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Orofacial Myofunctional Therapy

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The Role of Epiglottis in Obstructive Sleep Apnea

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Abstract

Orofacial myofunctional therapy (OMT) comprises the reeducation of the muscles, functions, and rest postures of the orofacial complex, which includes the lips, tongue, cheeks, and mandible, and is involved in the actions of sucking, chewing, swallowing, speech articulation, and more. OMT has been used as a clinical solution for several decades worldwide and its success has been documented. OMT can be used to treat orofacial dysfunctions in patients of all ages and those with a wide range of disorders and comorbidities. The effectiveness of this therapy in treating sleep-disordered breathing is limited by the lack of solid scientific evidence. We discuss our limited experience using OMT in patients with epiglottic collapse. We consider OMT can be useful in some selected cases of epiglottic collapse where all other therapies are not available.

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References

  1. Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med. 2013;188(8):996–1004. https://doi.org/10.1164/rccm.201303-0448OC.

    Article  PubMed Central  Google Scholar 

  2. White DP. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med. 2005;172(11):1363–70. https://doi.org/10.1164/rccm.200412-1631SO. Epub 2005 Aug 11.

    Article  PubMed  Google Scholar 

  3. Remmers JE, deGroot WJ, Sauerland EK, Anch AM. Pathogenesis of upper airway occlusion during sleep. J Appl Physiol Respir Environ Exerc Physiol. 1978;44(6):931–8. https://doi.org/10.1152/jappl.1978.44.6.931.

    Article  CAS  PubMed  Google Scholar 

  4. Remmers JE, Anch AM, deGroot WJ, Baker JP Jr, Sauerland EK. Oropharyngeal muscle tone in obstructive sleep apnea before and after strychnine. Sleep. 1980;3(3–4):447–53. https://doi.org/10.1093/sleep/3.3-4.447.

    Article  CAS  PubMed  Google Scholar 

  5. Isoni S, Feroah TR, Hajduk EA, Morrison DL, Launois SH, Issa FG, Whitelaw WA, Remmers JE. Anatomy of the pharyngeal airway in sleep apneics: separating anatomic factors from neuromuscular factors. Sleep. 1993;16(8 Suppl):S80–4. https://doi.org/10.1093/sleep/16.suppl_8.s80.

    Article  CAS  PubMed  Google Scholar 

  6. Malhotra A, Fogel RB, Edwards JK, Shea SA, White DP. Local mechanisms drive genioglossus activation in obstructive sleep apnea. Am J Respir Crit Care Med. 2000;161(5):1746–9. https://doi.org/10.1164/ajrccm.161.5.9907109.

    Article  CAS  PubMed  Google Scholar 

  7. Sériès F, Côté C, Simoneau JA, Gélinas Y, St Pierre S, Leclerc J, Ferland R, Marc I. Physiologic, metabolic, and muscle fiber type characteristics of musculus uvulae in sleep apnea hypopnea syndrome and in snorers. J Clin Invest. 1995;95(1):20–5. https://doi.org/10.1172/JCI117640.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Guilleminault C, Huang YS, Quo S. Apraxia in children and adults with obstructive sleep apnea syndrome. Sleep. 2019;42(12):zsz168. https://doi.org/10.1093/sleep/zsz168.

    Article  PubMed  Google Scholar 

  9. Garliner D. Myofunctional therapy. Gen Dent. 1976;24(1):30–40.

    CAS  Google Scholar 

  10. Amat P, O’Connor-Reina C, Plaza G. Rééducation myofonctionnelle _ orofaciale et syndrome d’apnées obstructives du sommeil: l’apport de la santé connectée. Revue d’Orthopédie Dento Faciale. 2021;55:457–76.

    Article  Google Scholar 

  11. Mario Diaz S, Ana Salazar C, Felipe Bravo G, Ocampo-Garcés A. Tratamiento del síndrome de apneas e hipopneas obstructivas del sueño con terapia miofuncional orofaríngea: Experiencia en hospital público de Chile. Rev Otorrinolaringol Cir Cabeza Cuello. 2019;79:395–403.

    Article  Google Scholar 

  12. Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009;179(10):962–6. https://doi.org/10.1164/rccm.200806-981OC.

