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Sleep speech-language therapy: considerations on two cases of elderly individuals with severe obstructive sleep apnea
Obstructive sleep apnea (OSA) may affect individuals in several age ranges, yet the incidence increases with age. CPAP is considered the gold standard in the rehabilitation of sleep breathing disorders (SBD), yet the literature presents several case reports in which the adherence to the use of CPAP is a therapeutic challenge. The other treatment options for SBD include the speech-language therapy – Orofacial Myofunctional Therapy (OMT).
To describe two cases of male elderly individuals with severe OSA, aged 77 and 78 years (patients 1 and 2), both referred by the sleep medicine specialist for speech-language treatment due to refusal to use the CPAP.
Individuals with OSA submitted to evaluations - MBGR protocol – Orofacial Myofunctional Clinical Examination and polysomnography – before and after the OMT program. Based on the initial data, the following therapeutic planing was established for 4 months: patient 1: 12 weekly sessions; patient 2: 4 weekly, two bimonthly and two monthly sessions. For both patients, the therapy addressed the orofacial functions of breathing, mastication, swallowing and myotherapeutic exercises, aiming to balance the orofacial muscle dynamics, reduce the intensity and frequency of snoring and obstructive breathing episodes during sleep. The patients were instructed to perform the orofacial exercises 3 times a day, control the orofacial functions and position during sleep. After 4 months of OMT, the patients were submitted to speech-language re-evaluation and returned to the sleep medicine specialist, who requested another polysomnography.
The following results were observed for both patients: reduction of tongue width and height, greater recruitment of palatal vault muscles and adequacy of orofacial functions. The polysomnography reveled changes in the following parameters: Patient 1: AHI (before 39.7/h x after 6.9/h) and oxygen saturation (before: mean 91% and minimum 77% x after: mean 92% and minimum 88%). Patient 2: AHI (before 36.6/h x after 4.5/h) and time with SpO2 <90%* (before: 2.3% x after: 0%).
In the literature, there is no recommendation of OMT for elderly individuals with severe OSA. However, it was observed that OMT was effective to reduce the AHI and enhance the oxygen saturation. Further investigations should be conducted on cases of elderly individuals with severe OSA who refuse to use the CPAP.
aging, obstructive sleep apnea, myofunctional therapy
Relato de Caso
Lilian Krakauer, Silvia Bertacci Manzi , Yasmin Salles Frazão, Vanessa Ieto