标题：EFFECTS OF NEUROMUSCULAR ELECTRICAL STIMULATION ON THE MASTICATORY MUSCLES AND PHYSIOLOGIC SLEEP VARIABLES IN ADULTS WITH CEREBRAL PALSY: A NOVEL THERAPY APPROACH- PILOT STUDY
出版社：Brazilian Association of Sleep and Latin American Federation of Sleep Societies
摘要：Cerebral palsy (CP) is a term employed to define a group of non-progressive neuromotor disorders caused by damage to the immature or developing brain, with consequent limitations regarding movement and posture. CP may impair oral pharynx muscular tonus leading to a compromised mastication and to sleep disorders (e.g.: obstructive sleep apnea -OSA). There is a lack of studies focusing the evaluation of the treatment of masticatory muscles with neuromuscular electrical stimulation (NMES) and also there is rare studies evaluating polysomnographic pattern of adults with CP. The aim of the present study was evaluate the effects of NMES on the masticatory muscles and physiologic sleep variables in adults with CP through electromyography (EMG) and polysomnography (PSG). The hypothesis is the NMES will improve masticatory function and sleep variables. METHODS 15 adults with CP underwent bilateral masseter and temporalis neuromuscular electrical stimulation (NMES) therapy and its effect over masticatory muscle and sleep variables were evaluated through EMG and PSG, respectively, prior and post 2 months of NMES therapy. EMG evaluation consisted of 3 tests in different position: rest, mouth opening and maximum clenching effort (MCE). RESULTS 13 patients completed the study. The EMG values in the resting position were 100% higher prior to therapy for all muscles analyzed (po0.05); mean mouth opening rose from 38.078.0 to 44.0710.0 cm (p¼0.03) and MCE was significantly only for right masseter, whereas other muscles exhibited improvements in comparison to baseline. Prior the study 4 patients presented mild OSA and 2 had moderate OSA. After 2 months of NMEE, PSG showed that mean apnea/hypopnea index (AHI) improved from 7.277.0/h to 2.371.5/h (po0.05) for apneic patients. For entire group, total sleep time improved from 185 min to 250 min (p¼0.04) and minimal SaO2 improved from 83.673.0 to 86.474.0 (p¼0.04). CONCLUSION NMES performed over a twomonth period led to an increase in the electrical activity of the masticatory muscles at rest, opening and during isometric contraction and improved sleep variables, including the elimination of sleep apneas events in CP patients. NMES may be a noninvasive option for the treatment of OSA in individuals with CP that do not accept oral appliance or continuous positive airway pressure (CPAP) therapies. Further studies with a larger sample size are needed to confirm these findings.
