The Role of Myofunctional Therapy in Treating Sleep-Disordered Breathing: A State-of-the-Art Review

Myofunctional therapy (MFT) may have a role in improving muscle tone and alleviating upper airway collapse in sleep-disordered breathing. The purposes of this state-of-the-art review are to first review systematically the current literature on the effectiveness of MFT in treating sleep-disordered breathing and then to provide an overview of the current understanding of patient selection, side effects, type and duration of exercises, guidance of exercise performance, evaluation of results, and how best to promote adherence. PubMed (Medline), the Cochrane Library, and the EMBASE, Scopus and SciELO databases were checked for relevant studies by three authors, and a total of 23 studies were included. This review focuses only on adults with sleep-disordered breathing. The available evidence shows a positive effect of MFT in reducing sleep apnoea, as measured using polysomnography and clinical variables (including snoring). There is no evidence of the utility of MFT for treating upper airway resistance syndrome, the duration of the effects of MFT, or regarding which MFT protocol is best. Despite these knowledge gaps, the available evidence suggests that MFT is a safe treatment modality.

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Upper airway resistance syndrome 2018: non-hypoxic sleep-disordered breathing

Expert Review of Respiratory Medicine ◽

10.1080/17476348.2019.1575731 ◽

2019 ◽

Vol 13 (4) ◽

pp. 317-326 ◽

Cited By ~ 3

Author(s):

William C. Arnold ◽

Christian Guilleminault

Keyword(s):

Sleep Disordered Breathing ◽

Airway Resistance ◽

Upper Airway ◽

Upper Airway Resistance Syndrome ◽

Upper Airway Resistance ◽

Disordered Breathing

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Sleep-disordered breathing in the obese

10.1093/med/9780199657742.003.0018 ◽

2017 ◽

Author(s):

Swapna Mandal ◽

Joerg Steier

Keyword(s):

Sleep Disordered Breathing ◽

Work Of Breathing ◽

Upper Airway ◽

Sleep Apnoea ◽

Respiratory Drive ◽

Prevalence Of Obesity ◽

Common Clinical Presentation ◽

Hypoventilation Syndrome ◽

Obesity Hypoventilation ◽

Disordered Breathing

Sleep-disordered breathing in the obese is not a small problem. Obesity-related sleep-disordered breathing is common and may include sleep apnoea or obesity hypoventilation syndrome. Patients present with symptoms of excessive daytime sleepiness, breathlessness, and, in severe cases, hypercapnic respiratory failure. In recent decades, the prevalence of obesity has increased exponentially. Although not exclusively responsible, obesity is directly linked to the development of sleep-disordered breathing due to high resistance in the upper airway, increased work of breathing, and high neural respiratory drive. Obese patients with sleep disorders are complicated with multiple metabolic, cardiovascular, and orthopaedic co-morbidities, frequently presenting at an advanced stage. This chapter reviews a common clinical presentation of an obese patient with a respiratory condition and the difficulties in their management. The chapter explains the complex underlying pathophysiology and the long-term management of these patients, and shows how sleep-disordered breathing may develop as a consequence of obesity.

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Co-morbidity (HFrEF and HFpEF): sleep-disordered breathing

ESC CardioMed ◽

10.1093/med/9780198784906.003.0420 ◽

2018 ◽

pp. 1829-1832

Author(s):

Martin R Cowie

Keyword(s):

Heart Failure ◽

Sleep Disordered Breathing ◽

Systolic Heart Failure ◽

Upper Airway ◽

Sleep Apnoea ◽

Respiratory Physiology ◽

Sympathetic Activation ◽

Central Sleep Apnoea ◽

Haemodynamic Changes ◽

Disordered Breathing

The majority of patients with heart failure have sleep-disordered breathing. There are two major types—obstructive (where the upper airway collapses, but respiratory effort continues) and central (with loss of central respiratory drive). The cyclical apnoea and hypopneas are associated with sleep disturbance, hypoxaemia, haemodynamic changes, and sympathetic activation. Heart failure patients appear to be partially protected from the daytime somnolence that usually accompanies sleep-disordered breathing, perhaps by a high level of background sympathetic activation. Patients with sleep-disordered breathing have a worse prognosis than those without. Improving the control of the heart failure syndrome can improve sleep-disordered breathing. Mask-based therapies of positive airway pressure targeted at sleep-disordered breathing can improve measures of sleep quality and partially normalize the sleep and respiratory physiology, but recent randomized trials of cardiovascular outcomes in central sleep apnoea have been neutral or have even suggested the possibility of harm, likely from increased sudden death. Further randomized outcome studies are required to determine whether mask-based treatment is appropriate for patients with chronic systolic heart failure and obstructive sleep apnoea, for those with heart failure with preserved ejection fraction, and for those with decompensated heart failure. New therapies for central sleep apnoea—such as implantable phrenic nerve stimulators—also require robust assessment.

