山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (4): 108-114.doi: 10.6040/j.issn.1673-3770.0.2020.286

• • 上一篇    下一篇

口面肌功能治疗对阻塞性睡眠呼吸暂停研究进展

李丹阳,梁辉   

  1. 山东第一医科大学第一附属医院/山东省千佛山医院 耳鼻咽喉科, 山东 济南 250014
  • 发布日期:2021-08-05
  • 通讯作者: 梁辉. E-mail:onlinelh@163.com
  • 基金资助:
    济南市科技计划(后补助)项目(201907062)

Advancements in orofacial myofunctional therapy for obstructive sleep apnea

LI Danyang,LIANG Hui   

  1. Department of Otorhinolaryngology, The First Hospital Affiliated Hospital of Shandong First Medical University/Shandong provincial Qianfoshan Hospital, Jinan 250000, Shandong, China
  • Published:2021-08-05

摘要: 目的 系统回顾口面肌功能治疗(OMT)相关文献,就OMT的动作、机制及对阻塞性睡眠呼吸暂停(OSA)的疗效进行分析。 方法 使用Pubmed、CNKI、万方医学进行搜索截至2020年6月前的相关文献。 结果 共回顾24篇研究,包括14篇研究成人OSA,10篇研究儿童OSA,其中有20项研究均显示治疗前后AHI有改善,但改善程度主要取决于OSA严重程度及治疗时间。 结论 研究证明OMT对治疗单纯打鼾、成人轻至重度OSA、儿童OSA均有效果,可作为治疗OSA的一种重要替代治疗。但OSA的发病机制尚不完全清楚,且相关临床试验和样本数量较少,仍需进一步研究。

关键词: 睡眠呼吸暂停,阻塞性, 口面肌功能治疗, 口咽运动, 成人, 儿童

Abstract: Objective The purpose of this study was to systematically review exercises of orofacial myofunctional therapy(OMT)and the mechanism of OMT to treat obstructive sleep apnea(OSA). Methods Studies extracted from PubMed, China National Knowledge Infrastructure, and Wanfang Medical Online up to June 2020 were included. Results Twenty-four studies involving adults and children were analyzed. Among them, 14 studies were on OSA in adults, while 10 were on OSA in children. Twenty studies measured the Apnea-Hypopnea Index and showed improvement, but the degree of improvement varied with the OSA severity and treatment time. Conclusion This study showed that OMT significantly affected simple snoring and mild to severe OSA in adults and pediatric OSA and could be used as an alternative treatment for OSA. However, the mechanism of OSA is unclear, and further studies are required because of the small number of clinical trials and sample size.

Key words: Sleep apnea, obstructive, Oroficial myofunctional therapy, Oropharyngeal exercises, Adult, Children

中图分类号: 

