By Peter Blais, RPSGT
Neuromuscular electrical stimulation (NMES) may be a noninvasive option for the treatment of obstructive sleep apnea (OSA) in individuals with cerebral palsy (CP) that do not accept oral appliance or CPAP therapies. The poster for this pioneering study was presented at the 2015 Annual Meeting of the American Academy of Dental Sleep Medicine (AADSM) and awarded the AADSM 2015 Clinical Research Award. A full paper on this study has since been published in PLOS One.
The author, Lilian Giannasi, is a PhD in Sleep Disorders from the University of Vale do Paraίba in Brazil who also did post-doctorate work in Bioscience from the State of São Paulo University, where she is currently part of a research group studying temporomandibular disorders and orofacial pain. Giannasi telles Dental Sleep Corner, “We will investigate how to apply this option as a supporting therapy with oral appliance. For several CP patients, therapies that help minimize the symptoms of OSA are imperative in improving their quality of life.”
NMES is a noninvasive therapy for strengthening muscles in patients with CP. It involves the administration of pulses of electrical current though electrodes placed over the muscle, and its benefits include the preservation of muscle strength, a reduction in spasticity, improved flexibility, and an increase in the range of motion of the affected limb. Considering the success of NMES regarding other muscle groups, Giannasi thought it seemed plausible that the use of this therapy on the masticatory muscles would be equally beneficial for the treatment of spasticity in this musculature. She says this is the first study to apply NMES to the masticatory muscles in adults with CP and evaluate its effect on sleep patterns.
In the study, 15 adults with CP underwent bilateral masseter and temporalis NMES therapy and sleep variables were evaluated through electromyography and polysomnography prior and post 2 months of therapy. The study concluded that NMES 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 apnea events in CP patients.
In the PLOS One paper, the authors state, “NMES is a promising treatment option for patients with CP and opens a new field of research, including the use of this therapy on individuals without CP. NMES could be employed to improve muscle tone and the function of upper airway muscles, thereby preventing the occurrence of sleep apnea.” Further studies with a larger sample size are needed to confirm these findings, the authors note.
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