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1259 Periodic Neck Myoclonus During Sleep (PNMS) is Associated with Upper Airway Resistant Syndrome, but Resolves with CPAP

SLEEP ◽

10.1093/sleep/zsaa056.1253 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A479-A479

Author(s):

Majed A Alfi ◽

Alon Y Avidan

Keyword(s):

Rem Sleep ◽

Sleep Disordered Breathing ◽

Incidental Finding ◽

Upper Airway ◽

Nrem Sleep ◽

Clinical History ◽

Temporal Association ◽

Sleep State ◽

Upper Airway Resistance Syndrome ◽

Disordered Breathing

Abstract Introduction Periodic neck myoclonus during Sleep (PNMS) is a movement disorder of sleep characterized by sudden myoclonic flexion or version of the head that manifest during REM and NREM sleep. While its finding has been attributed to a normal physiologic phenomenon, to the best of our knowledge, our case represents the first report of with PNMS attributed to sleep disordered breathing with resolution using CPAP Report of Case A 22 y/o male with no significant clinical history was referred for evaluation of snoring and excessive sleepiness. Nocturnal polysomnogram coupled with expanded EMG montage demonstrates evidence of upper airway resistance syndrome (UARS), characterized by frequents respiratory effort-related arousals (RERAS), primarily during REM sleep associated with arousals. The majority of these events resulted in sudden myoclonic movements of the neck and head that were associated with arousals and sleep fragmentation. PNMS manifested in the PSG as a flexion myoclonic motor artifact lasting 200-800 ms during REM sleep with an associated EEG arousal. The overall Respiratory Disturbance Index (RDI) was12/hr. The subsequent application of CPAP at a setting of 5-6 cm resolved these movements supporting this origin as a phenomenon of sleep-state instability. Conclusion While previous investigators have explained PNMS as an incidental finding or one common in patients with RBD, our case highlights a potential new mechanism for their appearance. This case helps shed more light on the origin of PNMS as a secondary phenomenon related to sleep state instability due to sleep disordered breathing given the temporal association with RERAS and dramatic resolution with CPAP therapy.

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Faculty Opinions recommendation of Changes in lung volume and upper airway using MRI during application of nasal expiratory positive airway pressure in patients with sleep-disordered breathing.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718356433.793494027 ◽

2014 ◽

Author(s):

Neil Freedman

Keyword(s):

Lung Volume ◽

Airway Pressure ◽

Sleep Disordered Breathing ◽

Positive Airway Pressure ◽

Upper Airway ◽

Expiratory Positive Airway Pressure ◽

Disordered Breathing

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Apnoea–hypopnoea indices determined via continuous positive airway pressure (AHI-CPAPflow) versus those determined by polysomnography (AHI-PSGgold): a protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-044499 ◽

2021 ◽

Vol 11 (5) ◽

pp. e044499

Author(s):

Fanny Bertelli ◽

Carey Meredith Suehs ◽

Jean Pierre Mallet ◽

Marie Caroline Rotty ◽

Jean Louis Pepin ◽

...

Keyword(s):

Systematic Review ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Sleep Disordered Breathing ◽

Positive Airway Pressure ◽

Meta Analysis ◽

Sleep Apnoea ◽

Obstructive Sleep ◽

The Impact ◽

Disordered Breathing

Introduction To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea–hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. Methods and analysis No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. Ethics and dissemination This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/Trial registration numbers CRD42020159914/NCT04526366; Pre-results

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569 Correlation between age and initial findings of sleep disordered breathing in children with achondroplasia

SLEEP ◽

10.1093/sleep/zsab072.567 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A224-A225

Author(s):

Fayruz Araji ◽

Cephas Mujuruki ◽

Brian Ku ◽

Elisa Basora-Rovira ◽

Anna Wani

Keyword(s):

