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Y.-J. Lai1, C.-H. Hung2, C.-Y. Lin3
1Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, 2College of Medicine, National Cheng Kung University, Department of Physical Therapy, Tainan, Taiwan, 3National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Department of Otolaryngology, Tainan, Taiwan
Background: Obstructive sleep apnea syndrome (OSA) is manifested as a decrease (hypopnea) and cessation (apnea) of airflow. Fragmentation of airflow leads patient to have comorbidity like coronary artery disease and metabolic abnormality. Continuous positive airway pressure is the gold standard treatment of OSA, but the patients' adherence is low. Transoral robotic surgery (TORS), which is a kind of alternative treatment, remove the extra soft tissue of the tongue base and soft palate, but the success rate was only 66.9% and the symptoms might relapse because of aging and gaining weights. Myofunctional therapeutic training (MFTT) can be a connective treatment to reeducate the upper airway muscles to promote and sustain the surgical outcomes.
Purpose: In our study, we investigated the effect of TORS surgery and combine therapy for OSA patients.
Methods: Eighteen adult patients were recruited, who were newly diagnosed with moderate to severe OSA. They were distributed to TORS (n=4) or TORS+MFTT (n=14) group depends on their willingness. Polysomnography (PSG), computed tomography (CT), questionnaires (Pittsburgh sleep quality index, PSQI; Snore Outcomes Survey, SOS; Epworth sleepiness scale, ESS), and the muscle strength of tongue and jaw-opening were assessed before TORS surgery, 6-week and 18-week after surgery. The components of MFTT program involved tongue exercise, soft palate exercise, pterygoid exercise and pharyngeal exercise. It began at 6th week after surgery and these patients underwent 12 weeks of the home-based oropharyngeal MFTT. During the training intervention period, subjects were interviewed every week for adjusting the treatment intensity.
Results: Mean age was 47 years old (SD 7.4) and body mass index (BMI) was 27.18 (SD 6.3) in TORS group. Mean age was 47.1 years old (SD 9.0) and body mass index (BMI) was 27.4 (SD 4.7) in TORS+MFTT group. In TORS group, only SOS score was significantly increase after surgery (from 29 to 60, p=0.003); however, BMI, neck circumference, AHI-supine, AHI-REM, scores of questionnaires, minimal anterior posterior distance of velopharynx and muscle strength of tongue and jaw were significantly improved after combined treatment of TORS and MFTT (p<0.05). Muscle strength of tongue and jaw were the significant predictors of AHI-supine and AHI-REM reduction.
Conclusion(s): Our study presented that oropharyngeal MFTT could improve the effect of TORS and improve OSA severity and symptoms.
Implications: MFTT may sustain the muscle strength after surgery and decrease the possibility of re-surgery. Combination of surgery and MFTT may be a new choice for OSA patients.
Funding, acknowledgements: This work was supported by National Cheng-Kung University Hospital (grant number NCKUH-10902002).
Keywords: obstructive sleep apnea, myofunctional therapeutic training, transoral robotic surgery
Topic: Musculoskeletal
Did this work require ethics approval? Yes
Institution: National Cheng Kung University Hospital
Committee: Institutional Review Board
Ethics number: A-BR-108-059
All authors, affiliations and abstracts have been published as submitted.