  • R766.7
[1] Patil SP, Schneider H, Schwartz AR, et al. Adult obstructive sleep apnea[J]. Chest, 2007, 132(1): 325-337. doi:10.1378/chest.07-0040.
[2] Afsharpaiman S, Shahverdi E, Vahedi E, et al. Continuous positive airway pressure compliance in patients with obstructive sleep apnea[J]. Tanaffos, 2016, 15(1): 25-30.
[3] Schwartz AR, Gold AR, Schubert N, et al. Effect of weight loss on upper airway collapsibility in obstructive sleep apnea[J]. Am Rev Respir Dis, 1991, 144(3 pt 1): 494-498. doi:10.1164/ajrccm/144.3_pt_1.494.
[4] Schmidt-Nowara W, Lowe A, Wiegand L, et al. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review[J]. Sleep, 1995, 18(6): 501-510. doi:10.1093/sleep/18.6.501.
[5] Langin T, Pépin JL, Pendlehury S, et al. Upper airway changes in snorers and mild sleep apnea sufferers after uvulopalatopharyngoplasty(UPPP)[J]. Chest, 1998, 113(6): 1595-1603. doi:10.1378/chest.113.6.1595.
[6] Wiegand DA, Latz B, Zwillich CW, et al. Upper airway resistance and geniohyoid muscle activity in normal men during wakefulness and sleep[J]. J Appl Physiol, 1990, 69(4): 1252-1261. doi:10.1152/jappl.1990.69.4.1252.
[7] Guimarães KC, Drager LF, Genta PR, et al. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome[J]. Am J Respir Crit Care Med, 2009, 179(10): 962-966. doi:10.1164/rccm.200806-981oc.
[8] Mohamed AS, Sharshar RS, Elkolaly RM, et al. Upper airway muscle exercises outcome in patients with obstructive sleep apnea syndrome[J]. Egypt J Chest Dis Tuberc, 2017, 66(1): 121-125. doi:10.1016/j.ejcdt.2016.08.014.
[9] Ieto V, Kayamori F, Montes MI, et al. Effects of oropharyngeal exercises on snoring: a randomized trial[J]. Chest, 2015, 148(3): 683-691. doi:10.1378/chest.14-2953.
[10] Baz H, Elshafey M, Elmorsy M, et al. The role of myofunctional therapy in maneging patients with mild to moderate obstructive sleep apnea[J]. PAN Arab Journal of Rhinology, 2012, 2(1):17-22.
[11] Diaféria G, Badke L, Santos-Silva R, et al. Effect of speech therapy as adjunct treatment to continuous positive airway pressure on the quality of life of patients with obstructive sleep apnea[J]. Sleep Med, 2013, 14(7): 628-635. doi:10.1016/j.sleep.2013.03.016.
[12] Diaféria G, Santos-Silva R, Truksinas E, et al. Myofunctional therapy improves adherence to continuous positive airway pressure treatment[J]. Sleep Breath, 2017, 21(2): 387-395. doi:10.1007/s11325-016-1429-6.
[13] Verma RK, Johnson J JR, Goyal M, et al. Oropharyngeal exercises in the treatment of obstructive sleep apnoea: our experience[J]. Sleep Breath, 2016, 20(4): 1193-1201. doi:10.1007/s11325-016-1332-1.
[14] Tang SX, Qing J, Wang YW, et al. Clinical analysis of pharyngeal musculature and genioglossus exercising to treat obstructive sleep apnea and hypopnea syndrome[J]. J Zhejiang Univ Sci B, 2015, 16(11): 931-939. doi:10.1631/jzus.b1500100.
[15] Eckert DJ, White DP, Jordan AS, et al. Defining phenotypic causes of obstructive sleep apnea. identification of novel therapeutic targets[J]. Am J Respir Crit Care Med, 2013, 188(8): 996-1004. doi:10.1164/rccm.201303-0448oc.
[16] McSharry DG, Saboisky JP, DeYoung P, et al. Physiological mechanisms of upper airway hypotonia during REM sleep[J]. Sleep, 2014, 37(3): 561-569. doi:10.5665/sleep.3498.
[17] Genta PR, Sands SA, Butler JP, et al. Airflow shape is associated with the pharyngeal structure causing OSA[J]. Chest, 2017, 152(3): 537-546. doi:10.1016/j.chest.2017.06.017.
[18] Hirata RP, Schorr F, Kayamori F, et al. Upper airway collapsibility assessed by negative expiratory pressure while awake is associated with upper airway anatomy[J]. J Clin Sleep Med, 2016, 12(10): 1339-1346. doi:10.5664/jcsm.6184.
[19] Osman AM, Carter SG, Carberry JC, et al. Obstructive sleep apnea: current perspectives[J]. Nat Sci Sleep, 2018, 10: 21-34. doi:10.2147/nss.s124657.
[20] 沈翎, 林宗通, 林兴, 等. 儿童阻塞性睡眠呼吸暂停低通气综合征危险因素的病例对照研究[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 25-29. doi:10.6040/j.issn.1673-3770.0.2018.086. SHEN Ling, LIN Zongtong, LIN Xing, et al. Risk factors associated with obstructive sleep apnea-hypopnea syndrome in children: a retrospective case-control study[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(2): 25-29. doi:10.6040/j.issn.1673-3770.0.2018.086.
