Authors (including presenting author) :
Lam KY, Wong SS, Yeung CHJ, Leung RWC, Law KM, Yip HS, Yeung YKA, Fung BKY
Affiliation :
(1)Physiotherapy Department, Kwong Wah Hospital
Introduction :
Orofacial myofunctional therapy (OMT) was proposed to reduce obstructive sleep apnea syndrome (OSAS) severity and associated symptoms in adults. Literature demonstrates that OMT promoted significant improvement in orofacial myofunctional status and sleep quality in adults with sleep disordered breathing (SDB). However, OMT as an adjunctive therapy for the treatment of sleep disordered breathing in adults is not commonly practised in Hong Kong.
Objectives :
To evaluate the application of orofacial myofunctional therapy to adult patients with sleep disordered breathing in reducing OSAS severity.
Methodology :
It was a retrospective analysis of the effectiveness of the program for adult patients with sleep disordered breathing. Subjects were referred from Department of Medicine and Geriatrics of Kwong Wah Hospital, Department of Otorhinolaryngology, Head and Neck Surgery of Yan Chai Hospital and Ear, Nose and Throat Department of Pamela Youde Nethersole Eastern Hospital. Data was retrieved from November 2020 to December 2022.
Inclusion criteria: patient diagnosed as sleep disordered breathing.
The outcome measures:
1. Daytime sleepiness: Epworth Sleepiness Scale (ESS)
2. Sleep related quality of life: Short version of Functional Outcomes Sleep Questionnaire (FOSQ-10)
3. Mouth opening: Maximal interincisal opening (MIO)
4. Tongue movement: Mouth opening tongue tip to incisive papilla (MOTTIP), Tongue range of motion ratio (TRMR)
5. Tongue strength and endurance: measured by Iowa Oral Performance Instrument (IOPI) machine
The 16-week OMT program consisted of 5 sessions training in orofacial exercise, breathing and postural re-education. Data was analysed by Wilcoxon Signed Rank test for paired comparison on mean, p<0.05 as significant at baseline and 1-month after completion of program.
Result & Outcome :
Thirty-six SDB adults (Female: 15, Male: 21) aged 57.9±13.0 with body mass index (BMI) 27.3±4.6 were recruited. All subjects completed post 1-month evaluation without significant change in BMI, FOSQ-10 and MIO.
MOTTIP increased significantly from 31.4±6.9 mm to 33.0±7.5 mm (p=0.016); TRMR increased significantly from 66.6±15.0% to 69.2±14.5% (p=0.034).
Tongue strength significantly improved from 39.1±11.8kPa to 43.4±9.7kPa (p=0.001). (norm: male 35.2±9kPa; female: 34.5±6.9kPa). Tongue endurance significantly improved from 10.4±8.8 seconds to 17.4±11.1 seconds (p<0.001) (norm: male 15.8±6.7 seconds; female: 17.9±8.1 seconds).
ESS significantly improved from 7.7±5.0 to 6.5±4.0kPa (p=0.037).
Conclusion
OMT improves OSAS symptoms in adult patients with SDB as reflected in improvement in ESS, MOTTIP, TRMR, tongue strength and tongue endurance which promote nose breathing pattern. Physiotherapist provides advice on weight reduction and postural re-education which are important component in SDB rehabilitation. Larger sample size is required to establish its effectiveness in local population.
