La rééducation oro-myo-fonctionnelle dans le syndrome d’apnées obstructives du sommeil: rôle et efficacité de l’orthophoniste

Located in Marseille, the clinic Bonneveine, a facility of the AVEC Group, offers comprehensive diagnostic assessments for sleep disorders.

Mathilde Faro, a speech therapist at Clinic Bonneveine, explains the importance of oromyofunctional rehabilitation in obstructive sleep apnea syndrome.

In a research article, the practitioner details sleep apnea, common misconceptions, the origins, treatments for this condition, as well as the role of the speech therapist and oromyofunctional rehabilitation.

What is sleep apnea?

Obstructive sleep apnea syndrome (OSAS) is a sleep disorder

characterized by nightly pharyngeal collapse, resulting in partial (hypopnea) or complete (apnea) obstruction of the airways. It affects 3 to 7% of men and 2 to 5% of women. It is estimated that 60% of affected patients remain undiagnosed. (Saunier, V,2022). OSAS causes constant micro-awakenings that the patient is not aware of. This results in daytime sleepiness, difficulties with concentration and memory. In severe cases, it can lead to cardiovascular complications (Inserm, 2017).

Common misconceptions

One can suffer from sleep apnea without being an overweight or snoring man. This condition can also affect young women with normal BMI who do not snore. A certain number of children also suffer from sleep apnea; according to Inserm, nearly 2% of children between the ages of two and six are affected by sleep apnea.

What are the causes?

OSAS has multiple factors and can be related to hypertrophy of the soft tissues of the upper airway, narrow facial bones, neuromuscular tone impairment, or a combination of these factors (S. Hannachi et.al, 2020). It is associated with numerous cardiovascular and metabolic comorbidities. There is a strong association between OSAS and hypertension, atherosclerosis, coronary artery disease, heart failure, strokes, type 2 diabetes, etc. The high prevalence of this disorder and its impact on the physical and mental health of patients make it a significant public health problem. Early multidisciplinary screening and treatment are essential.

What are the treatments?

Continuous positive airway pressure therapy (CPAP) is currently the gold standard treatment for OSAS. Its effectiveness has been well demonstrated, but its use is still hindered by difficulties with treatment adherence due to the discomfort of the device (Bironneau V. & Meurice, JC. 2019).

Other specific therapies include surgery and mandibular advancement devices (MAD). Although their effectiveness is less consistent than CPAP, they have a genuine impact in many cases, either eliminating or significantly reducing apneas enough to prevent daytime symptoms and reduce complications (Amat, P. & Tran Lu Y, E. 2019).

As OSAS has multiple causes, a multidisciplinary approach is the most effective. While rehabilitating orofacial functions is essential, it is also important to adopt a healthier lifestyle, access psychological support, and increase physical activity (L.-C. Chuang, et al. 2021).

What is the role of the speech therapist?

Gone are the days when speech therapists were limited to working on tongue positioning (although that perception has never been true). They play a central role in the management of OSAS. They are qualified professionals, along with physiotherapists, to carry out oromyofunctional rehabilitation by strengthening the tongue and respiratory muscles of the patient.

The various exercises proposed during rehabilitation sessions aim to tone the orofacial and oropharyngeal structures. These exercises have proven to be effective when combined with breathing, chewing, and swallowing exercises. Therefore, proper tongue positioning allows for easier airflow through the upper airways.

Oromyofunctional rehabilitation

The myofunctional approach in speech therapy provides educational support to help patients understand the importance of proper tongue position to establish nasal breathing during sleep and improve their quality of life. The goal is to free up the upper airways through strengthening the orofacial structures and restoring nasal breathing (De Felício et.al, 2018).

Oromyofunctional rehabilitation, first recognized by the ASHA (American Speech and Hearing Association) in 1990, is now an alternative that combines quality, effectiveness, and speed. While it cannot be considered the sole solution, it should always be proposed as complementary therapy to first-line treatments. Studies show better adherence to CPAP or MAD when combined with oromyofunctional rehabilitation (Camacho et al., 2015). In addition, restoring functions is crucial to maintain the results of traditional curative approaches. Thus, speech therapy does not replace other treatments but improves their outcomes or allows patients to potentially avoid them.

Studies have shown that oromyofunctional rehabilitation can lead to a significant reduction (up to 92.06%) in Apnea-Hypopnea Index (AHI) in adults, as well as a decrease in snoring intensity and frequency, reduced daytime sleepiness, and improved adherence to CPAP or MAD treatment (L.-C. Chuang, et al. 2021).

Society is currently facing a recent and widely underdiagnosed sleep disorder that has devastating effects due to major comorbid conditions. It is now essential to consider holistic patient care through an interdisciplinary approach to provide the best possible care systematically, early, individually, and in the long term.