Myofunctional Training for Obstructive Sleep Apnea Patients After Transoral Robotic Surgery
Study Details
Study Description
Brief Summary
Background: Obstructive Sleep Apnea Syndrome (OSA) is a kind of sleep disorder. The symptoms are intermittent, partial or complete upper airway collapse, seriously impacting oxygen saturation and oxidative stress. Some patients choose to do upper airway surgeries, but the success rate is only 60-70%. The symptoms might relapse because of aging and gaining weights. The purpose of our study is to compare the effect of transoral robotic surgery (TORS) and oropharyngeal rehabilitation (OPR) on patients after TORS. Methods: Participants above 20 years old who are newly diagnosed with mild to severe OSA (Apnea-hypopnea Index >5/h), and the physician will explain the treatment programs to every subject in clinic. Expected results: The hypothesis of this study is the success rate of surgery will be enhance by increasing tongue and jaw-opening muscle strength after OPR. The biomarkers of cardiovascular disease may decrease and both the collapse of upper airway and sleep quality may be improved after TORS and OPR.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
The participants above 20 years old who are newly diagnosed with mild to severe OSA (Apnea-hypopnea Index >5/h), and the physician will explain the treatment programs to every subject. By their willingness to choose the therapeutic method, the participants who select the surgery interventions will be assign to TORS or TORS+OPR group. The matched controls as well as age-, sex-, and body mass index-matched OSA participants will be selected from the patients who are waiting for oral appliance, losing weight and using continuous positive airway pressure. Before surgery, 6 week and 18 week after surgery, the investiagters will compare the polysomnography data, questionnaires of sleep quality, drug-induced sleep endoscopy and computed tomography as primary outcomes. The investigators will also compare the tongue and jaw-opening muscle strength and biomarkers of oxidative stress, anti-oxidative stress, inflammatory cytokines and matrix metalloproteinases 9 as secondary outcomes. The OPR would begin at 6 week after surgery, and participants will undergo three months of the home-based oropharyngeal myofunctional therapeutic training. During the training intervention period, participants will be interviewed one time per week for adjusting the treatment intensity.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Sham Comparator: Control Without the willingness of surgery, those participants waiting for oral appliance (Device), losing weights and using continuous positive airway pressure (Device) were distribute to control group. |
Device: oral appliance
It is a kind of treatment for the participants who refuse surgeries and choose to use other kinds of conservative treatment. The conservative treatments included oral appliance, losing weights and using continuous positive airway pressure. The oral appliance would be wore only at night and it would press the soft palate and protrude the jaw.
Device: using continuous positive airway pressure
The participants only used CPAP at night. The device composed of a main machine, pipe and mask. The participants would instruct to wore the mask. The main machine would give positive airway pressure to open the airway and avoid collapsing.
Other Names:
Behavioral: losing weights
The participants would ask to lose weight by changing their diets and exercising, without using drugs and surgeries.
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| Experimental: Transoral robotic surgery (TORS) The participants underwent TORS. TORS is a kind of surgery that the surgeons would remove the tonsils and the fat tissue of tongue base and suspend the soft palate. |
Procedure: transoral robotic surgery
transoral robotic surgery (TORS) which remove the extra soft tissue of the base of the tongue and soft palate in this study
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| Experimental: TORS+OPR The participants started OPR 6 weeks after TORS. Each exercise was repeated 10 times, 1-3 cycles per day, 3-5 sessions per week at their home and performed for 3 months. Patients were supervised by physical therapist once a week for 30 minutes. |
Procedure: transoral robotic surgery
transoral robotic surgery (TORS) which remove the extra soft tissue of the base of the tongue and soft palate in this study
Combination Product: oropharyngeal rehabilitation
OPR included exercise for soft palate, tongue and oropharynx. There are 13 movements in OPR. The movements would be teach by a physical therapist.
Other Names:
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Outcome Measures
Primary Outcome Measures
- Change from Baseline Apnea and Hypopnea index (AHI) at 6 months [through study completion, an average of 6 months]
Polysomnography included electroencephalographic, electro-oculographic, thoracic and abdominal respiratory inductance plethysmography and body position sensor to confirm the sleeping stage in one-night observation. Above measurements will be aggregated to arrive AHI.
- Change from Baseline Volume from hard palate to the base of epiglottis in computer tomography (CT) at 6 months [through study completion, an average of 6 months]
All patients underwent CT in a supine position. Each patient was instructed to maintain his/her tongue in the resting position, without swallowing, during CT. Volume from hard palate to the base of epiglottis was measured.
- Change from Baseline Cross section area on the tip of epiglottis in computer tomography (CT) at 6 months [through study completion, an average of 6 months]
All patients underwent CT in a supine position. Each patient was instructed to maintain his/her tongue in the resting position, without swallowing, during CT. Cross section area on the tip of epiglottis was measured.
- Change from Baseline Anterior to posterior distance on the tip of epiglottis in computer tomography (CT) at 6 months [through study completion, an average of 6 months]
All patients underwent CT in a supine position. Each patient was instructed to maintain his/her tongue in the resting position, without swallowing, during CT. Anterior to posterior distance on the tip of epiglottis was measured.
- Change from Baseline Lateral distance on the tip of epiglottis in computer tomography (CT) at 6 months [through study completion, an average of 6 months]
All patients underwent CT in a supine position. Each patient was instructed to maintain his/her tongue in the resting position, without swallowing, during CT. Lateral distance on the tip of epiglottis was measured.
- Change from Baseline Drug-induced sleep endoscopy (DISE) at 6 months [through study completion, an average of 6 months]
DISE was carried out by an experienced ENT surgeon in a semi-dark and quiet operating room with the patient supine lying on a hospital bed. Artificial sleep was induced by intravenous injection of propofol and midazolam (bolus injection of 1.5 mg) through a target-controlled infusion system (1.5 to 3.0 lg/mL), intending to the transition to unconsciousness with beginning of snoring and with the examiner evaluating decreased muscle reflexes of the eyelid. The severity of collapse in the upper airway was assessed by the surgeon.
- Change from Baseline Muscle Strength of Jaw at 6 months [through study completion, an average of 6 months]
Muscle strength of jaw was measured with a 'handheld' dynamometer (MicroFETâ—‹R2, Hoggan Scientific, USA) mounted on an adapted ophthalmic examination frame, to avoid alterations in chin and head position and to ensure consistent compression.
- Change from Baseline Muscle strength of tongue at 6 months [through study completion, an average of 6 months]
The muscle strength of the tongue was evaluated by the IOPI system, model 2.2 (Northwest, Co., LLC, Carnation, WA, USA).
Eligibility Criteria
Criteria
Inclusion Criteria:
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Clinical diagnosis of mild to severe OSA in the past year
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Age between 20-65 years old.
Exclusion Criteria:
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A history of malignancy or infection of the head and neck region and laryngeal trauma
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Craniofacial malformation
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Stroke
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Neuromuscular disease
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Heart failure
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Coronary artery disease.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | National Cheng Kung University Hospital | Tainan | Please Select | Taiwan | 412 |
Sponsors and Collaborators
- National Cheng-Kung University Hospital
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- NCKUH-10902002