背景:阻塞性睡眠呼吸暂停/低通气综合征(OSAHS)是一种普遍存在的疾病,影响了全球相当大一部分人口,在过去的20年里,它的患病率越来越高。OSAHS的特点是睡眠期间反复上呼吸道(UA)闭合,导致对生活质量产生重大影响,并增加心血管和代谢发病率。尽管持续气道正压通气(CPAP)是治疗的金标准,由于各种因素,患者的依从性仍然欠佳,如不适,副作用,和治疗不可接受。
目的:考虑到与CPAP依从性相关的挑战,我们探索了一种通过肌功能疗法靶向UA肌肉的替代方法.这种非侵入性干预涉及嘴唇的锻炼,舌头,或两者都可以改善口咽功能并减轻OSAHS的严重程度。为了开发用于基于家庭的肌功能治疗的便携式设备,并连续监测运动表现和依从性,本研究的主要结局是完成和坚持4周训练的程度.
方法:这项概念验证研究的重点是一种便携式设备,该设备旨在促进舌头和嘴唇的肌功能治疗,并能够精确监测运动表现和依从性。进行了一项临床研究,以评估该计划在改善睡眠呼吸障碍方面的有效性。参与者被指示进行舌头突出,唇压,控制呼吸作为各种任务的一部分,每周6次,持续4周,每节持续约35分钟。
结果:10名参与者被纳入研究(n=8名男性;平均年龄48岁,SD22岁;平均BMI29.3,SD3.5kg/m2;平均呼吸暂停低通气指数[AHI]20.7,SD17.8/小时)。在完成为期4周的计划的8名参与者中,总体依从率为91%(175/192次).对于舌头运动,成功率从第一天的66%(211/320练习;SD18%)增加到最后一天的85%(272/320练习;SD17%)(P=0.05)。训练结束后AHI没有明显变化,但成功的嘴唇运动改善与仰卧位AHI降低之间存在显著相关性(Rs=-0.76;P=0.03)。这些发现证明了该设备在肌功能治疗期间准确监测参与者在嘴唇和舌头压力练习中的表现的潜力。训练计划的多样性(it混合练习混合训练游戏),它能够为每个练习向参与者提供直接反馈,和治疗依从性的容易测量是我们的培训计划的主要优势。
结论:该研究的便携式家用肌功能疗法设备有望作为降低OSAHS严重程度的非侵入性替代方法,成功的嘴唇锻炼改善与AHI减少之间存在显着相关性,保证进一步的发展和调查。
BACKGROUND: Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a prevalent condition affecting a substantial portion of the global population, with its prevalence increasing over the past 2 decades. OSAHS is characterized by recurrent upper airway (UA) closure during sleep, leading to significant impacts on quality of life and heightened cardiovascular and metabolic morbidity. Despite continuous positive airway pressure (CPAP) being the gold standard treatment, patient adherence remains suboptimal due to various factors, such as discomfort, side effects, and treatment unacceptability.
OBJECTIVE: Considering the challenges associated with CPAP adherence, an alternative approach targeting the UA muscles through myofunctional therapy was explored. This noninvasive intervention involves exercises of the lips,
tongue, or both to improve oropharyngeal functions and mitigate the severity of OSAHS. With the goal of developing a portable device for home-based myofunctional therapy with continuous monitoring of exercise performance and adherence, the primary outcome of this study was the degree of completion and adherence to a 4-week training session.
METHODS: This proof-of-concept study focused on a portable device that was designed to facilitate tongue and lip myofunctional therapy and enable precise monitoring of exercise performance and adherence. A clinical
study was conducted to assess the effectiveness of this program in improving sleep-disordered breathing. Participants were instructed to perform
tongue protrusion, lip pressure, and controlled breathing as part of various tasks 6 times a week for 4 weeks, with each session lasting approximately 35 minutes.
RESULTS: Ten participants were enrolled in the
study (n=8 male; mean age 48, SD 22 years; mean BMI 29.3, SD 3.5 kg/m2; mean apnea-hypopnea index [AHI] 20.7, SD 17.8/hour). Among the 8 participants who completed the 4-week program, the overall compliance rate was 91% (175/192 sessions). For the
tongue exercise, the success rate increased from 66% (211/320 exercises; SD 18%) on the first day to 85% (272/320 exercises; SD 17%) on the last day (P=.05). AHI did not change significantly after completion of training but a noteworthy correlation between successful lip exercise improvement and AHI reduction in the supine position was observed (Rs=-0.76; P=.03). These findings demonstrate the potential of the device for accurately monitoring participants\' performance in lip and tongue pressure exercises during myofunctional therapy. The diversity of the training program (it mixed exercises mixed training games), its ability to provide direct feedback for each exercise to the participants, and the easy measurement of treatment adherence are major strengths of our training program.
CONCLUSIONS: The study\'s portable device for home-based myofunctional therapy shows promise as a noninvasive alternative for reducing the severity of OSAHS, with a notable correlation between successful lip exercise improvement and AHI reduction, warranting further development and investigation.