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6 Orofacial Myofunctional Therapy
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Fig. 6.6 Adult tongue tie
in a patient with
severe OSA
113
patient to open their mouth as wide as possible with their tongue down position. If
the difference is more signicant than 50% between the two measurements, that
patient is considered to have a pathological tongue tie or ankyloglossia (Fig.6.6).
From experience, whenever one is faced with a prominent anterior frenulum, one
should consider the possibility of a posterior or submucosal frenulum. Sometimes it
is possible to feel this structure behind the rst one, but usually the diagnosis is
made by following a functional examination protocol.
We recommend following the Hazelbaker protocol [26].
6.6.4.1 Tongue Tie Anatomical Evaluation
Appearance of the tongue when lifted: 2 points (round or square shaped), 1 point
(small indentation), 0 points (heart or V shaped).
Frenulum elasticity: 2 points (very elastic), 1 point (moderately elastic), 0 points
(no elasticity).
Length of the frenulum when the tongue is raised: 2 points (more than 1cm or
included on the tongue); 1 point, 1cm; 0 points (less than 1cm).
Insertion of the tongue frenulum into the tongue: 2 points (posterior to the tip), 1
point (at the tip), 0 points (notched or notched tip).
Insertion of the frenulum on the alveolar crest: 2 points (on the oor of the mouth
or below the crest), 1 point (just below the crest), 0 points (on the alveolar crest).
6.6.4.2 Tongue Tie Function Evaluation
Lateralization: 2 points (complete); 1 point (body of the tongue, but not the tip); 0
points (none).
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C. O’Connor-Reina et al.
Tongue elevation: 2 points (tip to half-open mouth), 1 point (only the edges to
half-open mouth), 0 points (tip remains on the alveolar ridge or only rises when the
mouth is closed).
Stick out the tongue: 2 points (point on the lower lip), 1 point (tip only on the
gum), 0 points (none of the above).
Tongue extension: 2 points (complete), 1 point (moderate or partial), 0 points
(little or none).
Tongue concavity: 2 points (completely concave edges), 1 point (concave edges);
0 point (no concavity).
Peristalsis: 2 points (complete anterior to posterior from the tip), 1 point (partial
originating posterior to the tip), 0 points (none).
Snapping during lactation: 2 points (none), 1 point (periodic), 0 points (with
each suck).
Perfect score, 14 points; 11 points, acceptable if anatomical evaluation is 10.
If <8, requires surgery.
6.6.4.3 Tongue Tie Surgery [27]
When talking about tongue tie surgery, we must establish different concepts.
Frenectomy consists of removing the frenulum tissue, (although it is sometimes also
used for lip frenulum surgery). Frenuloplasty consists of dissection of the frenulum
with a subsequent suture in zetaplasty of the defective tissue. Finally, frenectomy is
the most frequent treatment and only consists of carrying out a cut without a suture.
A laser (diode, CO2) or a conventional surgical technique can be used to perform the
procedure. No signicant differences have been demonstrated in these procedures
[27]. The therapeutic objective of surgery must be twofold on the one hand, to eliminate an anatomical barrier and, on the other, to develop a recovery of function. It is
essential to consider the possible treatment of restrictive frenulum with OMT before
and after surgery to recover any lost functionality. Cases have been described where
the apnea worsened after the surgical procedure. In our experience, this is because
the patient has not been treated with OMT beforehand [28]. We try to identify the
medial tongue septum (the fascia between the two heads of the upper branch of the
genioglossus muscle) and proceed with its dissection. Surgery should be performed
in a blunt and classical manner. The main objective of surgery is to eliminate restrictive brotic tissue, so the surgical technique must avoid the use of instruments that
may contribute to increasing brosis (electrocautery). Performing the surgery, while
the patient is awake is recommended in adults so that they can move their tongue
during surgery. During the intervention, the patient is asked to move the tongue
forward and up and to the sides to highlight the restrictions to be eliminated. In
cases where the surgery cannot be performed while the patient is awake (in the case
of children), we recommend using 2.0 silk points at the tip that would allow one to
move the tongue at all times. We recommend dissection with cold instruments
(120mm Metzenbaum scissors or curved or straight-tipped iris scissors), a sterile
swab, and a corrugated probe. If hemostasis is performed; it should be done with a
bipolar scalpel with low power output (10W). The tissue to be cut rst is pressed
with hemostatic forceps and, when it is found to be ischemic, is cut with scissors.