    Article  PubMed  Google Scholar 

  13. Rodríguez-Alcalá L, Martínez JM, Baptista P, Ríos Fernández R, Javier Gómez F, Parejo Santaella J, Plaza G. Sensorimotor tongue evaluation and rehabilitation in patients with sleep-disordered breathing: a novel approach. J Oral Rehabil. 2021;48(12):1363–72. https://doi.org/10.1111/joor.13247.

    Article  PubMed  Google Scholar 

  14. Hsu B, Emperumal CP, Grbach VX, Padilla M, Enciso R. Effects of respiratory muscle therapy on obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med. 2020;16(5):785–801. https://doi.org/10.5664/jcsm.8318.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Meghpara S, Chohan M, Bandyopadhyay A, Kozlowski C, Casinas J, Kushida C, Camacho M. Myofunctional therapy for OSA: a meta-analysis. Expert Rev Respir Med. 2021;22:1–7. https://doi.org/10.1080/17476348.2021.2001332.

    Article  CAS  Google Scholar 

  16. Ieto V, Kayamori F, Montes MI, Hirata RP, Gregório MG, Alencar AM, Drager LF, Genta PR, Lorenzi-Filho G. Effects of oropharyngeal exercises on snoring: a randomized trial. Chest. 2015;148(3):683–91. https://doi.org/10.1378/chest.14-2953.

    Article  Google Scholar 

  17. Diaféria G, Santos-Silva R, Truksinas E, Haddad FLM, Santos R, Bommarito S, Gregório LC, Tufik S, Bittencourt L. Myofunctional therapy improves adherence to continuous positive airway pressure treatment. Sleep Breath. 2017;21(2):387–95. https://doi.org/10.1007/s11325-016-1429-6.

    Article  PubMed  Google Scholar 

  18. Kuo YC, Song TT, Bernard JR, Liao YH. Short-term expiratory muscle strength training attenuates sleep apnea and improves sleep quality in patients with obstructive sleep apnea. Respir Physiol Neurobiol. 2017;243:86–91. https://doi.org/10.1016/j.resp.2017.05.007.

    Article  PubMed  Google Scholar 

  19. Villa MP, Evangelisti M, Martella S, Barreto M, Del Pozzo M. Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep Breath. 2017;21(4):1025–32. https://doi.org/10.1007/s11325-017-1489-2.

    Article  PubMed  Google Scholar 

  20. Carrasco-Llatas M, O'Connor-Reina C, Calvo-HenrĂ­quez C. The role of Myofunctional therapy in treating sleep-disordered breathing: a state-of-the-art review. Int J Environ Res Public Health. 2021;18(14):7291. https://doi.org/10.3390/ijerph18147291.

    Article  PubMed Central  Google Scholar 

  21. Rueda JR, Mugueta-Aguinaga I, VilarĂł J, Rueda-Etxebarria M. Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database Syst Rev. 2020;11(11):CD013449. https://doi.org/10.1002/14651858.CD013449.pub2.

    Article  PubMed  Google Scholar 

  22. O'Connor-Reina C, Plaza G, Garcia-Iriarte MT, Ignacio-Garcia JM, Baptista P, Casado-Morente JC, De Vicente E. Tongue peak pressure: a tool to aid in the identification of obstruction sites in patients with obstructive sleep apnea/hypopnea syndrome. Sleep Breath. 2020;24(1):281–6. https://doi.org/10.1007/s11325-019-01952-x.

    Article  PubMed  Google Scholar 

  23. Suzuki M, Okamoto T, Akagi Y, Matsui K, Sekiguchi H, Satoya N, Inoue Y, Tatsuta A, Hagiwara N. Efficacy of oral myofunctional therapy in middle-aged to elderly patients with obstructive sleep apnoea treated with continuous positive airway pressure. J Oral Rehabil. 2021;48(2):176–82. https://doi.org/10.1111/joor.13119.

    Article  PubMed  Google Scholar 

  24. Rodríguez-Alcalá L, Martín-Lagos Martínez JO, Connor-Reina C, Plaza G. Assessment of muscular tone of the tongue using a digital measure spoon in a healthy population: a pilot study. PLoS One. 2021;16(2):e0245901. https://doi.org/10.1371/journal.pone.0245901.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Youmans SR, Stierwalt JA. Measures of tongue function related to normal swallowing. Dysphagia. 2006;21(2):102–11. https://doi.org/10.1007/s00455-006-9013-z.