[21] Shepherd KL, Jensen CM, Maddison KJ, et al. Relationship between upper airway and inspiratory pump muscle force in obstructive sleep apnea[J]. Chest, 2006, 130(6): 1757-1764. doi:10.1378/chest.130.6.1757.
[22] Engelke W, Engelhardt W, Mendoza-Gärtner M, et al. Functional treatment of snoring based on the tongue-repositioning manoeuvre[J]. Eur J Orthod, 2010, 32(5): 490-495. doi:10.1093/ejo/cjp135.
[23] Cori JM, O'Donoghue FJ, Jordan AS. Sleeping tongue: current perspectives of genioglossus control in healthy individuals and patients with obstructive sleep apnea[J]. Nat Sci Sleep, 2018, 10: 169-179. doi:10.2147/nss.s143296.
[24] Blottner D, Salanova M, Püttmann B, et al. Human skeletal muscle structure and function preserved by vibration muscle exercise following 55 days of bed rest[J]. Eur J Appl Physiol, 2006, 97(3): 261-271. doi:10.1007/s00421-006-0160-6.
[25] Steele CM, Alsanei WA, Ayanikalath S, et al. The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review[J]. Dysphagia, 2015, 30(1): 2-26. doi:10.1007/s00455-014-9578-x.
[26] Suzuki H, Watanabe A, Akihiro Y, et al. Pilot study to assess the potential of oral myofunctional therapy for improving respiration during sleep[J]. J Prosthodont Res, 2013, 57(3): 195-199. doi:10.1016/j.jpor.2013.02.001.
[27] Vranish JR, Bailey EF. Inspiratory muscle training improves sleep and mitigates cardiovascular dysfunction in obstructive sleep apnea[J]. Sleep, 2016, 39(6): 1179-1185. doi:10.5665/sleep.5826.
[28] Kuo YC, Song TT, Bernard JR, et al. Short-term expiratory muscle strength training attenuates sleep apnea and improves sleep quality in patients with obstructive sleep apnea[J]. Respir Physiol Neurobiol, 2017, 243: 86-91. doi:10.1016/j.resp.2017.05.007.
[29] Herkenrath SD, Treml M, Priegnitz C, et al. Effects of respiratory muscle training(RMT)in patients with mild to moderate obstructive sleep apnea(OSA)[J]. Sleep Breath, 2018, 22(2): 323-328. doi:10.1007/s11325-017-1582-6.
[30] Matsumura E, Vecina ALC, Inocêncio LB, et al. Perception of the bed partner and the individual suffering from SNORING/OSAS before and after speech therapy[J]. Rev Cefac, 2014, 16. doi: 10.1590/1982-0216201425612.
[31] Atilgan E, Kunter E, Algun ZC. Are oropharyngeal exercises effective in Obstructive Sleep Apnea Syndrome?[J]. J Back Musculoskelet Rehabil, 2020, 33(2): 209-216. doi:10.3233/bmr-171101.
[32] 刘文君, 于雪莹, 吕丹, 等. 不同性别阻塞性睡眠呼吸暂停低通气综合征患者与上气道影像学相关性的研究[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 54-59. doi:10.6040/j.issn.1673-3770.0.2017.100. LIU Wenjun, YU Xueying, LYU Dan, et al. Correlation between obstructive sleep apnea hypopnea syndrome and upper airway measurements of different genders[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2017, 31(4): 54-59. doi:10.6040/j.issn.1673-3770.0.2017.100.
[33] Katz ES, D'Ambrosio CM. Pathophysiology of pediatric obstructive sleep apnea[J]. Proc Am Thorac Soc, 2008, 5(2): 253-262. doi:10.1513/pats.200707-111mg.
[34] Camacho M, Certal V, Abdullatif J, et al. Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis[J]. Sleep, 2015, 38(5): 669-675. doi:10.5665/sleep.4652.
[35] Villa MP, Brasili L, Ferretti A, et al. Oropharyngeal exercises to reduce symptoms of OSA after AT[J]. Sleep Breath, 2015, 19(1): 281-289. doi:10.1007/s11325-014-1011-z.
[36] Guilleminault C, Huang YS, Monteyrol PJ, et al. Critical role of myofascial reeducation in pediatric sleep-disordered breathing[J]. Sleep Med, 2013, 14(6): 518-525. doi:10.1016/j.sleep.2013.01.013.
[37] Lee SY, Guilleminault C, Chiu HY, et al. Mouth breathing, “nasal disuse, ” and pediatric sleep-disordered breathing[J]. Sleep Breath, 2015, 19(4): 1257-1264. doi:10.1007/s11325-015-1154-6.
[38] von Lukowicz M, Herzog N, Ruthardt S, et al. Effect of a 1-week intense myofunctional training on obstructive sleep apnoea in children with Down syndrome[J]. Arch Dis Child, 2019, 104(3): 275-279. doi:10.1136/archdischild-2018-315064.
[39] Levrini L, Salone GS, Ramirez-Yanez GO. Pre-fabricated myofunctional appliance for the treatment of mild to moderate pediatric obstructive sleep apnea: a preliminary report[J]. J Clin Pediatr Dent, 2018, 42(3): 236-239. doi:10.17796/1053-4628-42.3.13.
