title: Orofacial motor functions in pediatric obstructive sleep apnea and implications for myofunctional therapy.
abstract: OBJECTIVE
  The purposes of this study were (1) to identify possible differences in muscular and orofacial functions between children with obstructive sleep apnea (OSA) and with primary snoring (PS); (2) to examine the standardized difference between normal values of myofunctional scores and those of subjects with OSA or PS; and (3) to identify the features associated with OSA.
  
  
  METHODS
  Participants were 39 children (mean age 8 ± 1.2 years) of which, 27 had a diagnosis of OSA and 12 had PS. All participants were examined by an otorhinolaryngologist and underwent overnight polysomnography. Orofacial characteristics were determined through a validated protocol of orofacial myofunctional evaluation with scores (OMES), surface electromyography of masticatory muscles, and measurements of maximal lip and tongue strength. Reference values in the OMES were included to quantify the standardized difference (effect size = ES) relative to the groups studied and in the regression analysis.
  
  
  RESULTS
  The OSA group had lower scores in breathing and deglutition, more unbalanced masticatory muscle activities than PS group (P < 0.05), but both groups had similar reductions in orofacial strength. OSA had a large ES (Cohen's d > 0.8) in all analysed OMES scores, while PS group showed small and medium differences in breathing and mastication scores, respectively. The mobility of the stomatognathic components score was the most important to contribute for group status (57%, P < 0.0001) in the regression analysis.
  
  
  CONCLUSIONS
  Children with tonsillar hypertrophy and OSA had relevant impairments in orofacial functions and lesser muscular coordination than children with PS.
authors.affiliation: Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil; Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil. Electronic address: cfelicio@fmrp.usp.br.
authors.forename: Cláudia Maria
authors.initials: CM
authors.lastname: de Felício
authors.affiliation: Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil; Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil.
authors.forename: Franciele Voltarelli
authors.initials: FV
authors.lastname: da Silva Dias
authors.affiliation: Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil; Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil.
authors.forename: Gislaine Aparecida
authors.initials: GA
authors.lastname: Folha
authors.affiliation: Department of Neurosciences and Behavioral Sciences, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil.
authors.forename: Leila Azevedo
authors.initials: LA
authors.lastname: de Almeida
authors.affiliation: Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil; Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil.
authors.forename: Jaqueline Freitas
authors.initials: JF
authors.lastname: de Souza
authors.affiliation: Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil; Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil.
authors.forename: Wilma Terezinha
authors.initials: WT
authors.lastname: Anselmo-Lima
authors.affiliation: Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil; Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil.
authors.forename: Luciana Vitaliano Voi
authors.initials: LV
authors.lastname: Trawitzki
authors.affiliation: Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, SP, Brazil; Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil.
authors.forename: Fabiana Cardoso Pereira
authors.initials: FC
authors.lastname: Valera
mesh_terms: D002648:Child; D003679:Deglutition / Q000502:physiology; D004576:Electromyography; D005260:Female; D006801:Humans; D006984:Hypertrophy; D008046:Lip / Q000503:physiopathology; D008297:Male; D008410:Masticatory Muscles / Q000503:physiopathology*; D020247:Myofunctional Therapy; D014066:Palatine Tonsil; D010608:Pharyngeal Diseases / Q000503:physiopathology*; D017286:Polysomnography; D011446:Prospective Studies; D012119:Respiration; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000534:rehabilitation; D012913:Snoring / Q000503:physiopathology* / Q000534:rehabilitation; D014059:Tongue / Q000503:physiopathology
keywords: Children; Electromyography; Myofunctional therapy; Obstructive sleep apnea; Orofacial functions; Orofacial strength