Skip to main content
Erschienen in:

01.06.2019 | Sleep and Otolaryngology (H Gouveris, Section Editor)

Oropharyngeal Exercises for Treatment of Pediatric Obstructive Sleep-Disordered Breathing

verfasst von: Maria Pia Villa, Melania Evangelisti

Erschienen in: Current Sleep Medicine Reports | Ausgabe 2/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

We reviewed and discussed studies on the role of oropharyngeal exercises in the treatment of children with obstructive sleep-disordered breathing (SDB).

Recent Findings

There has been increasing recent evidence on the role of oropharyngeal exercises in the stepwise therapeutic approach in children with SDB.
An oropharyngeal evaluation, targeted to explore the presence of orofacial muscle hypotonia, should be part in the assessment of children with SDB, in order to recognize potential oropharyngeal characteristics to be treated.

Summary

Current literature demonstrates that oropharyngeal exercises help to treat oropharyngeal muscle dysfunction that persists following the standard treatment of SDB, and improve symptoms and polysomnographic sleep variables SDB related in pediatric population.
New studies to compare different oropharyngeal exercise programs and to evaluate the long-term effects of this therapeutic approach could contribute to the indication of oropharyngeal exercises for the treatment of obstructive SDB in children.
Literatur
1.
Zurück zum Zitat •• Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, et al. Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep. 2015;38(5):669–75 First systematic review on myofunctional therapy reported data in the literature on the efficacy of myofunctional treatment as an adjunct to other obstructive sleep apnea treatments. CrossRefPubMedPubMedCentral •• Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, et al. Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep. 2015;38(5):669–75 First systematic review on myofunctional therapy reported data in the literature on the efficacy of myofunctional treatment as an adjunct to other obstructive sleep apnea treatments. CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat •• Guilleminault C, Huang YS, Mon teyrol PJ, Sato R, Quo S, Lin CH. Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Med. 2013;14(6):518–25 The authors evaluated the impact of myofunctional reeducation in children with SDB referred for adenotonsillectomy, orthodontia, and myofunctional treatment in three different geographic areas. CrossRefPubMed •• Guilleminault C, Huang YS, Mon teyrol PJ, Sato R, Quo S, Lin CH. Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Med. 2013;14(6):518–25 The authors evaluated the impact of myofunctional reeducation in children with SDB referred for adenotonsillectomy, orthodontia, and myofunctional treatment in three different geographic areas. CrossRefPubMed
3.
Zurück zum Zitat •• Villa MP, Brasili L, Ferretti A, Vitelli O, Rabasco J, Mazzotta AR, et al. Oropharyngeal exercises to reduce symptoms of OSA after AT. SleepBreath. 2015;19(1):281–9 The authors evaluated the efficacy of oropharyngeal exercises in children with symptoms of obstructive sleep apnea syndrome (OSA) after adenotonsillectomy. •• Villa MP, Brasili L, Ferretti A, Vitelli O, Rabasco J, Mazzotta AR, et al. Oropharyngeal exercises to reduce symptoms of OSA after AT. SleepBreath. 2015;19(1):281–9 The authors evaluated the efficacy of oropharyngeal exercises in children with symptoms of obstructive sleep apnea syndrome (OSA) after adenotonsillectomy.
4.
Zurück zum Zitat Katz ES, D’Ambrosio CM. Pathophysiology of pediatric obstructive sleep apnea. Proc Am ThoracSoc. 2008;5:253–62.CrossRef Katz ES, D’Ambrosio CM. Pathophysiology of pediatric obstructive sleep apnea. Proc Am ThoracSoc. 2008;5:253–62.CrossRef
5.
Zurück zum Zitat •• Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J. 2016;47(1):69–94 This document summarizes the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep-disordered breathing (SDB) in childhood and considered the myofunctional therapy as an adjunct to other obstructive sleep apnea treatments. CrossRefPubMed •• Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J. 2016;47(1):69–94 This document summarizes the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep-disordered breathing (SDB) in childhood and considered the myofunctional therapy as an adjunct to other obstructive sleep apnea treatments. CrossRefPubMed
6.
Zurück zum Zitat Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Clinical practice guideline. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130(3):576–84.CrossRefPubMed Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Clinical practice guideline. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130(3):576–84.CrossRefPubMed
7.
Zurück zum Zitat Kheirandish-Gozal L, Bhattacharjee R, Gozal D. Autonomic alterations and endothelial dysfunction in pediatric obstructive sleep apnea. SleepMed. 2010;11(7):714–20. Kheirandish-Gozal L, Bhattacharjee R, Gozal D. Autonomic alterations and endothelial dysfunction in pediatric obstructive sleep apnea. SleepMed. 2010;11(7):714–20.
8.
