肌筋膜再教育在小儿睡眠呼吸障碍中的关键作用。

Critical role of myofascial reeducation in pediatric sleep-disordered breathing.

机构信息

Stanford University, Sleep Medicine Division, USA.

出版信息

Sleep Med. 2013 Jun;14(6):518-25. doi: 10.1016/j.sleep.2013.01.013. Epub 2013 Mar 21.

DOI:10.1016/j.sleep.2013.01.013

PMID:23522724

Abstract

BACKGROUND

Limited studies suggest that pubertal development may lead to a recurrence of sleep-disordered breathing (SDB) despite previous curative surgery. Our study evaluates the impact of myofunctional reeducation in children with SDB referred for adenotonsillectomy, orthodontia, and myofunctional treatment in three different geographic areas.

METHODS

A retrospective investigation of children with polysomnographic analysis following adenotonsillectomy were referred for orthodontic treatment and were considered for myofunctional therapy. Clinical information was obtained during pediatric and orthodontic follow-up. Polysomnography (PSG) at the time of diagnosis, following adenotonsillectomy, and at long-term follow-up, were compared. The PSG obtained at long-term follow-up was scored by a single-blinded investigator.

RESULTS

Complete charts providing the necessary medical information for long-term follow-up were limited. A subgroup of 24 subjects (14 boys) with normal PSG following adenotonsillectomy and orthodontia were referred for myofunctional therapy, with only 11 subjects receiving treatment. Follow-up evaluation was performed between the 22nd and 50th month after termination of myofunctional reeducation or orthodontic treatment if reeducation was not received. Thirteen out of 24 subjects who did not receive myofunctional reeducation developed recurrence of symptoms with a mean apnea-hypopnea index (AHI)=5.3±1.5 and mean minimum oxygen saturation=91±1.8%. All 11 subjects who completed myofunctional reeducation for 24 months revealed healthy results.

CONCLUSION

Despite experimental and orthodontic data supporting the connection between orofacial muscle activity and oropharyngeal development as well as the demonstration of abnormal muscle contraction of upper airway muscles during sleep in patients with SDB, myofunctional therapy rarely is considered in the treatment of pediatric SDB. Absence of myofascial treatment is associated with a recurrence of SDB.

摘要

背景

有限的研究表明，尽管先前进行了治愈性手术，但青春期发育仍可能导致睡眠呼吸障碍（SDB）复发。我们的研究评估了在三个不同地理区域接受腺样体扁桃体切除术、正畸和肌肉功能治疗的 SDB 儿童中，肌功能再教育对 SDB 的影响。

方法

对腺样体扁桃体切除术后行多导睡眠图分析并转诊接受正畸治疗且考虑行肌功能治疗的儿童进行回顾性研究。在儿科和正畸随访期间获得临床信息。比较诊断时、腺样体扁桃体切除术后和长期随访时的多导睡眠图（PSG）。由一名单盲研究者对长期随访时获得的 PSG 进行评分。

结果

提供长期随访所需必要医疗信息的完整图表有限。亚组 24 名（男 14 名）儿童在腺样体扁桃体切除术后和正畸后 PSG 正常，被转诊行肌功能治疗，但仅有 11 名儿童接受治疗。如果未接受肌功能治疗，则在肌功能再教育或正畸治疗结束后第 22 至 50 个月进行随访评估。24 名未接受肌功能再教育的儿童中有 13 名出现症状复发，平均呼吸暂停低通气指数（AHI）=5.3±1.5，平均最低血氧饱和度=91±1.8%。所有完成 24 个月肌功能再教育的 11 名儿童均显示健康结果。