Lessons from the Academy of Orofacial Myofunctional Therapy Meeting
This past weekend I had the pleasure of participating in the advanced course of the Academy of Orofacial Myofunctional Therapy (AOMT). The meeting was held at the Millennium Biltmore Hotel Los Angeles I have to admit as someone who has spent over 100 days a year in hotels for the last 20 years, even I was impressed by this hotel and rate the lobby and public areas of the hotel as a must see in Los Angeles. I was invited to support the group with the discussion of home sleep testing (HST) technologies and brought along a few Nox T3 by Carefusion units for the group to examine and for a few volunteers to trial. The Nox T3 is particularly suited to a group such as this because it is the only HST available with FDA 510(k) clearance for pediatric patients as well as adults. T3 also uses surface EMG leads to measure muscle activity for an objective measurement of sleep bruxism.
“Recent research has shown that myofunctional therapy may reduce the symptoms of sleep disordered breathing (such as snoring), and ameliorate mild to moderate OSA (obstructive sleep apnea). When functioning and used properly, the muscles of the tongue, throat, and face, can reduce obstruction to the airway.” – AOMT website
It is important to note that this group is extremely focused and interested in sleep apnea as well as oromyofunctional disorders (OMD’s ) so not surprisingly we had a great deal of interest in the home sleep testing device. I have attached a few documents for you to look through for more sleep related information.
- #22-Sleep Bruxism (2) – this is a description of how and why to collect sleep bruxism information
- RC2718 NOX T3 Portable Sleep Monitor Brochure (1) – this is a standard sales sheet that lists specifications of the device. It is important to note that the Nox T3 is the only HST device that has FDA clearance for pediatric patients.
- Sample Bruxism Report from the device. If you took a study I sent you this report
- T3RespiratorySummaryReport– Sample respiratory report showing all parameters that are collected in a standard Nox T3 study
- TITRATION END POINT. This is an article that was written by Dr John Viviano DDS. He lays out the basis for use of the Nox T3 in the dental office
- Clinical Guidelines for the Use of Unattended Portable Monitors. This is a copy of a clinical guideline as published by the American Academy of Sleep Medicine.
- This is a link to a video that shows a patient hookup so that you can get a sense of the ease of use https://www.youtube.com/watch?v=6rZAaUKwOD8
” Orofacial Myofunctional Disorders (OMDs) are disorders of the muscles and functions of the face and mouth. OMDs may affect, directly and/or indirectly, breastfeeding, facial skeletal growth and development, chewing, swallowing, speech, occlusion, temporomandibular joint movement, oral hygiene, stability of orthodontic treatment, facial esthetics, and more.
Most OMDs originate with insufficient habitual nasal breathing or with oral breathing. The subsequent adaptation of the muscles and the orofacial functions to a disordered breathing pattern creates many OMDs. Orofacial Myofunctional Disorders may impact treatments by orthodontists, dentists, dental hygienists, speech-language pathologists, and other professionals working in the orofacial area.” – AOMT Website
As to the HST studies collected at the meeting. Meeting attendees were representative of the standard dental office, generally very fit, healthy and asymptomatic for OSA. Volunteers sleep with the Nox T3 and sleep studies were conduct in a way consistent with generally accepted Home Sleep Testing practices.
The breakdown went as follows:
12 devices handed out over 2 nights
1 patient did not turn the device on properly so retook the study the next night
1 patient did not take the study because they decided to take the study later for personal reasons
2 patients chose not to wear the cannula so RIP Flow was used to score the studies
11 studies completed and reports generated. 10 patients in the normal AHI range. 1 volunteer in the moderate AHI range
In all, this adherence to protocol was consistent with what happens in any home sleep diagnostic program. Some patients follow directions closely, others go their own way. Usually with an application of best practices, excellent studies will result.
So was this the end of the story? Not at all
The volunteer below had a sleep time of 5 hrs and 38 minutes. AHI is reported at 8.0 or Mild which fits nicely with the volunteer interview which did not include any reports of snoring or sleep disordered breathing. It is however interesting to note that almost the entire nights AHI was collected between 3:55 AM and 4:56 AM if this one hour time frame is excluded the patients AHI drops to 1.9. The patient was also flow limited for 35% of the night which is consistent with UARS.
This volunteer displayed a great deal of snoring and flow limitation. AHI was Mild however the volunteer did complain of some daytime sleepiness.
This volunteer displayed some snoring and flow limitation. Volunteer did not seem surprised by the snoring report and also reported some sleepiness. The unexpected data came from the bruxism leads which showed 1970 bruxism bursts or 190 per hour and a BEI Bruxism episodes index of 1.3 which indicates a connection between sleep disordered breathing and this volunteer’s bruxism.
All in all it was a really great meeting with a lot to learn. I always enjoy programs that are designed by and for therapists. Lots to see and do with hands on and one on one learning experiences. I rate the programs by AOMT to be among the best I attend each year and I look forward to next year. You should click here and see if there is an upcoming course you can attend.