Tongue Exercises and Reflux Therapy for Upper Airway Resistance Syndrome
| Status: | Completed |
|---|---|
| Conditions: | Gastroesophageal Reflux Disease , Insomnia Sleep Studies, Pulmonary |
| Therapuetic Areas: | Gastroenterology, Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 11/18/2012 |
| Start Date: | August 2006 |
| End Date: | August 2006 |
Effectiveness of Tongue Exercises and Laryngopharyngeal Reflux Therapy on Upper Airway Resistance Syndrome
Tongue exercises are described to improved snoring and acid reflux symptoms. Acid reflux
treatment has been found to improve obstructive sleep apnea to a limited degree. Upper
airway resistance syndrome is caused by resistance to breathing, leading to multiple
respiratory event related arousals, leading to daytime fatigue and other various physical
ailments. Tongue base or retrolingual collapse is implicated in upper airway resistance
syndrome. We will measure sleep quality and quality of life indices before and after
treatment for subjects that undergo tongue exercises only, acid reflux treatment only, and
those that undergo both treatments.
Upper airway resistance syndrome (UARS) is a distinct clinical disorder characterized by
repetitive arousals during sleep due to soft tissue collapse of the pharynx. It is
associated with chronic daytime fatigue, insomnia, cold extremities, low blood pressure,
orthostatic intolerance, headaches/migraine/TMJ, and various gastrointestinal condition.
Obstructive sleep apnea (OSA) is different in that once obstruction of the pharynx occurs,
there are multiple periods of complete (apnea) or incomplete cessation of breathing
(hypopnea). Untreated, it has been strongly associated with daytime sleepiness,
hypertension, depression, coronary artery disease, stroke, and even death. One possible
mechanism of pharyngeal obstruction is that the posterior tongue is susceptible to collapse
when supine during sleep, which causes further collapse of the soft palate and related
structures. Acid reflux is also known to frequently coexist with UARS and OSA, possibly by
increasing upper airway edema and inflammation. Treating OSA has been shown to improve
reflux symptoms, and vice versa. Tongue exercises are also found to improve snoring and
reflux symptoms. This study aims to validate via pre and post treatment polysomnograms, the
effectiveness of tongue exercises alone, acid reflux treatment alone, or a combination of
both regimens. Twenty-five patients will be randomly assigned to each of the three groups.
Measurements include the percent improvement of major sleep indices within each group, as
well as between groups. Quality of life variables as well as acid reflux symptom scores will
be addressed as well.
Inclusion Criteria:
- men and women ages 18 to 45
- supine Park tongue position 3+ or greater
- tonsil size 2 or less
- Mueller's 2+ or less
- Friedman Stage II/III
- BMI ≤ 30
- Symptoms of sleep apnea or UARS lasting for > 3 months: excessive daytime
sleepiness, OR two of the following:
- Choking or gasping during sleep
- Recurrent awakenings from sleep
- Unrefreshing sleep
- Daytime fatigue
- cold extremities
- inability to sleep supine
- irritable bowel syndrome / GERD / bloating
- low blood pressure
- orthostatic intolerance
- AHI of < 5, and RDI > 10 (polysomnogram within 1 year of entry date)
Exclusion Criteria:
- Significant nasal obstruction
- Prior pharyngeal surgery
- History of radiation to the head and neck
- Dysmorphic facies or craniofacial syndrome
- ASA class IV or V
- Major depression or unstable psychiatric disorder
- Contraindications to taking Omeprozole
- Pregnancy
- Illiteracy (unable to complete required forms)
- No phone # or mailing address, or plans to change in 3 month period
- Any further upper airway surgery within three month period
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