[40] Chuang LC, Lian YC, Hervy-Auboiron M, et al. Passive myofunctional therapy applied on children with obstructive sleep apnea: a 6-month follow-up[J]. J Formos Med Assoc, 2017, 116(7): 536-541. doi:10.1016/j.jfma.2016.08.002.
[41] Chuang LC, Hwang YJ, Lian YC, et al. Changes in craniofacial and airway morphology as well as quality of life after passive myofunctional therapy in children with obstructive sleep apnea: a comparative cohort study[J]. Sleep Breath, 2019, 23(4): 1359-1369. doi:10.1007/s11325-019-01929-w.
[42] Huang YS, Hsu SC, Guilleminault C, et al. Myofunctional therapy: role in pediatric OSA[J]. Sleep Med Clin, 2019, 14(1): 135-142. doi:10.1016/j.jsmc.2018.10.004.
[43] Huang YS, Chuang LC, Hervy-Auboiron M, et al. Neutral supporting mandibular advancement device with tongue bead for passive myofunctional therapy: a long term follow-up study[J]. Sleep Med, 2019, 60: 69-74. doi:10.1016/j.sleep.2018.09.013.
[44] Villa MP, Evangelisti M, Martella S, et al. Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing?[J]. Sleep Breath, 2017, 21(4): 1025-1032. doi:10.1007/s11325-017-1489-2.
[45] Arens R, McDonough JM, Corbin AM, et al. Upper airway size analysis by magnetic resonance imaging of children with obstructive sleep apnea syndrome[J]. Am J Respir Crit Care Med, 2003, 167(1):65-70.
[1] 张丰珍, 王桂香, 魏沄沄, 张亚梅, 赵靖, 王华, 李宏彬, 李晓丹, 张杰. 合并轻度出血性疾病的扁桃体和(或)腺样体切除术患儿围手术期管理[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 66-72.
[2] 林一杭,李幼瑾. 肠道微生态在儿童变应性鼻炎中的研究现状[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 116-122.
[3] 李琳,高正文,崔楠,孙健平,黄贤明,崔静. 儿童慢性鼻窦炎基因表达谱的生物信息学分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 171-180.
[4] 鹿伟理,姜涛,李宪华. 多重致敏儿童变应性鼻炎患者sIgE特征分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 260-265.
[5] 杨扬, 王晓旭, 张杰. 儿童中耳胆脂瘤诊治进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 1-6.
[6] 高信忠, 林宗通, 沈翎, 刘平凡, 林兴, 许杨杨. 咽鼓管球囊扩张联合腺样体切除术治疗儿童分泌性中耳炎疗效分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 7-12.
[7] 马宁, 陈敏, 刘薇, 杨扬, 邵剑波, 郝津生, 刘冰, 张晓, 段晓岷, 张祺丰, 张杰. 儿童颞骨骨折临床特点和治疗策略[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 13-19.
[8] 胡春燕, 党攀红, 张睿, 樊孟耘. 儿童单侧感音性听力损失的听力学及影像学特征149例分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 31-36.
[9] 党攀红, 张睿, 胡春燕, 王洁, 樊孟耘. 儿童乳突-颞下迷路外面神经减压术8例临床分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 37-42.
[10] 刘珊珊, 韩书婧, 王晓旭, 李艳红, 倪鑫, 张杰. 儿童细菌性脑膜炎后听力损害危险因素的系统评价与Meta分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 48-54.
[11] 焦雪梅,杨扬,李春凤,张晓琳. 鼓膜置管对分泌性中耳炎患儿咽鼓管功能的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 60-63.
[12] 王蓬鹏,葛文彤,唐力行,杨小健,张薇,肖潇,韩阳. 开放性鼻整形切口治疗儿童先天性鼻中线囊肿及瘘管4例及文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 64-69.
[13] 李孟辉,郅莉莉,戚凯文,王珊珊,高倩,步美玲,姜荷云,冯绛楠,王金荣. 皮下免疫治疗对单一尘螨和合并霉菌过敏儿童哮喘的临床研究[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 75-80.
[14] 赵海涛, 王亚芳, 赫莉, 陈文静, 邢民者, 郑文娟,阎玉彦,刘晓峰. 可视喉镜在先天性舌根囊肿患儿手术麻醉中的应用[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 106-110.
[15] 师晓丽, 牟鸿. 多学科联合诊治重度儿童阻塞性睡眠呼吸暂停综合征并发肺动脉高压1例[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 116-119.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 张晗,黄一飞 . 抗角膜移植排斥的研究进展[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 84 -87 .
[2] 牛善利,柴茂文,李振秀 . 鼻内镜下鼻甲成形术治疗慢性肥厚性鼻炎60例[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 16 -18 .
[3] 孟庆国,卢永田,范献良 . 杀伤细胞免疫球蛋白样受体基因多态性与鼻咽癌的关联性[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 196 -199 .
[4] 马玉起,孔祥春 . 先天性双侧下唇窦道1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 199 -199 .
[5] 万俐佳,鲁海涛,姜义道,刘 辉,李 琴,佘腊枝 . 改良腭咽成形术治疗阻塞性睡眠呼吸暂停综合征41例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 204 -205 .
[6] 于青青 ,王跃建 . 硬质耳内镜的临床应用进展[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 222 -224 .
[7] 吉晓滨,邓家德,臧林泉,王 磊,谢 军 . 豚鼠变应性鼻炎模型血清组胺的测定[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 228 -230 .
[8] 向登,卢永田,孙焕吉 . 鼻内镜下修补脑脊液鼻漏19例并文献复习[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 234 -236 .
[9] 邱恩惠,李志春,方文旭 . 嗅觉障碍的中西医治疗[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 253 -257 .
[10] 殷国华,钟 笑 . 激光减容术治疗舌扁桃体肥大的远期疗效[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 280 -282 .