Zurück zum Zitat Chang SJ, Chae KY. Obstructive sleep apnea syndrome in children: epidemiology, pathophysiology, diagnosis and sequelae. Korean J Pediatr. 2010;53(10):863–71.CrossRefPubMedPubMedCentral Chang SJ, Chae KY. Obstructive sleep apnea syndrome in children: epidemiology, pathophysiology, diagnosis and sequelae. Korean J Pediatr. 2010;53(10):863–71.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Villa MP, Castaldo R, Miano S, Paolino MC, Vitelli O, Tabarrini A, et al. Adenotonsillectomy and orthodontic therapy in pediatric obstructive sleep apnea. SleepBreath. 2014;18(3):533–9. Villa MP, Castaldo R, Miano S, Paolino MC, Vitelli O, Tabarrini A, et al. Adenotonsillectomy and orthodontic therapy in pediatric obstructive sleep apnea. SleepBreath. 2014;18(3):533–9.
10.
Zurück zum Zitat Kaditis A, Kheirandish-Gozal L, Gozal D. Algorithm for the diagnosis and treatment of pediatric OSA: a proposal of two pediatric sleep centers. Sleep Med. 2012;13(3):217–27.CrossRefPubMed Kaditis A, Kheirandish-Gozal L, Gozal D. Algorithm for the diagnosis and treatment of pediatric OSA: a proposal of two pediatric sleep centers. Sleep Med. 2012;13(3):217–27.CrossRefPubMed
11.
Zurück zum Zitat Harvold EP, Tomer BS, Vargervik K, Chierici G. Primate experiments on oral respiration. Am J Orthod. 1981;79:359–72.CrossRefPubMed Harvold EP, Tomer BS, Vargervik K, Chierici G. Primate experiments on oral respiration. Am J Orthod. 1981;79:359–72.CrossRefPubMed
12.
Zurück zum Zitat Miller AJ, Vargervik K, Chierici G. Experimentally induced neuromuscular changes during and after nasal airway obstruction. Am J Orthod. 1984;85:385–92.CrossRefPubMed Miller AJ, Vargervik K, Chierici G. Experimentally induced neuromuscular changes during and after nasal airway obstruction. Am J Orthod. 1984;85:385–92.CrossRefPubMed
13.
Zurück zum Zitat Vargervik K, Miller AJ, Chierici G, Harvold E, Tomer BS. Morphologic response to changes in neuromuscular patterns experimentally induced by altered modes of respiration. Am J Orthod. 1984;85:115–24.CrossRefPubMed Vargervik K, Miller AJ, Chierici G, Harvold E, Tomer BS. Morphologic response to changes in neuromuscular patterns experimentally induced by altered modes of respiration. Am J Orthod. 1984;85:115–24.CrossRefPubMed
14.
15.
Zurück zum Zitat •• de Felício CM, da Silva Dias FV, Trawitzki LVV. Obstructive sleep apnea: focus on myofunctional therapy. Nat Sci Sleep. 2018;10:271–286. eCollection 2018. Review. This review summarized and discussed the effects of OMT on OSA, the therapeutic programs employed, and their possible mechanisms of action. •• de Felício CM, da Silva Dias FV, Trawitzki LVV. Obstructive sleep apnea: focus on myofunctional therapy. Nat Sci Sleep. 2018;10:271–286. eCollection 2018. Review. This review summarized and discussed the effects of OMT on OSA, the therapeutic programs employed, and their possible mechanisms of action.
16.
Zurück zum Zitat Šujanská A, Ďurdík P, Rabasco J, Vitelli O, Pietropaoli N, Villa MP. Surgical and non-surgical therapy of obstructive sleep apnea syndrome in children. Acta Med (Hradec Kralove). 2014;57(4):135–41.CrossRef Šujanská A, Ďurdík P, Rabasco J, Vitelli O, Pietropaoli N, Villa MP. Surgical and non-surgical therapy of obstructive sleep apnea syndrome in children. Acta Med (Hradec Kralove). 2014;57(4):135–41.CrossRef
19.
Zurück zum Zitat •• Villa MP, Evangelisti M, Martella S, Barreto M, Del Pozzo M. Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep Breath. 2017;21(4):1025–32. https://doi.org/10.1007/s11325-017-1489-2 The authors demonstrated that oropharyngeal exercises appear to effectively modify tongue tone, reduce SDB symptoms and oral breathing, and increase oxygen saturation, and may thus play a role in the treatment of SDB. CrossRefPubMed •• Villa MP, Evangelisti M, Martella S, Barreto M, Del Pozzo M. Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep Breath. 2017;21(4):1025–32. https://​doi.​org/​10.​1007/​s11325-017-1489-2 The authors demonstrated that oropharyngeal exercises appear to effectively modify tongue tone, reduce SDB symptoms and oral breathing, and increase oxygen saturation, and may thus play a role in the treatment of SDB. CrossRefPubMed
20.
Zurück zum Zitat de Felício CM, da Silva Dias FV, Folha GA, de Almeida LA, de Souza JF, Anselmo-Lima WT, et al. Orofacial motor functions in pediatric obstructive sleep apnea and implications for myofunctional therapy. Int J Pediatr Otorhinolaryngol. 2016 Nov;90:5–11.CrossRefPubMed de Felício CM, da Silva Dias FV, Folha GA, de Almeida LA, de Souza JF, Anselmo-Lima WT, et al. Orofacial motor functions in pediatric obstructive sleep apnea and implications for myofunctional therapy. Int J Pediatr Otorhinolaryngol. 2016 Nov;90:5–11.CrossRefPubMed
21.
Zurück zum Zitat Chuang LC, Lian YC, Hervy-Auboiron M, Guilleminault C, Huang YS. Passive myofunctional therapy applied on children with obstructive sleep apnea: a 6-month follow-up. J Formos Med Assoc. 2017 Jul;116(7):536–41.CrossRefPubMed Chuang LC, Lian YC, Hervy-Auboiron M, Guilleminault C, Huang YS. Passive myofunctional therapy applied on children with obstructive sleep apnea: a 6-month follow-up. J Formos Med Assoc. 2017 Jul;116(7):536–41.CrossRefPubMed
22.