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The dissection is complete when the patient can place the tip of the tongue in the
area of the incisal papilla. At the same time, while the mouth is open, as wide as
possible and they can suck against the anterior palate without restriction.
Subsequently, the mucosal defect is sutured with vicryl rapide 30 (coated vicryl
Ethicon US LLC) (Video 2).
6.6.5 Muscular Strength
It is advantageous to assess the muscle strength of the lingual muscles and the
perioral muscles. We recommend using of Iowa Oral Performance Instrument
(IOPI, Northwest Co., LLC, Carnation WA, USA) to identify the hypotonic
patient most likely to improve with this treatment [11]. The main measurements
of the IOPI focus on evaluating the strength of the lingual muscles and the strength
of the perioral muscles. It is performed by compressing a balloon connected to the
device that the patient inserts into their mouth. To measure the maximum anterior
lingual force, the patient is asked to perform a peak compression of the balloon
while resting on the papilla. This value corresponds to the tone of the genioglossus muscle. Three measurements are made with a 1-min rest between each. The
highest value obtained is taken as a reference. For the buccinator muscles, the
balloon is placed between the gingival mucosa and the cheek, then the patient is
asked to make a contraction with the balloon. The value obtained corresponds to
the tone of the buccinator muscle. Measurements are obtained in kilopascals
(Fig.6.7). Using reference tables obtained from the normal population allows the
patient to know the state of their musculature during the test and provides a reference of where their muscle tone should be, based on their age and gender [29].
Finally, it has been shown that patients with SDB have lower than average values
on this test and that an increase in values translates into improved [5] sleep quality
of sleep [30].
Fig. 6.7 Example of the
use of IOPI in consulting
buccinator muscle
measurement
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Fig. 6.8 Tongue digital
spoon
C. O’Connor-Reina et al.
Figure 6.7 shows a patient who gives permission to use scientically his image
elsewhere; however, you can shade the eyes in order not to be recognized.
Another instrument recommended for measuring tongue strength is the Tongue
Digital Spoon (TDS) (Fig.6.8). We have carried out 20 tongue strength measurements using the TDS in a healthy adult population, with the IOPI as the gold standard. To validate the procedure, we performed replicate measurements on 20
individuals aged 20–70. We found a mean TDS measurement of 115.99g/cm2 in
young subjects, 98.47g/cm2 in middle-aged subjects, and 84.23g/cm2 in older people. There was a signicant difference in the measurements between younger and
older participants. There was also a signicant correlation between TDS and IOPI
measurements (Pearson correlation coefcient, r=0.69, P<0.001). We found the
TDS to be a valuable tool in daily clinical practice for measuring of the strength of
the tongue in a healthy population. It has potential application in oropharyngeal
monitoring and rehabilitation [31].
6.7 Exercises
Two types of exercises are highlighted isometric exercises that are aimed at correcting a motor tone deciency (hypotonia) with which repetitions can be performed,
and those exercises that are beyond a functional problem and require the introduction of more complex isotonic exercises, including evaluation by a speech therapist.
Therefore, it is essential to perform them with a certain rhythm (Video 3).
There are no strict regulations these exercises or how they should be performed
[32]. Therefore, it is recommended to group them into batches of 9, with a maximum
duration of 20min before going to bed. Examples of these exercises are shown in our
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video in books [33] or Apps [34, 35] (Video 4). The ideal is to have the advice of a
specialist speech therapist with regular weekly visits to evaluate the correct execution
of the exercises, quantifying the anatomical changes through questionnaires [33].
However, when there is no access to a speech therapist, using the values obtained
through the IOPI is recommended. An increase in these values implies the correct
performance of the exercises. In our practice, we organize monthly appointments with
our patients; this measurement does not require a consultation longer than 5min.
Based on our experience, we consider adapting the exercises to the anatomical
location of the collapse diagnosed with sleep-induced endoscopy [5]. In other
words, if the presence of a tongue collapse is conrmed through drug-induced sleep
endoscopy (DISE), we would inform our speech therapist of this diagnosis to tailor
the exercises appropriately [11].
