Authors (including presenting author) :
Leung RWC(1), Wong SS(1), Chan CYY(1), Law KM(1), Lee CC(2), Tang M(2), Fung BKY(1), Li CM(1)
Affiliation :
(1)Physiotherapy Department, Kwong Wah Hospital; (2)Department of Otorhinolaryngology, Head and Neck Surgery, Yan Chai Hospital, Hong Kong
Introduction :
Sleep disordered breathing (SDB) is prevalent among adult population in Hong Kong. The orofacial myofunctional therapy (OMT) was proposed with success for reducing obstructive sleep apnea syndrome (OSAS) severity and associated symptoms in adults. Current literature demonstrates that OMT promoted significant improvement in apnea hypopnea index, sleepiness outcomes, snoring, sleep and life quality and change of orofacial myofunctional status. However, OMT as an adjunctive therapy for the treatment of SDB in adults is not practised in Hong Kong.
Objectives :
To evaluate the application of orofacial myofunctional therapy to adult patients with sleep disordered breathing
Methodology :
It is a retrospective analysis of the effectiveness of the program for adult patients with SDB. Data was retrieved from September 2018 to September 2019. The inclusion criteria was patient diagnosed as SDB with snoring concern. They underwent type 2 sleep study prior to the program. Basic anthropometry, daytime sleepiness and sleep related quality of life (SRQoL) were captured by ENT surgeon in Yan Chai Hospital. Physiotherapists in Kwong Wah Hospital assessed the orofacial myofunctional status. The outcome measures included: 1. OSAS severity: Apnoea Hypopnoea Index (AHI) in sleep study 2. Daytime sleepiness: Epworth Sleepiness Scale (ESS) 3. SRQoL: Short version of Functional Outcomes Sleep Questionnaire (FOSQ-10) 4.Snoring intensity: Berlin Questionnaire 5.Mouth opening: Maximal interincisal mouth opening 6. Tongue movement: Mouth opening tongue tip to incisive papilla, Tongue range of motion ratio, Free tongue length 7. Tongue strength and endurance: measured by IOPI machine 8. Breathing pattern: Mouth or nose breathing at daytime. The 12-week 4 sessions OMT program consisted of orofacial exercise, breathing and postural re-education. Data was reported as mean and standard deviation. Wilcoxon Signed Rank test was used for paired comparison, p< 0.05 as significant. Outcome at baseline, 1-month and 6-month after completion of program were analysed.
Result & Outcome :
Twenty-two SDB adults (Female:8, Male:14) aged 44.1±11.4 with body mass index (BMI) 26.6±4.9 were recruited. Eighteen subjects completed post 6-month evaluation and finished post 9-month sleep study. AHI decreased from 22.07±20.59 to 12.8±12.15 by 42.0%. ESS demonstrated improvement at baseline, post 1-month and post 6- month evaluation: ESS decreased from 8.57±4.3 to 7.33±3.69(p=0.032) to 8.67±4.08. FOSQ-10 showed no significant change from 82.64±14.67 to 79.24±18.05 to 78.67±23.30p= 0.535). Snoring intensity improved significantly from 3.1±0.94 to 2.33±0.97(p=0.009) to 2.33±0.77(p=0.017). Significant improvement was shown in mouth opening, tongue movement, tongue strength and endurance: MIO increased significantly from 48.55±5.75 mm to 50.00±5.78 mm(p=0.014) to 48.47±6.08(p=0.009); MOTTIP increased significantly from 30.91±7.93mm to 34.95±5.79 mm (p=0.001) to 32.8±6.21mm(p=0.014); TRMR increased from 63.49%±13.8% to 70.4±10.7% (p=0.002) to 67.7%±12.9%(p=0.055); Free tongue length increased from 29.45±6.55 mm to 34.65±5.92mm (p< 0.001) to 34.93±4.75(p=0.001); Tongue strength and endurance improved significantly from 51.95±14.62kPa to 58.05±12.95kPa(p=0.006) to 59.73±13.68kPa(p=0.021) and from 11.05±8.12 seconds to 16.55±10.1seconds(p=0.002) to 18.53±17.07seconds respectively. Mouth breathing was corrected to nose breathing in 12 adults in post 6- month.
