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Título

OROFACIAL AND OROPHARYNGEAL EVALUATION PROTOCOL FOR AOS (OOEPA): COMPARISON WITH OBSTRUCTION SITES

Introdução

Obstructive sleep apnea (OSA) is known for its high prevalence in the population and serious consequences. Polysomnography is considered the gold standard exam, but does not evaluate the location of pharyngeal closure in relation to anatomy. Drug Induced Sleep Endocopy (DISE) evaluates the obstruction site (s) in similar as sleep situation and thus directs treatment. It is considered expensive and variable depending on the drug / sedation used. We seek simpler and lower cost methods that can help predict the site and type of obstruction.

Objetivo

To organize a simple assessment instrument with questionnaires and orofacial and oropharyngeal myofunctional assessment specific to sleep breathing disorders, seeking to provide myofunctional predictors of collapse areas during sleep.

Métodos

29 subjects (male); age 22-65 years; mild, moderate and severe apnea; ENT indication for DISE; signed the consent form. Excluded: age over 65 years and maxillary deficiency. Questionnaires were applied (Pittsburgh, Berlin/Snore and Epworth); OOEPA which evaluated the soft palate, palatal pillars and uvula (structure and mobility); tonsils (size), jaw position relative to bony bases, hard palate (depth and width); tongue (habitual posture and volume), floor of the mouth (mylohyoid muscle), sucking the tongue and maintaining (tongue / mobility), “lowering the back of the tongue” (tongue/stimulus) scored by three speech therapists with expertise; Sonoendoscopy according to obstruction site (palatine veil (V), oropharynx lateral wall (O), tongue base (T) and epiglottis (E)). Performed (t-test) for comparison between groups without and with obstruction in VOTE with questionnaires and OOEPA (p = 0.05).

Resultados

They were significantly different between the groups without and with obstruction: Berlin frequency (p = 0.026) of velopharynx VOTE; Berlin intensity (p = 0.023) and Berlin frequency (p = 0.032) of VOTE in oropharynx lateral wall; tongue mobility by sucking the tongue and maintaining (p = 0.017) VOTE in velopharynx; hard palate depth and width (p = 0.015 and p = 0.047) of VOTE in epiglottis; tonsils (p = 0.048) of epiglottis VOTE; habitual tongue position (p = 0.001) of VOTE in epiglottis; floor of the mouth (p = 0.013) of epiglottis VOTE.

Conclusões

Simple speech-language evaluation with questionnaires and orofacial and oropharyngeal myofunctional assessment specific for sleep-disordered breathing indicate some myofunctional predictors of collapse areas.

Palavras-chave

obstructive sleep apnea,
myofunctional therapy,
endoscopy

Área

Projeto

Autores

Fabiane Kayamori, Daniella Nazário, Fabio Augusto Winckler Rabelo, Eric Rodrigues Thuler, Esther Mandelbaum Gonçalves Bianchini