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Effects of oropharyngeal exercises on snoring intensity, symptoms, upper airway anatomy and colapsability of upper airways awake and asleep in patients with primary snoring and mild to moderate obstructive sleep apnea


Obstructive sleep apnea (OSA) is a serious public health problem. In cases of primary snoring, mild to moderate OSA, there is no standard treatment. We recently demonstrated that a new therapy with oropharyngeal muscle exercises (oropharyngeal, myofunctional therapy) in patients with moderate OSA was able to improve by 40% the severity of the disease (Am J Respir Crit CareMed, 2009). However, it remains unclear if the therapy is effective in mild cases of upper airway obstruction and the mechanisms by which this new therapy works remains unclear. Objective: To study the effects of therapy on oropharyngeal myofunctional in a series of clinical and physiologic variables in patients with a wide spectrum of upper airway obstruction, including primary snoring and mild to moderate OSA. Method: Prospective and randomized study will include 40 patients of both sexes with newly diagnosed primary snoring (n = 16), mild to moderate OSA (n = 24) that will be randomized to 3 months of myofunctional oropharyngeal therapy (nasal lavage and oropharyngeal exercises 3 times per day) or sham treatment (nasal lavage and use of nasal dilator during sleep). Patients will be evaluated at the beginning and end of the study by: 1. Full polysomnography with objective measurement of snoring 2. Magnetic Resonance Imaging (MRI) of the upper airway; 3. Negative expiratory pressure while awake (NEP), 4. Critical Closing Pressure (PCrit) in the Pharynx and direct observation of the upper airway (UA) during induced sleep 5. Tongue strength; 6. Subjective questionnaires, including sleep quality, snoring and sleepiness. Impact: *The study will test and expand the use of oropharyngeal exercises to patients with mild forms of upper airway obstruction including primary snoring and mild OSA. Several mechanism by which oropharyngeal exercises are effective will be tested. (AU)

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Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
HIRATA, RAQUEL PASTRELLO; KAYAMORI, FABIANE; SCHORR, FABIOLA; MORIYA, HENRIQUE TAKACHI; ROMANO, SALVATORE; INSALACO, GIUSEPPE; GEBRIM, ELOISA; FRANCO DE OLIVEIRA, LUIS VICENTE; GENTA, PEDRO RODRIGUES; LORENZI-FILHO, GERALDO. Influence of interface and position on upper airway collapsibility assessed by negative expiratory pressure. Sleep and Breathing, v. 21, n. 3, p. 631-638, . (12/20743-5, 11/12120-5)
HIRATA, RAQUEL P.; SCHORR, FABIOLA; KAYAMORI, FABIANE; MORIYA, HENRIQUE TAKACHI; ROMANO, SALVATORE; INSALACO, GIUSEPPE; GEBRIM, ELOISA M.; FRANCO DE OLIVEIRA, LUIS VICENTE; GENTA, PEDRO R.; LORENZI-FILHO, GERALDO. Upper Airway Collapsibility Assessed by Negative Expiratory Pressure while Awake is Associated with Upper Airway Anatomy. JOURNAL OF CLINICAL SLEEP MEDICINE, v. 12, n. 10, p. 1339-1346, . (11/12120-5, 12/20743-5)

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