Zurück zum Zitat •• Lee SY, Guilleminault C, Chiu HY, Sullivan SS. Mouth breathing, "nasal disuse," and pediatric sleep-disordered breathing. Sleep Breath. 2015;19(4):1257–64 The authors assessed the presence of mouth breathing during sleep post-T&A in children with residual OSA. Persistence of mouth breathing post-T&A plays a role in progressive worsening through an increase of upper airway resistance during sleep with secondary impact on orofacial growth. CrossRefPubMed •• Lee SY, Guilleminault C, Chiu HY, Sullivan SS. Mouth breathing, "nasal disuse," and pediatric sleep-disordered breathing. Sleep Breath. 2015;19(4):1257–64 The authors assessed the presence of mouth breathing during sleep post-T&A in children with residual OSA. Persistence of mouth breathing post-T&A plays a role in progressive worsening through an increase of upper airway resistance during sleep with secondary impact on orofacial growth. CrossRefPubMed
23.
Zurück zum Zitat •• Cheng SY, Kwong SHW, Pang WM, Wan LY. Effects of an oral-pharyngeal motor training programme on children with obstructive sleep apnea syndrome in Hong Kong: a retrospective pilot study. Hong Kong J Occup Ther. 2017;30(1):1–5 The findings of this study support the role of occupational therapist in oromotor training modalities to improve the respiratory function for children with OSAS. CrossRefPubMedPubMedCentral •• Cheng SY, Kwong SHW, Pang WM, Wan LY. Effects of an oral-pharyngeal motor training programme on children with obstructive sleep apnea syndrome in Hong Kong: a retrospective pilot study. Hong Kong J Occup Ther. 2017;30(1):1–5 The findings of this study support the role of occupational therapist in oromotor training modalities to improve the respiratory function for children with OSAS. CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med. 2010;182(5):676–83.CrossRef Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med. 2010;182(5):676–83.CrossRef
25.
Zurück zum Zitat Ye J, Liu H, Zhang GH, Li P, Yang QT, Liu X, et al. Outcome of adenotonsillectomy for obstructive sleep apnea syndrome in children. Ann Otol Rhinol Laryngol. 2010;19(8):506–13.CrossRef Ye J, Liu H, Zhang GH, Li P, Yang QT, Liu X, et al. Outcome of adenotonsillectomy for obstructive sleep apnea syndrome in children. Ann Otol Rhinol Laryngol. 2010;19(8):506–13.CrossRef
26.
Zurück zum Zitat Guimarães KC, Drager LF, Genta PR, Marcondes BF. Lorenzi-FilhoG . Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009;179(10):962–6.CrossRefPubMed Guimarães KC, Drager LF, Genta PR, Marcondes BF. Lorenzi-FilhoG . Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009;179(10):962–6.CrossRefPubMed
27.
Zurück zum Zitat Fonteles CS, de MirandaMota AC, Lima RA, Borges PC, da Silveira A. Conservative management of severe open bite and feeding difficulties in patient with Noonan syndrome. Cleft Palate Craniofac J. 2013;50(2):242–8.CrossRefPubMed Fonteles CS, de MirandaMota AC, Lima RA, Borges PC, da Silveira A. Conservative management of severe open bite and feeding difficulties in patient with Noonan syndrome. Cleft Palate Craniofac J. 2013;50(2):242–8.CrossRefPubMed
28.
Zurück zum Zitat Abeleira MT, Seoane-Romero JM, Outumuro M, Caamaño F, Suárez D, Carmona IT. A multidisciplinary approach to the treatment of oral manifestations associated with Beckwith-Wiedemann syndrome: a long-term case report. J Am Dent Assoc. 2011;142(12):1357–64.CrossRefPubMed Abeleira MT, Seoane-Romero JM, Outumuro M, Caamaño F, Suárez D, Carmona IT. A multidisciplinary approach to the treatment of oral manifestations associated with Beckwith-Wiedemann syndrome: a long-term case report. J Am Dent Assoc. 2011;142(12):1357–64.CrossRefPubMed
29.
Zurück zum Zitat Folha GA, Valera FC, de Felício CM. Validity and reliability of a protocol of orofacial myofunctional evaluation for patients with obstructive sleep apnea. Eur J Oral Sci. 2015;123:165–72.CrossRefPubMed Folha GA, Valera FC, de Felício CM. Validity and reliability of a protocol of orofacial myofunctional evaluation for patients with obstructive sleep apnea. Eur J Oral Sci. 2015;123:165–72.CrossRefPubMed
30.
Zurück zum Zitat Potter NL, Short R. Maximal tongue strength in typically developing children and adolescents. Dysphagia. 2009;24(4):391–7.CrossRefPubMed Potter NL, Short R. Maximal tongue strength in typically developing children and adolescents. Dysphagia. 2009;24(4):391–7.CrossRefPubMed
31.
Zurück zum Zitat Rappai M, Collop N, Kemp S, deShazo R. The nose and sleep-disordered breathing: what we know and what we do not know. Chest. 2003;124(6):2309–23 Review.CrossRefPubMed Rappai M, Collop N, Kemp S, deShazo R. The nose and sleep-disordered breathing: what we know and what we do not know. Chest. 2003;124(6):2309–23 Review.CrossRefPubMed
32.
Zurück zum Zitat Van Dyck C, Dekeyser A, Vantricht E, Manders E, Goeleven A, Fieuws S, et al. The effect of orofacial myofunctional treatment in children with anterior open bite and tongue dysfunction: a pilot study. Eur J Orthod. 2016;38(3):227–34.CrossRefPubMed Van Dyck C, Dekeyser A, Vantricht E, Manders E, Goeleven A, Fieuws S, et al. The effect of orofacial myofunctional treatment in children with anterior open bite and tongue dysfunction: a pilot study. Eur J Orthod. 2016;38(3):227–34.CrossRefPubMed
33.
Metadaten
Titel
Oropharyngeal Exercises for Treatment of Pediatric Obstructive Sleep-Disordered Breathing
verfasst von
Maria Pia Villa
Melania Evangelisti
Publikationsdatum
01.06.2019
Verlag
Springer International Publishing
Erschienen in
Current Sleep Medicine Reports / Ausgabe 2/2019
Elektronische ISSN: 2198-6401
DOI
https://doi.org/10.1007/s40675-019-00136-z