The main drawback of this, a priori attractive therapy, is a lack of adherence,
which is less than 10% [36]. According to our experience, this is because the patient
does not understand why some exercises are to be performed. There is a lack of
feedback when evaluating the results, and there is a lack of communication with the
therapist in situations where regular visits are not possible.
We suggest improving this adherence by:
• Providing the patient with as much information as possible about the anatomical
causes of their SDB, offering to explain their DISE and IOPI.
• Repeating the sleep studies as needed at the end of a series of exercises and, if it
is not possible, use the information of diagnostic applications on the market.
Repeating IOPI monthly, we are aware of the need for accuracy in the perfor-
mance of the exercises.
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6.8 Providing All thePossible Means ofContact (i.e.,
Telemedicine) Between theTherapist
andthePatient [20]
We have recently published our protocol where OMT is included as routine therapy
in all patients treated in our institution [37].
Our group has published a study with nonadherent patients to any therapy. The
main factors to adhere to OMT were proper tongue function without tongue restriction and low IOPI scores on the tongue strength measures [38]. We hypothesize that
the ideal patients for this therapy are those with these characteristics.
6.9 Conclusions
OMT for treating SDB is a valuable therapy with promising satisfactory results.
However, more well-designed, science-based studies are needed to conrm
this point.
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C. O’Connor-Reina et al.
Like any therapy, proper selection of the patient is essential. A patient who would
benet the most from this therapy manifests a hypotonic phenotype of the oral cavity with the absence of anatomical abnormalities that limit the performance of
exercises.
Beforehand, because this therapy has the lowest adherence, the therapist must be
provided with enough diagnostic and therapeutic tools to treat this problem.
Take-Home Message
• Orofacial myofunctional therapy (OMT) uses a combination of physical therapy
exercises to improve the bite, breathing, and facial posture of those with orofa-
cial myofunctional disorders (OMDs). It is a valuable therapy with promising,
satisfactory results.
References
1. Mason RM, Franklin H. Orofacial myofunctional disorders and otolaryngologists.
Otolaryngology. 2014;4(04):e110. https://doi.org/10.4172/2161- 119X.1000e110.
2. Garliner D.In: Garliner D, editor. Myofunctional therapy. Philadelphia: Saunders; 1976.
3. Puhan MA. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ. 2006;332(7536):266–70. https://doi.org/10.1136/
bmj.38705.470590.55.
4. Meghpara S, Chohan M, Bandyopadhyay A, Kozlowski C, Casinas J, Kushida C, Camacho
M.Myofunctional therapy for OSA: a meta-analysis. Expert Rev Respir Med. 2021;22:1–7.
https://doi.org/10.1080/17476348.2021.2001332.
5. O’Connor-Reina C, Ignacio Garcia JM, Rodriguez Ruiz E, Morillo Dominguez MDC, Ignacio
Barrios V, Baptista Jardin P, Casado Morente JC, Garcia Iriarte MT, Plaza G.Myofunctional
therapy app for severe apnea-hypopnea sleep obstructive syndrome: pilot randomized controlled trial. JMIR Mhealth Uhealth. 2020;8(11):e23123. https://doi.org/10.2196/23123.
6. Carrasco-Llatas M, O’Connor-Reina C, Calvo-Henríquez C.The role of myofunctional therapy in treating sleep-disordered breathing: a state-of-the-art review. Int J Environ Res Public
Health. 2021;18(14):7291. https://doi.org/10.3390/ijerph18147291.
7. Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Dening phenotypic causes of
obstructive sleep apnea: identication of novel therapeutic targets. Am J Respir Crit Care Med.
2013;188(8):996–1004. https://doi.org/10.1164/rccm.201303- 0448OC.
8. Dotan Y, Pillar G, Tov N, Oliven R, Steinfeld U, Gaitini L, etal. Dissociation of electromyogram and mechanical response in sleep apnoea during propofol anaesthesia. Eur Respir
J. 2013;41(1):74–84. https://doi.org/10.1183/09031936.00159611.
9. Bilston LE, Gandevia SC.Biomechanical properties of the human upper airway and their
effect on its behavior during breathing and in obstructive sleep apnea. J Appl Physiol.
2014;116(3):314–24. https://doi.org/10.1152/japplphysiol.00539.2013.
