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Título

Morphofunctional analysis of the upper airway during oropharyngeal exercises for Sleep-Disordered Breathing

Introdução

Orofacial Myofunctional Therapy is presented as alternative treatment for SDB, evidenced in published studies. However, the morphofunctional mechanisms that trigger the results obtained are poorly elucidated.

Objetivo

To perform morphofunctional analysis of the upper airway (UA) during oropharyngeal exercises to verify their immediate effects on mobility, stiffening, modification of the pharyngo-laryngeal spaces and identify the exercises that bring greater changes.

Métodos

15 healthy adults, mean age 27.5, both genders, were selected and trained for 4 weeks for proper execution of 13 exercises selected for analysis. Data were collected by recording the UA dynamics through Nasofibrolaryngoscopy in two regions: nasopharynx and oro-hypopharynx during each exercise. Data from 390 videos were analyzed by 3 judges (ENT) blinded to exercises and to subjects. Statistical analyses: Fleiss Kappa Agreement Coefficient (agreement between judges) Friedman Test (exercises comparison).CAAE: 94754418.4.0000.5482.

Resultados

Exercises with better effects (p<0,001) were detected. In nasopharyngeal vision: Intense responses (median 3.0) for soft palate elevation, constriction, medialization and tonification were obtained with forced inspiration (Respiron), forced expiration (Respiron inverted), semi-occluded vocal tract (LaxVox), soft palate and uvula elevation exercises. Moderate responses for pharyngeal wall opening with lingual propulsion and intraoral lingual lateralization exercises. Moderate responses for soft palate lowering movement with tongue-down and intraoral lingual lateralization.
In oro-hypopharynx vision, moderate responses were obtained for: pharyngeal lateral wall opening with sweep the hard palate, tongue pressure on hard palate; forced expiration, LaxVox, lingual propulsion and intraoral lingual lateralization. Opening of the retrolingual region and opening of the epiglottis with sweep the hard palate, tongue pressure on hard palate, lingual propulsion and intraoral lingual lateralization.
Pharyngeal lateral wall closure movement with lowering tongue base and soft palate and uvula elevation. Retrolingual region closure with lowering tongue base. Epiglottis closure with tongue snapping and lowering tongue base.

Conclusões

This morphofunctional analysis allowed to identify which exercise provides greater modifications for each pharyngeal region. Results suggested that proper assessment and therapy customization seems essential.

Palavras-chave

Sleep apnea, Myofunctional Orofacial Therapy, Nasofibrolaryngoscopy

Área

Área Clínica

Instituições

Pontifícia Universidade Católica de São Paulo - São Paulo - Brasil

Autores

Andresa Santos da Silva, Fabio Augusto Winckler Rabelo, Eric Rodrigues Thuller, Fabiane Kayamori , Esther Mandelbaum Gonçalves Bianchini