Hypotonia as a Reason for the Sleep Breathing Respiratory Disease Epidemy of the XXI Century

Obstructive sleep apnea (OSA) affects approximately 1000 million people in the World. Since Guilleminault discovered this disease in 1976, its incidence has grown exponentially. In his posthumous article, he stated hypotonia as the main reason for suffering in OSA. Unfortunately, how to study this issue in OSA patients has not yet received much consideration.

Our group is focused on how to evaluate this condition in all OSA patients in order to identify the hypotonic phenotype and verifying the reason it occured.

Myofunctional therapy is nowadays a promising therapy to enhance upper airway muscle strength and tone. This therapy needs to be applied in selected patients as following the criteria of 4P Medicine. Unfortunately the evaluation of the muscle condition is not considered in all official guidelines from worldwide sleep disordered breathing associations.

After many years of research, we have proposed a protocol based on functional evaluation of these patients and proposing an initial treatment focusing on improving myofunctional disorders by oropharyngeal exercises assisted by a myofunctional therapist and telemedicine. This protocol evaluates the patient’s muscle condition providing information about their praxis, stereoagnosis and strength. We also perform a Drug-Induced Sleep Enodoscopy providing the patients the objective information about the visual behavior of their upper airway during sleep. We examine routinely the stereoagnosis , tongue movements and measure the strength of the genioglossi muscle using Iowa oral performance test (IOPI ) and Tongue Digital Spoon (TDS) tools. If this patient has values below average, we propose a course of oropharyngeal exercises based on telemedicine with our app Airway Gym, and if there is a functional disorder we referred to a speech therapist.

Before starting the therapy, if the patient is suitable, we inform that after 90 sessions, patients have a probability of 70% to reduce 50% of their AHI. In our experience based on telemedicine we have 63% of adherence to our therapy without limitation realted to age, sex, BMI or systemic condition. We are absolutely aware that functional assesment must be mandatory in all OSA patients and all sleep specialists should be capable to identify this disorders providing a solution always complementary with tradtional therapies.