Myofunctional Therapy as an Effective Treatment of Obstructive Sleep Apnea in a Patient with Systemic Sclerosis

Keywords

obstructive sleep apnea - systemic sclerosis - orofacial myofunctional therapy

Introduction: Systemic sclerosis (SSc) is a chronic autoimmune disease of the connective tissue. Sleeping difficulty was observed in 76% of SSc patients. Orofacial myofunctional therapy (OMT) has been used in the treatment of obstructive sleep apnea (OSA). There are no studies on the benefit of OMT as a treatment in patients with SSc and OSA.

Objective: Describe OMT as a treatment for mild OSA in patients with SSc and microstomia.

Methods: Case Report Patient C.A.G., female, 45 years old, presents with excessive daytime sleepiness, initial insomnia and difficulty concentrating. She has been diagnosed with SSc for 10 years, with skin, esophageal, vascular and pulmonary involvement, besides migraine, hydrocephalus and depression. Physical examination revealed scleroderma facies, limited mouth opening due to microstomia and body mass index (BMI) 18.36. Type 1 polysomnography (PSG) showed AHI 7.02/h, lower limb periodic movement index (PLMI) 8/h, oxyhemoglobin desaturation index (ODI) 1.4/h and snoring during the recording. Mild sleep apnea was found, and the patient was referred to OMT. Biweekly consultations were carried out, in addition to guided exercises at home by a speech therapist certified in sleep, for 3 months. The PSG performed after 3 months of OMT showed an AHI of 4.53/h. PLMI 7/h, ODI 0.18/h and no snoring was recorded. There was no significant variation in BMI during the period (17.97). The patient remains on OMT and medical follow-up.

Results: Discussion Studies show that longer disease duration, higher BMI and higher pulmonary artery pressure correlate with OSA in patients with SSc. Skin thickness, interstitial lung disease (ILD), gastroesophageal reflux disease (GERD), depression, increased PLMI and restless legs syndrome also correlates with sleep disorders. OMT reduces snoring, AHI, daytime sleepiness and improves ODI. In the present case, the patient has systemic symptoms that can be correlated to reduced sleep quality, such as depression, ILD and GERD. The proposed treatment demonstrated effectiveness in reducing and normalizing AHI, abolishing the presence of snoring and improving ODI, in agreement with the results described in the literature on the effects of OMT.

Conclusion: Therefore, OMT can be an alternative in the treatment of patients with SSc and OSA. It's essential to treat other systemic complaints that can affect sleep quality with a multidisciplinary approach being fundamental for better clinical results.