Optimal nighttime sleep breathing:
+ Nasal breathing
+ Lips closed with tongue suctioned to hard palate
+ Quiet breathing; should not be audible or noisy
RED FLAGS
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Open or pursed lips/dry lips (Thome-Pocheco, 2015 et al.)
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Low forward tongue position (Harari et al., 2010; Correa et al., 2008)
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Short upper lip with reduced function (Abreu et al., 2008)
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Voluminous & everted lower lip (Abreu et al., 2008)
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Anterior oral seal: lip to tongue (Harari et al., 2010)
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Hypotonic oral facial musculature (Abreu et al., 2008)
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Forward head posture (Cuccia et al., 2008; Krakauer & Guilherme, 2000)
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Facial retrusion (Valera et al., 2006)
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Posterior cross bite, open bite, overjet (Valera et al., 2006)
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Nasal congestion (Harari, 2010)
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Drooling (Kuroishi et al., 2015)
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Halitosis (Motta et al., 2011)
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Hyponasal speech (Kuroishi et al., 2015)
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Alterations of muscle activity for speaking, chewing, & swallowing (Dutra et al., 2006)
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Impacts of mouth breathing can be seen effecting reading comprehension, mathematics, and working memory. (Kuroishi et al., 2015)
What to look for:
+ Snoring or audible breathing
+ Gasping for air/cessation of breathing
+Mouth breathing
+ Lips apart/mouth open
+ Restless sleep/moves a lot
+ Sleeping in strange positions
+ Multiple awakenings
+ Enuresis/or getting up multiple times to urinate
+ Sweating
+ Bruxism (teeth grinding)
+ Hyperextension of the neck
+ Awaking tired, in spite of ample sleep.
Stats:
+ 25-50% of preschoolers have sleep problems (Lavigne et al., 1999)
+ 80% of children with neurodevelopmental conditions have sleep problems (Ipsiroglu et al., 2015).
+ 6-9 fold increase in the expected incidence of OSA among first grade children who ranked in the lowest 10th percentile of their class (Gozal, 2008).
+ Sleep plays an integral part in the development & plasticity of the brain (Frank, Issa, & Stryker, 2001).
+ “Sleep disorders can impair children’s IQ as much as lead exposure” (Bronson & Merryman, 2009, p. 33).
+ “We find that a history of sleep-disordered breathing alone increased the odds by 40 percent of a child having a special educational need.” - Karen Bonuck, PhD, Sleep Researcher, Albert Einstein College
Impacts
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Autonomic Deregulation (increased sympathetic tone & “fight or flight” mode) impacts the brain’s ability to access the prefrontal cortex critical for learning.
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Neurocognitive impact specifically to areas of executive function skills
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Academics (meta-analysis looking at reading comprehension, reading, spelling, math, science)
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Socialization (issues with emotional regulation leading to aggression, twice as likely to exhibit bullying behaviors)
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Behavioral health and emotional well-being (issues with self-regulation and behaviors, higher risk for depression in teens with OSA)
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Phonology
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Oral functions: speech, swallowing, and chewing.
Why Choose Link to Communication?
Link to Communication, LLC, collaborates with other airway-trained professionals. It is the only private speech and feeding clinic in Lincoln housed within a dental office to better collaborate with the dental community. Within our office there is a CBCT/I-CAT (3D-Dental Scan), trained doctor in airway assessment and sleep apnea treatment.
+ Myofunctional therapy decreases apnea-hypopnea index by approximately 50% in adults and 62% in children.
+ Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments.
Camacho M., Certal V., Abdullatif J., Zaghi S., Ruoff CM., Capasso R., & Kushida, CA. (2015). Myofunctional therapy to treat obstructive sleep apnea: A systematic review and meta-analysis. Sleep, 38(5), 669-675.
Further reading
The Tongue Was Involved, But What Was the Trouble? The search for the cause of a preschooler’s difficult behavior leads to a surprising discovery.
Nicole Archambault, EdS, MS, CCC-SLP
Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.