    Article  PubMed  Google Scholar 

  26. Clark HM, Solomon NP. Age and sex differences in orofacial strength. Dysphagia. 2012 Mar;27(1):2–9. https://doi.org/10.1007/s00455-011-9328-2.

    Article  PubMed  Google Scholar 

  27. Clark HM, O'Brien K, Calleja A, Corrie SN. Effects of directional exercise on lingual strength. J Speech Lang Hear Res. 2009;52(4):1034–47. https://doi.org/10.1044/1092-4388(2009/08-0062).

    Article  Google Scholar 

  28. IOPI Medical. Qualitative guidelines for interpreting tongue elevation strength (Pmax). 2021; https://iopimedical.com/normal-values/. Accessed 10 Nov 2021.

  29. Randerath WJ, Galetke W, Domanski U, Weitkunat R, Ruhle KH. Tongue-muscle training by intraoral electrical neurostimulation in patients with obstructive sleep apnea. Sleep. 2004;27(2):254–9. https://doi.org/10.1093/sleep/27.2.254.

    Article  PubMed  Google Scholar 

  30. O’Connor Reina C, Plaza G, Ignacio-Garcia JM, Baptista P, Garcia Iriarte MT, Casado JC, et al. New mHealth application software based on myofunctional therapy applied to sleep-disordered breathing in non-compliant subjects. Sleep Sci Pract. 2020;4, 3:1. https://doi.org/10.1186/s41606-019-0040-8.

    Article  Google Scholar 

  31. Chuang LC, Hwang YJ, Lian YC, Hervy-Auboiron M, Pirelli P, Huang YS, Guilleminault C. 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. Sleep Breath. 2019;23(4):1359–69. https://doi.org/10.1007/s11325-019-01929-w.

    Article  PubMed  Google Scholar 

  32. Shamim-Uzzaman QA, Bae CJ, Ehsan Z, Setty AR, Devine M, Dhankikar S, Donskoy I, Fields B, Hearn H, Hwang D, Jain V, Kelley D, Kirsch DB, Martin W, Troester M, Trotti LM, Won CH, Epstein LJ. The use of telemedicine for the diagnosis and treatment of sleep disorders: an American Academy of sleep medicine update. J Clin Sleep Med. 2021;17(5):1103–7. https://doi.org/10.5664/jcsm.9194.

    Article  PubMed  PubMed Central  Google Scholar 

  33. O’Connor Reina C, García Iriarte MT, Casado-Morente JC, Plaza Mayor G, Baptista PM, Vicente GE. New app “apnea bye” increases adherence in myofunctional therapy to treat sleep disordered breathing. Otolaryngol Neck Surg. 2018;159(1_suppl):P326–7.

    Google Scholar 

  34. O'Connor Reina C, Plaza Mayor G, Ignacio-Garcia JM, Baptista Jardin P, Garcia-Iriarte MT, Casado-Morente JC. Floppy closing door epiglottis treated successfully with an Mhealth application based on Myofunctional therapy: a case report. Case Rep Otolaryngol. 2019;2019:4157898. https://doi.org/10.1155/2019/4157898.

    Article  PubMed Central  Google Scholar 

  35. O'Connor-Reina C, Ignacio Garcia JM, Rodriguez Ruiz E, Morillo Dominguez MDC, Ignacio Barrios V, Baptista Jardin P, Casado Morente JC, Garcia Iriarte MT, Plaza G. Myofunctional therapy app for severe apnea-hypopnea sleep obstructive syndrome: pilot randomized controlled trial. JMIR Mhealth Uhealth. 2020;8(11):e23123. https://doi.org/10.2196/23123.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Strollo PJ Jr, Gillespie MB, Soose RJ, Maurer JT, de Vries N, Cornelius J, Hanson RD, Padhya TA, Steward DL, Woodson BT, Verbraecken J, Vanderveken OM, Goetting MG, Feldman N, Chabolle F, Badr MS, Randerath W, Strohl KP, Stimulation Therapy for Apnea Reduction (STAR) Trial Group. Upper airway stimulation for obstructive sleep apnea: durability of the treatment effect at 18 months. Sleep. 2015;38(10):1593–8. https://doi.org/10.5665/sleep.5054.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Mason RM, Franklin H. Orofacial myofunctional disorders and otolaryngologists. Otolaryngol (Sunnyvale). 2010;4:e110. https://doi.org/10.4172/2161-119X.1000e110.

