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The influence of speech therapy in the adherence of continuous positive airway pressure devices in sleep apnea syndrome: case report.
Studies show that some patients have difficulty on Continuos positive airway pressure (CPAP) adherence in the treatment of Obstructive sleep apnea syndrome (OSAS).
To present a case report of OSAS which the myofunctional therapy improved adherence to CPAP.
Patient, female, 73 years old, diagnosed with sleep apnea syndrome and heart arrhytmia, presenting difficulty using CPAP. She was referred by the sleep physician to speech therapy. Iniatially, she reported that she was having trouble to sleep, developing panic in the sleep time, described as breathing discomfort, fear and accerelated heartbeat. Her husband reported the presence of intense snoring on the nigths that she could sleep. During daytime, she was very tired and sleepy. In her first polysomnography (2012), the AHI was 26,5/hour, classified as moderate sleep apnea, and minimum oxygen saturation of 86%. She tried CPAP therapy, but she could not addapt and ended up abandoning treatment. When she returned to the sleep physician, a new polysomnography (split night) was requested (2015), which indicated a therapeutic pressure of 10,5cm H2O. She was referred to CPAP therapy again, although this time with combined speech therapy. In the myofunctional therapy, breathing exercises were used with and without the mask in the seated position until reaching the lay down position. Information about sleep hygiene, sleep schedule and rhythm were also given during therapy sessions. Daily exercises were suggested, 3 times a day, involving intraoral sensitization of the tongue; and isometric and isotonic exercises associated with oropharyngeal muscle strengthening and mobility, and facial as: snapping and tongue pressure on the palate, elevation and rotation of tongue in the oral vestibule, /B/prolonged, fry laryngeal; Crackling, protrusion and retraction of lips, and blowing and sucking with different resistances. The sessions started weekly and, as time went by, semiannually
Nowadays, she uses CPAP all night, 5,27h/night on average, with significant reduction of symptoms, besides the control of the arrhythmia, leading the cardiologist to gradually decrease the dose of amiodarone from 200mg, to 100mg and, currently, to suspend it. The patient has been using CPAP for 3 years, with good adeherence and AHI 1/hour.
The myofunctional therapy assisted in the adherence to CPAP treatment and the improvement of patient's quality of life.
Myofunctional therapy, positive airway pressure, apnea, arrhythmia
Relato de Caso
UNIAUP - Sao Paulo - Brasil
CLAUDIA ARAUJO NAVARRO, CAROLINA COZZI MACHADO