Kompaktes Leitlinien-Wissen Neurologie (Link öffnet in neuem Fenster)

Mit medbee Pocketcards schnell und sicher entscheiden.
Leitlinien-Wissen kostenlos und immer griffbereit auf ihrem Desktop, Handy oder Tablet.

Neu im Fachgebiet Neurologie

Kaum Vorteile durch intraarterielle Lyse während Thrombektomie

Nach der Thrombektomie kleinere Fragmente über eine intraarterielle Lyse auflösen – dies könnte die Schlaganfalltherapie verbessern. Zwei aktuelle Studien ergeben für die periprozedurale Lyse jedoch keine großen Vorteile. Die Frage, wie viel sie nützt, bleibt weiter offen.

Nasenstimulation lindert chronische Migräne

Wird die Naseninnenseite durch Vibrationen stimuliert, kann dies offenbar die Zahl der Migränetage von Menschen mit chronischer Migräne deutlich senken. Darauf deuten die Resultate einer randomisiert-kontrollierten deutsch-finnischen Untersuchung.

Stumme Schlaganfälle − ein häufiger Nebenbefund im Kopf-CT?

In 4% der in der Notfallambulanz initiierten zerebralen Bildgebung sind „alte“ Schlaganfälle zu erkennen. Gar nicht so selten handelt es sich laut einer aktuellen Studie dabei um unbemerkte Insulte. Bietet sich hier womöglich die Chance auf ein effektives opportunistisches Screening?

Die elektronische Patientenakte kommt: Das sollten Sie jetzt wissen

Am 15. Januar geht die „ePA für alle“ zunächst in den Modellregionen an den Start. Doch schon bald soll sie in allen Praxen zum Einsatz kommen. Was ist jetzt zu tun? Was müssen Sie wissen? Wir geben in einem FAQ Antworten auf 21 Fragen.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.