    Article  Google Scholar 

  38. Guilleminault C, Huseni S, Lo L. A frequent phenotype for paediatric sleep apnoea: short lingual frenulum. ERJ Open Res. 2016;2(3):00043–2016. https://doi.org/10.1183/23120541.00043-2016.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Yuen HM, Au CT, Chu WCW, Li AM, Chan KC. Reduced tongue mobility: an unrecognised risk factor of childhood obstructive sleep Apnoea. Sleep. 2021;45:zsab217. https://doi.org/10.1093/sleep/zsab217.

    Article  Google Scholar 

  40. de Felício CM, Medeiros AP, de Oliveira MM. Validity of the 'protocol of oro-facial myofunctional evaluation with scores' for young and adult subjects. J Oral Rehabil. 2012;39(10):744–53. https://doi.org/10.1111/j.1365-2842.2012.02336.x.

    Article  PubMed  Google Scholar 

  41. Borrmann PF, O'Connor-Reina C, Ignacio JM, Rodriguez Ruiz E, Rodriguez Alcala L, Dzembrovsky F, Baptista P, Garcia Iriarte MT, Casado Alba C, Plaza G. Muscular assessment in patients with severe obstructive sleep apnea syndrome: protocol for a case-control study. JMIR Res Protoc. 2021;10(8):e30500. https://doi.org/10.2196/30500.

    Article  PubMed Central  Google Scholar 

  42. Kuo IC, Hsin LJ, Lee LA, Fang TJ, Tsai MS, Lee YC, Shen SC, Li HY. Prediction of Epiglottic collapse in obstructive sleep apnea patients: epiglottic length. Nat Sci Sleep. 2021;13:1985–92. https://doi.org/10.2147/NSS.S336019.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Kim HY, Sung CM, Jang HB, Kim HC, Lim SC, Yang HC. Patients with epiglottic collapse showed less severe obstructive sleep apnea and good response to treatment other than continuous positive airway pressure: a case-control study of 224 patients. J Clin Sleep Med. 2021;17(3):413–9. https://doi.org/10.5664/jcsm.8904.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kanemaru S, Kojima H, Fukushima H, Tamaki H, Tamura Y, Yamashita M, Umeda H, Ito J. A case of floppy epiglottis in adult: a simple surgical remedy. Auris Nasus Larynx. 2007;34(3):409–11. https://doi.org/10.1016/j.anl.2007.01.009.

    Article  Google Scholar 

  45. Moeller M, Weber S, Coceani-Paskay L, Amat P, Bianchini E, Botzer E, et al. Déclaration de consensus sur l’évaluation et la rééducation myofonctionnelles orofaciales chez les patients souffrants de SAOS: proposition d’un processus international par la méthode Delphi. Rev Orthop Dento Faciale. 2021;55(4):513–21. https://doi.org/10.1051/odf/2021035.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Head of Otorhinolaryngology Department in Hospital Quironsalud Marbella, Marbella, Spain

    Carlos O’Connor-Reina

  2. Department of Otorhinolaryngology, Hospital Universitario Dr. Peset, Valencia, Spain

    Marina Carrasco-Llatas

  3. Department of Otorhinolaryngology, IMED Hospital, Valencia, Spain

    Marina Carrasco-Llatas

Authors
  1. Carlos O’Connor-Reina
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  2. Marina Carrasco-Llatas
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Correspondence to Carlos O’Connor-Reina .

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Editors and Affiliations

  1. General Hospital Celje, Celje, Slovenia

    Matej Delakorda

  2. Jan Tooropstraat, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

    Nico de Vries

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O’Connor-Reina, C., Carrasco-Llatas, M. (2023). Orofacial Myofunctional Therapy. In: Delakorda, M., de Vries, N. (eds) The Role of Epiglottis in Obstructive Sleep Apnea. Springer, Cham. https://doi.org/10.1007/978-3-031-34992-8_16

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  • DOI: https://doi.org/10.1007/978-3-031-34992-8_16

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