Lead Author Affiliation

Dental Hygiene

Lead Author Program & Year

Dental Hygiene

Presentation Category

Other

Introduction/Context/Diagnosis

Obstructive sleep apnea (OSA) is when the upper airways are partially or completely blocked during sleep. Although it is more common in adults it can also be seen in children. According to some studies, “the problem affects 1%-5% of the child population,” (de Felicio, 2018). One of the common causes of OSA in adults is obesity, and adults show signs of feeling sleepy throughout the day. The most common cause of obstructive sleep apnea in children is enlarged tonsils or adenoids, and is often seen in preschool children when tonsil hypertrophy is more common (de Felicio, 2018). One researcher discussed how “the peak prevalence of childhood OSA is at 2-8 years, which is the age when the tonsils and adenoids are the largest in relation to the underlying airway size…OSA also occurs in children with upper airway narrowing due to malocclusion and craniofacial anomalies, “(Verma, 2010). For children with enlarged tonsils and adenoids, adenotonsillectomy is usually the first treatment planned to improve obstructive sleep apnea and reduce upper airway problems. However, recurrence of obstructive sleep apnea has been reported (Chuang, 2019) in many patients. Recurrence or residual obstructive sleep apnea has been seen in 13%-29% in low risk populations and can be seen to reach up to 73% if the child is obese (de felicio, 2016). Some of the early signs of pediatric sleep apnea are mouth breathing, snoring, restless sleep, and sleep terrors. Obstructive sleep apnea in children can lead to “low school performances, attention deficit and hyperactivity, low weight-height development, and cardiovascular dysfunction,” (de Felicio 2018). Dental health care providers should be able to recognize whether the child has enlarged tonsils or adenoids and refer the patient to the appropriate health care provider to obtain the best treatment or therapy. One of the therapy methods used to help patients with sleep apnea is myofunctional therapy. Myofunctional therapy are muscle exercises targeted especially to the facial muscles which help us chew and swallow. The exercises involved help strengthen the orofacial and oropharyngeal muscles. Myofunctional therapy can use a combination of exercises and devices to help train muscles to be stronger. These exercises train patients to place their tongue in the correct position, which is when the tip of the tongue is placed on the hard palate right behind the front teeth. Myofunctional therapy is oftentimes used in conjunction with other treatments such as orthodontic treatment. Through myofunctional therapy patients have been able to improve their quality of sleep and reduce obstructive sleep apnea.

Methods/Treatment Plan

The study of the use of myofunctional therapy to help improve obstructive sleep apnea in children through a review of the literature.

Results/Outcome

Studies have shown myofunctional therapy can help reduce sleep apnea in children. Multiple studies have shown how exercises that target the soft palate, tongue, and facial muscles can help children breathe through their nose and maintain proper lip seal and tongue positioning. Apnea-hypopnea index reduced 4.87 ± 3.0/h to 1.84 ± 3.2/h, which was a 62% reduction (Camacho, 2015). The control group at the two month follow up showed no changes in their AHI, which remained at 4.56/h (Camacho, 2015). Not only did the apnea-hypopnea index decrease in these patients but snoring did as well. There was a reduction in snoring from 14.05 ± 4.89% to 3.87 ± 4.12%. This was a 72.4% reduction in snoring before and after the therapy was conducted. Therapists have also used passive myofunctional therapy, which is when children are asked to wear device at night to move the tongue in the correct position while they are sleeping. With the help of the oral device the researchers saw a decrease in the AHI. The results of the study showed there was a decrease in the apnea-hypopnea index in sleep from 5.4 ± 5.9/h to 1.9 ± 2.5/h, and a decrease in the apnea-hypopnea index in REM sleep from 510.3 ± 11.8/h to 5.9 ± 11.4/h (Chuang, 2017). Different researchers have seen using myofunctional therapy in conjunction with orthodontics can also help reduce AHI. In the study conducted by Villa, the AHI was 6.3 ± 4.7/h and decreased to 2.4 ± 2.0/h (Villa, 2011).

Significance/Conclusions

Sleep apnea affects many individuals across the world. Inadequate breathing habits, such as mouth breathing, can lead to incorrect tongue position and weak orofacial muscles. One of the ways to help patients get better or improve their sleep apnea is by going through myofunctional therapy. The research has shown that myofunctional therapy can help individuals strengthen their orofacial and oropharyngeal muscles. By strengthening these muscles, the patients can learn to place their tongue in the correct place and reduce mouth breathing. However, a lot of the research shown has been conducted with myofunctional therapy being used in conjunction with other treatments, such as orthodontic treatment or adenotonsillectomy. There needs to be more research conducted on how myofunctional therapy for children alone has an affect on the airways and how it can reduce sleep apnea. Most of the research which was analyzed showed a lot of studies conducted with adults and children and lacked complete pediatric studies.

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The Effect of Myofunctional Therapy on Children with Sleep Apnea

Obstructive sleep apnea (OSA) is when the upper airways are partially or completely blocked during sleep. Although it is more common in adults it can also be seen in children. According to some studies, “the problem affects 1%-5% of the child population,” (de Felicio, 2018). One of the common causes of OSA in adults is obesity, and adults show signs of feeling sleepy throughout the day. The most common cause of obstructive sleep apnea in children is enlarged tonsils or adenoids, and is often seen in preschool children when tonsil hypertrophy is more common (de Felicio, 2018). One researcher discussed how “the peak prevalence of childhood OSA is at 2-8 years, which is the age when the tonsils and adenoids are the largest in relation to the underlying airway size…OSA also occurs in children with upper airway narrowing due to malocclusion and craniofacial anomalies, “(Verma, 2010). For children with enlarged tonsils and adenoids, adenotonsillectomy is usually the first treatment planned to improve obstructive sleep apnea and reduce upper airway problems. However, recurrence of obstructive sleep apnea has been reported (Chuang, 2019) in many patients. Recurrence or residual obstructive sleep apnea has been seen in 13%-29% in low risk populations and can be seen to reach up to 73% if the child is obese (de felicio, 2016). Some of the early signs of pediatric sleep apnea are mouth breathing, snoring, restless sleep, and sleep terrors. Obstructive sleep apnea in children can lead to “low school performances, attention deficit and hyperactivity, low weight-height development, and cardiovascular dysfunction,” (de Felicio 2018). Dental health care providers should be able to recognize whether the child has enlarged tonsils or adenoids and refer the patient to the appropriate health care provider to obtain the best treatment or therapy. One of the therapy methods used to help patients with sleep apnea is myofunctional therapy. Myofunctional therapy are muscle exercises targeted especially to the facial muscles which help us chew and swallow. The exercises involved help strengthen the orofacial and oropharyngeal muscles. Myofunctional therapy can use a combination of exercises and devices to help train muscles to be stronger. These exercises train patients to place their tongue in the correct position, which is when the tip of the tongue is placed on the hard palate right behind the front teeth. Myofunctional therapy is oftentimes used in conjunction with other treatments such as orthodontic treatment. Through myofunctional therapy patients have been able to improve their quality of sleep and reduce obstructive sleep apnea.