10. Guilleminault C, Huang YS, Quo S.Apraxia in children and adults with obstructive sleep
apnea syndrome. Sleep. 2019;42(12):zsz168. https://doi.org/10.1093/sleep/zsz168.
11. O’Connor-Reina C, Plaza G, Garcia-Iriarte OMT, Ignacio-Garcia JM, Baptista P, CasadoMorente JC, De Vicente E. Tongue peak pressure: a tool to aid in the identication of
obstruction sites in patients with obstructive sleep apnea/hypopnea syndrome. Sleep Breath.
2020;24(1):281–6. https://doi.org/10.1007/s11325- 019- 01952- x.
12. Vargervik K, Miller AJ, Chierici G, Harvold E, Tomer BS.Morphologic response to changes in
neuromuscular patterns experimentally induced by altered modes of respiration. Am J Orthod.
1984;85(2):115–24. https://doi.org/10.1016/0002- 9416(84)90003- 4.
6 Orofacial Myofunctional Therapy
https://t.me/medicina_free
13. Linder-Aronson S.Adenoids. Their effect on mode of breathing and nasal airow and their
relationship to characteristics of the facial skeleton and the dentition. A biometric, rhinomanometric and cephalometro-radiographic study on children with and without adenoids.
Acta Otolaryngol Suppl. 1970;265:1–132.
14. Lee SY, Guilleminault C, Chiu HY, Sullivan SS.Mouth breathing, “nasal disuse,” and pediatric sleep-disordered breathing. Sleep Breath. 2015;19:1257–64. https://doi.org/10.1007/
s11325- 015- 1154- 6.
15. Messineo L, Taranto-Montemurro L, Azarbarzin A, Oliveira Marques MD, Calianese N, White
DP, Wellman A, Sands SA. Breath-holding as a means to estimate the loop gain contribution to obstructive sleep apnoea. J Physiol. 2018;596(17):4043–56. https://doi.org/10.1113/
JP276206.
16. Mangin D, Bequignon E, Zerah-Lancner F, Isabey D, Louis B, Adnot S, Papon JF, Coste A,
Boyer L, Devars du Mayne M.Investigating hyperventilation syndrome in patients suffering from empty nose syndrome. Laryngoscope. 2017;127(9):1983–8. https://doi.org/10.1002/
lary.26599.
17. Van Dixhoorn J, Duivenvoorden HJ. Efcacy of Nijmegen questionnaire in recognition
of the hyperventilation syndrome. J Psychosom Res. 1985;29(2):199–206. https://doi.
org/10.1016/0022- 3999(85)90042- X.
18. Galeotti A, Festa P, Viarani V, etal. Prevalence of malocclusion in children with obstructive
sleep apnoea. Orthod Craniofac Res. 2018;21:242–7. https://doi.org/10.1111/ocr.12242.
19. Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, Brietzke
SE, Darrow DH, Goldstein N, Levi J, Meyer AK. Clinical consensus statement: ankyloglossia in children. Otolaryngol Head Neck Surg. 2020;162(5):597–611. https://doi.
org/10.1177/0194599820915457.
20. Jiménez DG, Romero MC, Galán IR, Martínez MG, Pando MR, Prieto CL.Prevalence of
ankyloglossia in newborns in Asturias (Spain). Anales de Pediatría (English Edition).
2014;81(2):115–9. https://doi.org/10.1016/j.anpede.2013.10.007.
21. Guilleminault C, Huseni S, Lo L.A frequent phenotype for paediatric sleep apnoea: short
lingual frenulum. ERJ Open Res. 2016;2(3):00043–2016. https://doi.org/10.1183/2312054
1.00043- 2016.
22. Guilleminault C, Akhtar F.Pediatric sleep-disordered breathing: new evidence on its development. Sleep Med Rev. 2015;24:46–56. https://doi.org/10.1016/j.smrv.2014.11.008.
23. Flores-Mir C, Korayem M, Heo G, Witmans M, Major MP, Major PW.Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome: a systematic
review and meta-analysis. J Am Dent Assoc. 2013;144(3):269–77. https://doi.org/10.14219/
jada.archive.2013.0113.