Sleep Apnea ◽

Primary Care Physicians ◽

Sleep Disordered Breathing ◽

Upper Airway ◽

Sleep Study ◽

Surgical Interventions ◽

Screening Guidelines ◽

Obstructive Sleep ◽

Children’S Sleep ◽

Disordered Breathing

Abstract Introduction Achondroplasia (ACH) occurs approximately 1 in 20,000–30,000 live births. They are prone to sleep disordered breathing specifically due to the upper airway stenosis, enlarged head circumference, combined with hypotonia and limited chest wall size associated with scoliosis at times. The co-occurrence of sleep apnea is well established and can aide in the decision for surgical intervention, however it is unclear at what age children should be evaluated for sleep apnea. Screening is often delayed as during the daytime there is no obvious gas exchange abnormalities. Due to the rareness of this disease, large studies are not available, limiting the data for discussion and analysis to develop guidelines on ideal screening age for sleep disordered breathing in children with ACH. Methods The primary aim of this study is to ascertain the presence of sleep disorder breathing and demographics of children with ACH at time of first polysomnogram (PSG) completed at one of the largest pediatric sleep lab in the country. The secondary aim of the study is to identify whether subsequent polysomnograms were completed if surgical interventions occurred and how the studies differed over time with and without intervention. Retrospective review of the PSGs from patients with ACH, completed from 2017–2019 at the Children’s Sleep Disorders Center in Dallas, TX. Clinical data, demographics, PSG findings and occurrence of interventions were collected. Results Twenty-seven patients with the diagnosis of ACH met criteria. The average age at the time of their first diagnostic PSG was at 31.6 months of age (2.7 years), of those patients 85% had obstructive sleep apnea (OSA),51% had hypoxemia and 18% had hypercapnia by their first diagnostic sleep study. Of those with OSA, 50% were severe. Majority were females, 55%. Most of our patients were Hispanic (14%), Caucasian (9%), Asian (2%), Other (2%), Black (0%). Each patient had an average of 1.9 PSGs completed. Conclusion Our findings can help create a foundation for discussion of screening guidelines. These guidelines will serve to guide primary care physicians to direct these patients to an early diagnosis and treatment of sleep disordered breathing. Support (if any):

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0897 Sleep Disordered Breathing In Pediatric Patients With Turner Syndrome

SLEEP ◽

10.1093/sleep/zsaa056.893 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A341-A342

Author(s):

Y A Yu ◽

B V Vaughn

Keyword(s):

Sleep Apnea ◽

Turner Syndrome ◽

Sleep Disordered Breathing ◽

Pediatric Patients ◽

Genetic Disorder ◽

Case Series ◽

Growth Failure ◽

Retrospective Chart Review ◽

Upper Airway Resistance Syndrome ◽

Disordered Breathing

Abstract Introduction Turner syndrome (TS) is a common genetic disorder that affects phenotypic females with partial or complete absence of one X chromosome. It typically presents with characteristic facial appearance, neck webbing, lymphedema, linear growth failure, and ovarian insufficiency. TS is also associated with other disorders, though sleep related disorders are not commonly reported. We present a case series of pediatric patients diagnosed with TS and assess their risk for sleep disordered breathing. Methods This study utilized retrospective chart review of the electronic medical record at the University of North Carolina at Chapel Hill from April 2014 to January 2019. Only pediatric patients under the age of 18 years who had previously undergone polysomnography and carrying the diagnosis of Turner syndrome were included in this study. Polysomnography results were reviewed. Results Retrospective chart analysis yielded ten (10) patients who qualified for inclusion. The mean age was 8.3 years (age range 1-15 years). Nine (9) patients were found to have sleep disordered breathing ranging from upper airway resistance syndrome to moderate sleep apnea (AHI range 1.2 to 6.2). Six (6) patients were found to have elevated periodic limb movement indices (PLM index range 5.1 to 30). Parasomnias and hypoventilation were not seen. Conclusion Our case series illustrates that sleep disordered breathing may be more common in TS than previously realized. Eklund et al. found that females with TS had more retrognathic mandibles and maxillas, shorter mandibles, and larger cranial base angles. These findings may indicate elevated risk of sleep apnea. Further studies are needed to define the overall risk of sleep disordered breathing in TS. Support None.

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