Establishment of the Avec Group located in Marseille, the Bonneveine clinic offers treatment for sleep disorders through a complete diagnostic assessment.
Mathilde Faro, speech therapist at the Bonneveine clinic, explains the importance of oro-myo-oro-functional rehabilitation in obstructive sleep apnea syndrome.
In a research article, the practitioner details sleep apnea, preconceived ideas, the origins, treatments of this pathology, as well as the role played by the speech therapist and oral-myo-functional rehabilitation.
What is sleep apnea?
Obstructive sleep apnea syndrome (OSAS) is a sleep disorder
marked by nocturnal pharyngeal collapse leading to partial (hypopnea) or complete (apnea) obstruction of the airways. It is found in 3 to 7% of men and 2 to 5% of women. It is estimated that 60% of affected patients are not diagnosed. (Saunier, V, 2022). OSA causes incessant micro-awakenings of which the patient is not aware. This results in daytime sleepiness, difficulty concentrating and remembering. In the most serious forms, it can lead to cardiovascular complications (Inserm, 2017).
The ideas received
You can suffer from sleep apnea without being overweight or a snorer. This pathology can also affect young women, with a normal BMI, who do not snore. A certain number of children also suffer from sleep apnea; according to Inserm, nearly 2% of children aged two to six are affected by sleep apnea.
What origin(s)?
OSAS is of multifactorial origin, it can be linked to hypertrophy of the soft tissues of the upper airways, narrowness of the bony bases of the face, damage to neuromuscular tone or a combination of these different factors (S. Hannachi et. al, 2020). It is associated with numerous cardiovascular and metabolic comorbidities. There is a strong association between OSA and high blood pressure, atherosclerosis, coronary artery disease, heart failure, stroke, type II diabetes, etc. The high prevalence of this disorder as well as the repercussions on the physical and mental health of patients make it a real public health problem. In this sense, screening and multidisciplinary care as early as possible are essential.
What treatment(s)?
Continuous positive airway pressure (CPAP) therapy is the standard treatment for OSA to date. Its effectiveness has been well demonstrated, but its use still remains hampered today by difficulties in adhering to treatment generated by the discomfort of the device (Bironneau V. & Meurice, JC. 2019).
Other specific therapies include surgery and mandibular advancement orthoses (MAOs). Although their effectiveness is less constant than CPAP, they are truly effective in a good number of cases, with either a disappearance of apnea or a significant reduction, sufficient to avoid daytime symptoms and reduce complications. (Amat, P. & Tran Lu Y, E. 2019).
As OSAS is of multifactorial origin, multidisciplinary management represents the most effective approach. If it is fundamental to re-educate orofacial functions, it is also essential to acquire a better lifestyle, access psychological support as well as reinforce physical activity (L.-C. Chuang, et al . 2021).
What role does the speech therapist play?
Gone are the days when the speech therapist was limited to re-educating the “hair” on the tongue (although this time has only ever existed in collective consciousness), it occupies a central role in the management of OSA. She is in fact the qualified professional, in the same way as the physiotherapist, to carry out oro-myo-functional rehabilitation by strengthening the muscles of the patient’s tongue and respiratory tract.
The different exercises offered during the rehabilitation sessions aim to tone the
oropharyngeal and orofacial structures. These have been shown to be effective combined with breathing, chewing and swallowing exercises. Therefore, a good lingual position will allow easier passage of air into the upper airways (VAS).
Oro-myo-functional rehabilitation
The myofunctional approach to speech therapy aims at an educational proposal to help the patient understand the importance of an adequate lingual position in order to establish nasal breathing during sleep to achieve a better quality of life. The objective is therefore to free the upper airways (VAS) through muscular strengthening of the orofacial structures and restoration of nasal breathing (De Felício et.al, 2018).
Oro-myo-functional rehabilitation, recognized for the first time in 1990 by ASHA
(American Speech and Hearing Association), today represents an alternative combining quality, efficiency and speed. If it cannot be considered as a solution on its own, it must systematically be offered as a complementary therapy to first-line treatments. Indeed, studies show better adherence to CPAP or OAM when they are supplemented by oro-myo-functional rehabilitation (Camacho et al, 2015). In addition, restoration of functions is imperative to sustain the results of traditional curative approaches. Thus, speech therapy would not replace other treatments but would improve the results or allow patients to not necessarily have to resort to them.
Studies have proven that oromyo-functional rehabilitation allows a significant reduction in the AHI (Apnea Hypopnea Index) of up to 92.06% in adults, a reduction in intensity and frequency snoring, reduced sleepiness
daytime as well as better adherence to treatment with CPAP or OAM (L.-C. Chuang, et al. 2021).
Society is currently facing a recent sleep pathology, largely under-resourced.
diagnosed and devastating due to the associated major comorbid pathologies. It is now essential to consider patient care in a holistic, interdisciplinary manner in order to offer the best care, systematically, early, individualized and over the long term.
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