Effect of Myofunctional Therapy on Outcomes in Mild to Moderate Sleep Apnea

对退伍军人医疗保健的预期影响：睡眠呼吸暂停是最常见的慢性疾病之一 退伍军人健康管理局(VHA)的条件。由于诊断工作的增加， 许多退伍军人睡眠计划现在遇到了更高水平的退伍军人被诊断为轻度到 中度阻塞性睡眠呼吸暂停(OSA)。口腔面部肌功能疗法(OMT)需要 OSA的康复方法，可以为VHA患者和提供者提供治疗选择 这不需要在晚上睡觉时使用昂贵而繁重的医疗设备。 项目背景：阻塞性睡眠呼吸暂停综合征患者的基本医疗治疗需要使用 设备(持续气道正压(CPAP)或口腔用具)，这些设备很难 轻至中度疾病的患者每晚定期使用。因为大多数人 这些患者经常停止使用这些治疗方法，他们继续面临着更高的风险 未经治疗的阻塞性睡眠呼吸暂停综合征的后果。未经治疗和治疗不足的阻塞性睡眠呼吸暂停综合征继续恶化 年龄和体重的增加，这只会增加OSA后果的风险。OSA 后果包括增加一系列医疗合并症(例如，糖尿病， 心血管疾病、难治性高血压和抑郁症)和 由于白天过度昏昏欲睡而导致的白天功能，包括机动车辆或 工作场所事故、工作表现受损和更高的离婚风险。口腔面 肌功能疗法(OMT)对阻塞性睡眠呼吸暂停综合征采取康复治疗方法，由等张疗法组成 以及针对口腔(例如，舌头)和口咽(例如，软腭侧向)的等长练习 咽壁)。 项目目标：这项研究的目的是检查口腔面部肌功能的影响 患有轻中度睡眠呼吸暂停的退伍军人的治疗。要回答的主要问题是 OMT是否改善了OSA严重程度、患者功能状态和OSA症状的测量 与假OMT相比。 项目方法：我们提出了一项为期6个月的随机、对照、非盲、单中心研究。 口面部肌功能疗法(OMT)与假面部肌功能疗法(SHAM)的比较 OMT)。干预组的参与者将接受为期3个月的积极OMT干预，而 Sham OMT将提供锻炼和活动建议，这些建议没有 治疗功能或效果，包括一般的呼吸练习、放松和伸展关节 脖子和肩膀。这项研究的主要结果衡量标准将是小组之间的变化 OSA疾病严重程度的主要衡量标准(呼吸暂停-低呼吸指数)。重要的次要目标将 重点关注患者的功能状态和OSA症状(例如，白天过度嗜睡和睡眠 质量)。[主要研究时间点为3个月，而6个月时间点将评估 疗效的持续时间。]

Anticipated Impact on Veteran’s Healthcare: Sleep apnea is one of the most common chronic conditions in the Veterans Health Administration (VHA). Because of increased efforts at diagnosis, many VA sleep programs are now encountering higher levels of veterans diagnosed with mild-to- moderate obstructive sleep apnea (OSA). Orofacial Myofunctional Therapy (OMT) takes a rehabilitative approach to OSA and can provide VHA patients and providers with a therapeutic option that does not require the use of an expensive and burdensome medical device at night while asleep. Project Background: The primary medical therapies for patients with OSA require the use of medical devices (continuous positive airway pressure (CPAP) or oral appliances), which are difficult for patients with mild-to-moderate disease to use regularly on a nightly basis. Because the majority of these patients often stop using these therapies, they continue to be at increased risk of the consequences of untreated OSA. Untreated and undertreated OSA continues to worsen with increasing age and weight, which only compounds the risk of OSA consequences. OSA consequences include the increased risk of a range of medical comorbidities (e.g., diabetes, cardiovascular disease, treatment-resistant hypertension, and depression) and impairments in daytime functioning due to excessive daytime sleepiness, including increased for motor vehicle or workplace accidents, work performance impairments, and higher risk of divorce. Orofacial Myofunctional Therapy (OMT) takes a rehabilitative approach to OSA and is comprised of isotonic and isometric exercises that target the oral (e.g., tongue) and oropharyngeal (e.g., soft palate, lateral pharyngeal wall). Project Objectives: The purpose of this study is to examine the effect of Orofacial Myofunctional Therapy in veterans with mild-to-moderate sleep apnea. The main question to be answered is whether OMT improves measures of OSA severity, patient functional status, and OSA symptoms when compared to sham OMT. Project Methods: We propose a 6-month randomized, controlled, non-blinded, single-center study of Orofacial Myofunctional Therapy (OMT) compared to sham Orofacial Myofunctional Therapy (sham OMT). Participants in the intervention arm will undergo 3-months of active OMT intervention while the sham OMT will be provided with recommendations of exercise and activities that do not have a therapeutic function or effect, including general breathing exercises, relaxation, and stretching of the neck and shoulders. The primary outcome measure for the study will be between-group change in the primary measure of OSA disease severity (apnea-hypopnea index). Important secondary aims will focus on patient functional status and OSA symptoms (e.g., excessive daytime sleepiness and sleep quality). [The primary study timepoint is 3 months, while the 6-month timepoint will assess the duration of therapeutic effect.]