Authors (including presenting author) :
Chan EYT(1), Yeung MF(1), Cindy Chan (2), Cheng SY(3), Fung Brigitte (2), Pang Amanda(3), Chan WS(1), Kwok KL(1), Leung SY(1)
Affiliation :
(1) Department of Paediatrics and Adolescent, (2) Physiotherapy Department, (3) Occupational Therapy Department
Introduction :
Obstructive sleep apnea (OSA) is caused by upper airway obstruction. Recent evidences showed that children with OSAS are a disorder of oral-facial growth. Adenotonsillectomy was the traditional surgical treatment for OSA but around half of the cases had residual OSA afterwards. Currently, oral-pharyngeal motor training (OMT) program has been used to reduce the symptoms of sleep disordered breathing (such as snoring), and OSA.
Objectives :
This study aims to investigate the effectiveness of OMT in children with mild to moderate OSAS in Hong Kong children and adolescent.
Methodology :
This is a randomized controlled trial study. There are 2 patient groups, group A: medical therapy (nasal corticosteroid) and structured OMT exercise (12weeks), group B: medical therapy and having advice on simple chewing exercise. Pre and post polysomnography (PSG), sleep related questionnaire results were being compared. Children with mild to moderate OSAS as defined by apnea-hypopnea index (AHI) >1-10 and presence of symptoms of OSAS were recruited. Children were excluded if they are younger than 6 years of age, moderate degree of mental retardation and neuromuscular diseases. Primary outcome measures are quality-of-life questionnaire (OSA-18) and AHI. Secondary outcomes included changes in tongue strength, changes in scores of Nordic Orofacial Test-Screening (NOT-S), and Sleep Related Breathing Disorder (SRBD). All children had the tongue strength measured by the Iowa Oral Performance Instrument (IOPI). The 12-week OMT exercise program included exercises for the tongue, jaw, cheeks, lips and spine.
Result & Outcome :
Interim results were reported.
A total of 36 children were randomized and completed the program (median age 12.4 years, IQR 10.0 to 14.8 years).
For pre and post AHI, patients in group A were 3.7 (2.1-9.1) and 1.2 (0.1 to 8.9) respectively, p=0.064; patients in group B were 3.9 (1.8-8.7) and 3.7 (0.7-10.4) respectively, p=0.234.
For pre and post OSA 18, patients in group A were 70.0 (57.0-76.8) and 53.5 (41.5-61.3) respectively, p=0.007; patients in group B were 58.5 (47.0-74.5) to 55.0 (38.5-71.3) respectively, p=0.080.
Both patient groups showed improvement in tongue strength (group A: median 41.9kPa, IQR 25.8-55.3 to 47.9kPa, IQR 44.5 to 62.3 (p=0.001); Group B: median 38.0kPa, IQR 22.7-53.4 to 45.7kPa, IQR 35.5 to 56.0 (p=0.012). Both groups showed improvement in NOT-S, Group A: 4.0 (2.8-6.3) to 2.0 (1.0-5.0), p=0.001; Group B: 4.5 (3.0-5.3) to 3.0 (2.0-5.0), p=0.025 and improvement on SRBD, Group A: 11.0(8.0-13.0) to 8.0(7.0-10.0), p=0.039; group B: 10.5 (6.5-13.5) vs 9.0 (4.0-10.0), p = 0.027).
In paediatric mild to moderate OSA, quality of life and symptoms were improved by medical therapy, which may be further enhanced by a structured OMT, while AHI seems to improve in medical and structured OMT treatment group only.
