YS, Guilleminault C (2013) Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences. Front Neurol 3(184):1–7Google Scholar
- 6.Harvold EP, Tomer BS, Vargervik K, Chierici G (1981) Primate experiments on oral respiration. Am J Orthod 79(4):359–372CrossRefGoogle Scholar
- 7.Miller AJ, Vargervik K, Chierici G (1984) Experimentally induced neuromuscular changes during and after nasal airway obstruction. Am J Orthod 85(5):385–392CrossRefGoogle Scholar
- 8.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(2):115–124CrossRefGoogle Scholar
- 9.Rubin RM (1987) Effects of nasal airway obstruction on facial growth. Ear Nose Throat J 66(5):212–219PubMedGoogle Scholar
- 10.Vargervik K, Harvold EP (1987) Experiments on the interaction between orofacial function and morphology. Ear Nose Throat J. 66(5):201–208PubMedGoogle Scholar
- 11.Katyal V, Pamula Y, Martin AJ, Daynes CN, Kennedy JD, Sampson WJ (2013) Craniofacial and upper airway morphology in pediatric sleep-disordered breathing: systematic review and meta-analysis. Am J Orthod Dentofac Orthop 143(1):20–30CrossRefGoogle Scholar
- 12.Flores-Mir C, Korayem M, Heo G, Witmans M, Major MP, Major PW (2013) Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome: a systematic review and meta-analysis. J Am Dent Assoc 144(3):269–277CrossRefGoogle Scholar
- 13.Huang YS, Guilleminault C, Lee LA, Lin CH, Hwang FM (2014) Treatment outcomes of adenotonsillectomy for children with obstructive sleep apnea: a prospective longitudinal study. Sleep. 37(1):71–76CrossRefGoogle Scholar
- 14.Pirelli P, Saponara M, Guilleminault C (2004) Rapid maxillary expansion in children with obstructive sleep apnea syndrome. Sleep. 27(4):761–766CrossRefGoogle Scholar
- 15.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):669–675CrossRefGoogle Scholar
- 16.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):281–289CrossRefGoogle Scholar
- 17.Huang YS, Chuang LC, Hervy-Auboiron M, Paiva P, Lin CH, Guilleminault C (2019) Neutral supporting mandibular advancement device with tongue bead for passive myofunctional therapy: a long term follow-up study. Sleep Med 60:69–74. https://doi.org/10.1016/j.sleep.2018.09.013 CrossRefPubMedGoogle Scholar
- 18.Chuang LC, Lian YC, Hervy-Auboiron M, Guilleminault C, Huang YS (2017) Passive myofunctional therapy applied on children with obstructive sleep apnea: a 6-month follow-up. J Formos Med Assoc 116(7):536–541CrossRefGoogle Scholar
- 19.Lian YC, Huang YS, Guilleminault C, Chen KT, Hervy-Auboiron M, Chuang LC, Tsai AI (2017) The preliminary results of the differences in craniofacial and airway morphology between preterm and full-term children with obstructive sleep apnea. J Dent Sci 12(3):253–260CrossRefGoogle Scholar
- 20.Villa MP, Bernkopf E, Pagani J et al (2002) Randomized controlled study of an oral jaw- positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion. Am J Respir Crit Care Med 165(1):123–127CrossRefGoogle Scholar
- 21.Fan Y C (1995) A study of radiographic cephalometric analysis and Taiwanese standards [thesis]. Taipei: National Taiwan UniversityGoogle Scholar
- 22.Perez CV, de Leeuw R, Okeson JP, Carlson CR, Li HF, Bush HM, Falace DA (2013) The incidence and prevalence of temporomandibular disorders and posterior open bite in patients receiving mandibular advancement device therapy for obstructive sleep apnea. Sleep Breath 17(1):323–332CrossRefGoogle Scholar
- 23.De Almeida FR, Lowe AA, Tsuiki S et al (2005) Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome. J Clin Sleep Med 1(2):143–152PubMedGoogle Scholar
- 24.Chen H, Lowe AA, de Almeida FR, Fleetham JA, Wang JA (2008) Three-dimensional computer assisted study model analysis of long-term oral-appliance wear. Part 2. Side effects of oral appliances in obstructive sleep apnea patients. Am J Orthod Dentofac Orthop 134(3):408–417CrossRefGoogle Scholar
- 25.Ngiam J, Balasubramaniam R, Darendeliler MA (2013) Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea. Aust Dent J 58(4):408–419CrossRefGoogle Scholar
- 26.Arens R, Marcus CL (2004) Pathophysiology of upper airway obstruction: a developmental perspective. Sleep. 27(5):997–1019CrossRefGoogle Scholar
- 27.Arens R, McDonough JM, Corbin AM et al (2003) Upper airway size analysis by magnetic resonance imaging of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 167(1):65–70CrossRefGoogle Scholar
- 28.Arens R, McDonough JM, Costarino AT et al (2001) Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 164(4):698–703CrossRefGoogle Scholar
- 29.Huon LK, Liu SY, Shih TT et al (2016) Dynamic upper airway collapse observed from sleep MRI: BMI-matched severe and mild OSA patients. Eur Arch Otorhinolaryngol 273(11):4021–4026CrossRefGoogle Scholar