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      Muscular Assessment in Patients With Severe Obstructive Sleep Apnea Syndrome: Protocol for a Case-Control Study

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          Abstract

          Background

          Myofunctional therapy is currently a reasonable therapeutic option to treat obstructive sleep apnea-hypopnea syndrome (OSAHS). This therapy is based on performing regular exercises of the upper airway muscles to increase their tone and prevent their collapse. Over the past decade, there has been an increasing number of publications in this area; however, to our knowledge, there are no studies focused on patients who can most benefit from this therapy.

          Objective

          This protocol describes a case-control clinical trial aimed at determining the muscular features of patients recently diagnosed with severe OSAHS compared with those of healthy controls.

          Methods

          Patients meeting set criteria will be sequentially enrolled up to a sample size of 40. Twenty patients who meet the inclusion criteria for controls will also be evaluated. Patients will be examined by a qualified phonoaudiologist who will take biometric measurements and administer the Expanded Protocol of Orofacial Myofunctional Evaluation with Scores (OMES), Friedman Staging System, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index questionnaires. Measures of upper airway muscle tone will also be performed using the Iowa Oral Performance Instrument and tongue digital spoon devices. Evaluation will be recorded and reevaluated by a second specialist to determine concordance between observers.

          Results

          A total of 60 patients will be enrolled. Both the group with severe OSAHS (40 patients) and the control group (20 subjects) will be assessed for differences between upper airway muscle tone and OMES questionnaire responses.

          Conclusions

          This study will help to determine muscle patterns in patients with severe OSAHS and can be used to fill the gap currently present in the assessment of patients suitable to be treated with myofunctional therapy.

          Trial Registration

          ISRCTN Registry ISRCTN12596010; https://www.isrctn.com/ISRCTN12596010

          International Registered Report Identifier (IRRID)

          PRR1-10.2196/30500

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          Most cited references24

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          World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.

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            Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study.

            The effect of obstructive sleep apnoea-hypopnoea as a cardiovascular risk factor and the potential protective effect of its treatment with continuous positive airway pressure (CPAP) is unclear. We did an observational study to compare incidence of fatal and non-fatal cardiovascular events in simple snorers, patients with untreated obstructive sleep apnoea-hypopnoea, patients treated with CPAP, and healthy men recruited from the general population. We recruited men with obstructive sleep apnoea-hypopnoea or simple snorers from a sleep clinic, and a population-based sample of healthy men, matched for age and body-mass index with the patients with untreated severe obstructive sleep apnoea-hypopnoea. The presence and severity of the disorder was determined with full polysomnography, and the apnoea-hypopnoea index (AHI) was calculated as the average number of apnoeas and hypopnoeas per hour of sleep. Participants were followed-up at least once per year for a mean of 10.1 years (SD 1.6) and CPAP compliance was checked with the built-in meter. Endpoints were fatal cardiovascular events (death from myocardial infarction or stroke) and non-fatal cardiovascular events (non-fatal myocardial infarction, non-fatal stroke, coronary artery bypass surgery, and percutaneous transluminal coronary angiography). 264 healthy men, 377 simple snorers, 403 with untreated mild-moderate obstructive sleep apnoea-hypopnoea, 235 with untreated severe disease, and 372 with the disease and treated with CPAP were included in the analysis. Patients with untreated severe disease had a higher incidence of fatal cardiovascular events (1.06 per 100 person-years) and non-fatal cardiovascular events (2.13 per 100 person-years) than did untreated patients with mild-moderate disease (0.55, p=0.02 and 0.89, p<0.0001), simple snorers (0.34, p=0.0006 and 0.58, p<0.0001), patients treated with CPAP (0.35, p=0.0008 and 0.64, p<0.0001), and healthy participants (0.3, p=0.0012 and 0.45, p<0.0001). Multivariate analysis, adjusted for potential confounders, showed that untreated severe obstructive sleep apnoea-hypopnoea significantly increased the risk of fatal (odds ratio 2.87, 95%CI 1.17-7.51) and non-fatal (3.17, 1.12-7.51) cardiovascular events compared with healthy participants. In men, severe obstructive sleep apnoea-hypopnoea significantly increases the risk of fatal and non-fatal cardiovascular events. CPAP treatment reduces this risk.
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              Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force.

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                Author and article information

                Contributors
                Journal
                JMIR Res Protoc
                JMIR Res Protoc
                ResProt
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                1929-0748
                August 2021
                6 August 2021
                : 10
                : 8
                : e30500
                Affiliations
                [1 ] Phonoaudiology Section Otorhinolaryngology Department Hospital Italiano de Buenos Aires Buenos Aires Argentina
                [2 ] Otorhinolaryngology Department Hospital Quironsalud Marbella Marbella (Malaga) Spain
                [3 ] Otorhinolaryngology Department Hospital Quironsalud Campo de Gibraltar Palmones, Cadiz Spain
                [4 ] Pulmonology Department Hospital Quironsalud Marbella Malaga Spain
                [5 ] Pulmonology Department Hospital Quironsalud Campo de Gibraltar Palmones, Cadiz Spain
                [6 ] Otorhinolaryngology Department Clinica Universitaria de Navarra Pamplona Spain
                [7 ] Otorhinolaryngology Department Hospital Universitario Virgen de Valme Sevilla Spain
                [8 ] School of Medicine Clinica Universitaria de Navarra Pamplona Spain
                [9 ] Otorhinolaryngology Department Hospital Universitario Sanitas la Zarzuela Madrid Spain
                [10 ] Otorhinolaryngology Department Hospital Universitario Fuenlabrada Madrid Spain
                [11 ] School of Medicine Universidad Rey Juan Carlos I Madrid Spain
                Author notes
                Corresponding Author: Carlos O'Connor-Reina coconnor@ 123456us.es
                Author information
                https://orcid.org/0000-0001-9920-5273
                https://orcid.org/0000-0002-1670-4235
                https://orcid.org/0000-0002-8062-335X
                https://orcid.org/0000-0002-2830-5733
                https://orcid.org/0000-0002-5148-5111
                https://orcid.org/0000-0002-1728-2644
                https://orcid.org/0000-0002-6601-5331
                https://orcid.org/0000-0003-4066-0137
                https://orcid.org/0000-0002-2849-6154
                https://orcid.org/0000-0001-6409-4921
                Article
                v10i8e30500
                10.2196/30500
                8380583
                34115605
                ab7222b4-61b8-4e85-a588-26c35d3a5af3
                ©Paz Francisca Borrmann, Carlos O'Connor-Reina, Jose M Ignacio, Elisa Rodriguez Ruiz, Laura Rodriguez Alcala, Florencia Dzembrovsky, Peter Baptista, Maria T Garcia Iriarte, Carlos Casado Alba, Guillermo Plaza. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 06.08.2021.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

                History
                : 20 May 2021
                : 11 June 2021
                : 11 June 2021
                : 11 June 2021
                Categories
                Protocol
                Protocol

                myofunctional therapy,sleep apnea,sleep disordered breathing,speech therapy,phenotype,sleep,therapy,protocol,muscle,assessment,case study,exercise,airway,respiratory

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