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Orofacial myofunctional therapy coadjuvant to the use of CPAP
In a previous study, OSA patient´s using CPAP showed greater adherence with orofacial myofunctional therapy (OMT). However, little information is described about the limitations of this coadjuvant treatment in relation to OMT concomitant with the use of CPAP.
To verify the modification of SpO2 saturation after OMT in patient with severe OSA using CPAP.
clinical case, female, 64 years old, BMI=28kg/m2(overweight), severe apnea, use of CPAP, nasal mask for ten years, well adapted. Pre AHI polysomnography =103 (no/h); 193 (OA), 9 (CA), 12 (MA) and 285 (H), SpO292%, mean 93% and minimum 76%. Sonendoscopy: V-circumferential 100%, O-lateral 70%, T-anteroposterior 90%. Biologix pre: ODI (oxygen desaturation index) 60.3 events/h, SpO2 min 80%, SpO2 mean 93%. Referred by ENT for speech therapy assessment regarding myofunctional conditions to verify the reduction of respiratory events. Clinical evaluation: apparent maxillomandibular deficiency; functional hypotonia of oral inferior orbicularis; buccinators with good contraction; voluminous, wide, crenated and high tongue, with habitual posture on the floor of the mouth,
reduced response of vertical, transverse, longitudinal and styloglossus muscles. Reduced lowering reflex, FTP=4, when being directed FTP=1. Reduced oropharyngeal space: oropharyngeal pillars close to/posterior wall of the oropharynx. [A]vowel production: vertical soft palate and uvula and transverse mobility of pillars, all reduced. Pulling the air/mobility: good vertical(soft palate), reduced transverse (pillars), good(uvula). Small uvula. Palatine tonsils=1. Tongue strength (IOPI) below normal, anterior 42KPa and media 48KPa. 15 weekly sessions of OMT were carried out, associated with the maintenance of the use of CPAP. Focusing changes in volume and tone of the muscles of the tongue, lips, floor of the mouth and oropharyngeal region. Through isotonic, isometric and isocinetic exercises, use of respiratory stimulators and adequacy of oral functions. The reassessment showed improvement on the tone and mobility of the lip, tongue, floor of the mouth and oropharyngeal. Tongue strength test (IOPI) anterior 49KPa and media 45KPa.
Biologix pos OMT: ODI43.9events/h, SpO2 min83%, SpO2mean 92%.
Improvement in minimum SpO2 desaturation and improvement in ODI with OMT. However, the indices obtained with the OMT are insufficient because it is a serious case and need the continuity of the use of CPAP.
obstructive sleep apnea, myofunctional therapy,
Daniella Nazario, Fabiane Kayamori, Esther Mandelbaum Gonçalves Bianchini