24. Katyal V, Pamula Y, Martin AJ, Daynes CN, Kennedy JD, Sampson WJ. Craniofacial and
upper airway morphology in pediatric sleep-disordered breathing: systematic review and metaanalysis. Am J Orthod Dentofac Orthop. 2013;143(1):20–30.e3. https://doi.org/10.1016/j.
ajodo.2012.08.021.
25. Marchesan IQ.Lingual frenulum protocol. Int J Orofacial Myol. 2012;38:89–103.
26. Hazelbaker AK. Assessment tool for lingual frenulum function (ATLFF). Clin Lactat.
2017;8(3):132–3.
27. Zaghi S, Valcu-Pinkerton S, Jabara M, Norouz-Knutsen L, Govardhan C, Moeller J, Sinkus V,
Thorsen RS, Downing V, Camacho M, Yoon A.Lingual frenuloplasty with orofacial myofunctional therapy: exploring safety and efcacy in 348 cases. Laryngoscope Investig Otolaryngol.
2019;4(5):489–96. https://doi.org/10.1002/lio2.297.
28. Genther DJ, Skinner ML, Bailey PJ, Capone RB, Byrne PJ.Airway obstruction after lingual frenulectomy in two infants with Pierre-Robin sequence. Int J Pediatr Otorhinolaryngol.
2015;79(9):1592–4. https://doi.org/10.1016/j.ijporl.2015.06.035.
29. Clark HM, Solomon NP. Age and sex differences in orofacial strength. Dysphagia.
2012;27(1):2–9. https://doi.org/10.1007/s00455- 011- 9328- 2.
119
120
https://t.me/medicina_free
30. de Felício CM, da Silva Dias FV, Folha GA, de Almeida LA, de Souza JF, Anselmo-Lima
WT, Trawitzki LV, Valera FC. Orofacial motor functions in pediatric obstructive sleep
apnea and implications for orofacial myofunctional therapy. Int J Pediatr Otorhinolaryngol.
2016;90:5–11. https://doi.org/10.1016/j.ijporl.2016.08.019.
31. Villa MP, Evangelisti M, Martella S, Barreto M, Del Pozzo M. Can myofunctional therapy
increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep
Breath. 2017;21:1025–32. https://doi.org/10.1007/s11325- 017- 1489- 2.
32. Rodríguez-Alcalá L, Martín-Lagos Martínez J, O’Connor-Reina C, Plaza G.Assessment of
muscular tone of the tongue using a digital measure spoon in a healthy population: a pilot
study. PLoS One. 2021;16(2):e0245901. https://doi.org/10.1371/journal.pone.0245901.
33. Guimarães KC.Apnéia e ronco: tratamento miofuncional orofacial. São José dos Campos/SP
Ed Pulso. 2009.
34. O’Connor RC, Plaza G, Ignacio-Garcia JM, Baptista Jardin P, Garcia-Iriarte MT, CasadoMorente JC, De Vicente GE, Rodriguez-Reina A.New mHealth application software based on
myofunctional therapy applied to sleep-disordered breathing in non-compliant subjects. Sleep
Sci Pract. 2020;4:3. https://doi.org/10.1186/s41606- 019- 0040- 8.
35. O’Connor RC, Garcia-Iriarte M, Casado-Morente J.New app “Apnea Bye” increases adherence in myofunctional therapy to treat sleep disordered breathing. In: Otolaryngol Neck Surg
(1 Suppl). 2018 Presented at: American Academy of Otolaryngology-Head and Neck Surgery
2018 Annual Meeting & OTO Experience; October 7–10, 2018; Atlanta, GA.
36. Díaz M, Salazar A, Bravo F, Ocampo-Garcés A.Tratamiento del síndrome de apneas e hipopneas obstructivas del sueño con terapia miofuncional orofaríngea: Experiencia en hospital
público de Chile. Rev otorrinolaringol cir cabeza cuello. 2019;79(4):395–403. https://doi.
org/10.4067/S0718- 48162019000400395.
37. Rodriguez-Alcalá L, Ignacio-García J, Serrano Angulo MS, Benjumea F, Casado JC,
O’Connor- Reina CI. Tongue+ protocol for the diagnosis of obstructive sleep apnoea in
Quirónsalud Marbella hospital [version 1; peer review: awaiting peer review]. F1000Research.
