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Orofacial Myofunctional Therapy in elderly OSA subject
Human aging is associated with several diseases as obstructive sleep apnea (OSA). OSA´s prevalence ranges between 13 and 32% in people aged over 65 years and it has been associated with a great range of adverse events, increasing morbidity and mortality. Continuous positive airway pressure (CPAP) is the major treatment option for OSA. However, the adherence seems to be reduced in elderly people which leads to a constant search for alternatives. Orofacial Myofunctional Therapy (OMT), resourse of speech therapy, has been considered an alternative treatment for OSA aiming to increase the muscular tonus and functional pattern of orofacial structures, nonetheless there are scarce studies in people aged over 70 years.
To describe the clinical evolution of an elderly OSA subject submitted to OMT.
Female moderate OSA subject, apnea/hypopnea index (AHI) 24.8, aged 70 years, body mass index (BMI) 26.4 kg/m2, story of snoring, breathing pauses, awakenings, reduced nasal airflow and bad sleep quality. CPAP was referred to 5 cm H2O, however it was rejected. The subject was submitted to sleep questionnaires (Epworth Sleepiness Scale - ESS, Pittsburg Sleep Quality Index-PSQI and Berlin Questionnaire-BQ), speech therapy evaluation (OMES-E protocol) and OMT. OMT was conducted in weekly speech therapy sessions during 30 minutes for 6 months. The subject was recommended to perform 4 to 6 exercises in 2 different periods a day between the sessions. After 17 weeks of OMT, all the protocols was repeated, includind polysomnography (PSG).
The subject presented changes in posture, mobility, and tonus of orofacial structures (OMES-E=88), reduced nasal airflow, daytime sleepiness (ESS=11), impairment on sleep quality (PSQ=21), intense snoring (BQ=6). In the PSG parameters, presented AHI 24.8, mean oxygen saturation (SpO2) 92%, percentage of sleep time below 90% of SpO2 (T90) 25%, and fragmented sleep, sleep fragmentation index (SFI)12. At the reassessment, presented BMI 26.8, improving of posture, mobility, and tonus of oropharyngeal structures (OMES-E=94), nasal airflow, as well as subjective sleep parameters (BQ=2, ESS=7, PSQI=8).The control PSG analysis showed AHI 5.2, mean SpO2 95%, T90 1%, SFI 7.2.
The findings suggest that OMT resulted in improvement of PSG parameters and myofunctional structures with a good adherence to the treatment. However, further studies with large numbers of individuals are required.
Obstructive sleep apnea, speech therapy, treatment, aged
Relato de Caso
DANIELLE BARRETO E SILVA, ANA PAULA MAGALHÃES MEDEIROS