2022;11:322. https://doi.org/10.12688/f1000research.75472.1.
38. O’Connor-Reina C, Ignacio Garcia JM, Rodriguez Alcala LR, Rodríguez Ruiz E, Garcia
Iriarte MT, Casado Morente JC, Baptista P, Plaza G.Improving adherence to myofunctional
therapy in the treatment of sleep-disordered breathing. J Clin Med. 2021;10(24):5772. https://
doi.org/10.3390/jcm10245772.
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OSA inChildren
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StaceyIshman
7.1 Introduction
Unlike in adults, obstructive sleep apnea (OSA) in children often presents without
witnessed apneas, and the signs and symptoms may be more subtle than those in
adults. This can make identication hard since children are not likely to complain
about sleep problems; thus, a sibling or parent/guardian will often be the rst to
express concerns about a child’s sleep. Concerns often include restless sleep, fatigue
or sleepiness (hypersomnia), difculty falling or staying asleep (insomnia), sleeping in strange positions, or other abnormal behaviors during sleep (parasomnias).
Because of this, a complete history and physical are essential when considering
sleep disorders in children.
7
7.2 Epidemiology
Epidemiologic studies of sleep-disordered breathing (SDB) and OSA in children in
the United States report OSA rates of 1%–4% in the United States [1].
Parental reports of snoring (scaled often to always) range from 3.2% to 34.5% in
one summary [1], while another summary noted snoring in 10% to 25% of preschool and elementary school children [2]. Unlike adults, the incidence of OSA
seems to be similar between girls and boys but becomes more prevalent in boys in
adolescence [1].
SDB is also strongly associated with high body mass index (BMI) and low socioeconomic status, Black and Asian race, but the relationship between these factors is
not yet well understood [3–10]. OSA severity is also associated with Black race,
S. Ishman (*)
University of Wisconsin - Madison, Madison, WI, USA
e-mail: Stacey.Ishman@cchmc.org
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
P. M. Baptista et al. (eds.), Obstructive Sleep Apnea,
https://doi.org/10.1007/978-3-031-35225-6_7
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S. Ishman
Table 7.1 Conditions
associated with OSA and
snoring in children
Achondroplasia
Apert syndrome
Beckwith–Wiedemann syndrome
Cleft palate
Crouzon syndrome
Down syndrome (Trisomy 21)
Klippel–Feil syndrome
Mucopolysaccharidosis
Obesity
Pierre–Robin sequence
Pfeiffer syndrome
Prader–Willi syndrome
Treacher–Collins syndrome
even after controlling for obesity, family income, and maternal education [11].
However, neighborhood-level socioeconomic status, including poverty level, may
explain a signicant portion of the Black race effect. Parents and caregivers of children with craniofacial anomalies may mistakenly assume that SDB and OSA are
“normal” for their child, and thus, screening is critical for these children [18]. See
Table7.1 for a list of conditions associated with a high risk of pediatric OSA. In
addition to these listed genetic conditions, children with choanal atresia, cerebral
palsy, head and neck lymphangiomas, and those who have undergone pharyngeal
ap repair are at risk for OSA and snoring.
7.3 Consequences ofOSA
Consequences of OSA include poor school performance and learning difculties
which include lower scores in memory, learning, and problem-solving skills than in
nonsnoring children [2, 12]. In the 2000s, observational studies reported that children with OSA are at risk for decreased quality of life (QOL), and neurocognitive,
behavioral, and emotional difculties. Difculties related to neurocognition, behavior and QOL tended to normalize after the resolution of SDB, but recent evidence
has shown that executive function and attention may not improve [13–16]. A 2020
randomized, controlled trial of preschool children who underwent either early adenotonsillectomy (T&A) or observation reported no benet in neurocognitive measures for those who underwent surgery [17].
Pulmonary and cardiovascular complications have also been reported including,
elevated systemic blood pressure in children with OSA [18–22]. Further, a dose–
response relationship has been reported to exist between SDB and blood pressure
severity in children [23]. It has also been reported that children with elevated blood
pressure are more likely to experience hypertension and metabolic syndrome as
adults [24]. In addition, children with hypertension have been shown to improve
their blood pressure after T&A compared to nonhypertensive controls [25, 26].
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