IOPI Medical Q3 2023 Newsletter - Obstructive Sleep Apnea Research!

So far, the PNW summer is off to a pleasantly mild start. There have been a few 90-degree days to which we have said ‘no thank you,’ but otherwise it has been glorious. We hope that you are also able to enjoy summer, in whatever way restores and fuels you.

This quarter we are bringing you some exciting news about a new market for IOPI Medical, including great new research. Keep reading for all the details!

Our Clinical Consultant, Ed Bice has also made good on his promise from the previous newsletter with the next installment of Anatomy and Physiology, discussing the information required to develop appropriate rehab treatment plans for those with swallowing disorders.

The past few months have also seen us back on the conference track. It has been wonderful to see so many familiar faces and meet so many new ones. As promised, we will be in Boston for ASHA in November, but what we’re really looking forward to is ASHA 2024 in Seattle! We’re so proud of our hometown and look forward to sharing it with you. We may even host a special event. Stay tuned!

Also don’t forget to visit our website. It gives you the opportunity to interact with our IOPI staff, and Patient Advocacy tools (have you seen the Dysphagia Cost tool?!). You can also use our Get a Quote page if you’re need of pricing information. It’s quick and easy! You can also follow us on Instagram (iopimedical), Twitter (@iopimedical) & Facebook (IOPI Medical LLC) for the latest news and information.

Please Note: IOPI Medical offices will be closed on September 4th in observance of Labor Day.

We are incredibly excited to share that the IOPI has been used in exciting new research concerning the benefits of tongue strengthening to improve obstructive sleep apnea.

Recent publications have investigated the relationship between tongue strength and sleep apnea. Weakness of the genioglossus, one of eight tongue muscles, has been implicated as a cause of obstructive sleep apnea (Cori et al., 2018; Mediano et al., 2019; Sériès et al., 1996).

Exercise with the IOPI improves tongue strength (Adams et al., 2013). A 2020 study found that the IOPI has potential as a screening tool for the identification of OSA. Other studies have investigated the use of IOPI as a treatment tool to mitigate genioglossus weakness and improve symptoms of obstructive sleep apnea.

Check out our Article Spotlight & Hot Off the Press sections where we share some recent findings in the area of OSA.

Step One: Anatomy and Physiology

As promised in the previous newsletter, this installment will continue discussing information necessary to develop a rehabilitative treatment plan for people with swallowing disorders. The first step on the journey is understanding the anatomy and physiology of the swallow. I know, I know, we all took a basic course in anatomy and physiology. In the United States, it is typically an undergraduate course. There is no practical application at the time of the course and, in many cases, very little prior knowledge. Therefore, the information must be accommodated rather than assimilated, which requires much more cognitive energy. In some cases, the information is memorized for an exam and quickly left behind. Unfortunately, the clinician’s lack of understanding of anatomy and physiology can lead to ineffective or possibly harmful treatments. Let us consider a few examples.

Suppose a patient presents with a primary complaint of drooling. In that case, clinicians often recommend a pharmacological intervention such as a scopolamine patch. However, determining the cause of the drooling is necessary before recommending such an intervention. The issue is, does the person have excessive saliva production (Bavikatte et al., 2012)? To answer the question, the clinician must understand the possibilities. Is it an issue with sensation in the lips (trigeminal nerve)? Is there an problem with swallow frequency regulated by the central pattern generator (Jean, 2001)? Is it due to the muscle tone of the lips (Stranc & Fogel, 1984)? The differential diagnosis could inform an efficacious treatment plan. Saliva is responsible for microbial homeostasis and protection of the mouth, aiding in bolus formation and clearance, digestion, taste and smell, and wound healing (Roblegg et al., 2019). A lack of knowledge in this area could lead to recommending medication to reduce saliva production, which may lead to harm as saliva serves several roles in maintaining health.

Another example is the upper esophageal sphincter (UES) opening. The opening involves sphincter relaxation, anterior laryngeal traction, and intrabolus pressure. Consequently, residue in the pyriform sinuses requires examination of time to UES opening, duration of UES opening, and perhaps a manometric assessment to determine if relaxation occurs. Without the information, paired with the etiology of the dysphagia, it is not possible to determine if the patient would possibly benefit from the Mendelsohn maneuver, Botox, dilatation, or a combination of interventions. Without an understanding of the mechanism of UES opening, it is not possible to properly assess and treat the dysfunction.

The examples could go on. Suffice it to say that it is necessary for clinicians responsible for assessing and treating swallowing disorders to have a thorough knowledge of anatomy and physiology. The good news is that learning anatomy and physiology does not require a continuing education course. Simply grab a textbook off the shelf. There are a finite number of muscles and nerves, and they do not change!

Stay tuned; there is more to come!

Many of you may already be familiar with our esteemed Clinical Consultant, Ed Bice, but did you know, you can learn from him from the comfort of your office or home? IOPI Medical offers ASHA Continuing Education Units with our two FREE courses.

The Role of Oral Musculature in Swallowing and the Therapeutic Benefits of the IOPI, will review the oral musculature and its essential functions, as well as explore exercise principles and how the IOPI can be integrated into a dysphagia treatment plan.

Our second course, Research Update, summarizes recent findings related to the IOPI.

Click the button below to register!

The study investigated the correlation of the Orofacial Myofunctional Evaluation with Scores, Friedman and Epworth Sleepiness Scale, Iowa Oral Performance Instrument (IOPI), and Tongue Digital Spoon with severe obstructive sleep apnea-hypopnea syndrome (OSAHS) in 29 patients. All four tools correlated with the presences of OSAHS. The investigation found that an IOPI score below 48 kPa showed a specificity of 0.72 and a sensitivity of 0.79 with an adjusted odds ratio of 9.96 and a 0.82 area under the curve.

Tongue Peak Pressure: A tool to aid in the identification of obstruction sites in patients with obstructive sleep apnea/hypopnea syndrome

O'Connor-Reina C, Plaza G, Garcia-Iriarte MT, Ignacio-Garcia JM, Baptista P, Casado-Morente JC, De Vicente E. Tongue peak pressure: a tool to aid in the identification of obstruction sites in patients with obstructive sleep apnea/hypopnea syndrome. Sleep Breath. 2020 Mar;24(1):281-286. doi: 10.1007/s11325-019-01952-x. Epub 2019 Nov 19. PMID: 31745755.

https://pubmed.ncbi.nlm.nih.gov/31745755/

The study investigated the correlation of tongue peak pressure assessed with the Iowa Oral Performance Instrument (IOPI) with the topographic site of obstruction in 35 patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). The IOPI measurements were significantly lower in people with OSAHS than in the healthy controls. A significant correlation was found between the IOPI measurements and the T size during drug-induced sleep endoscopy. The authors concluded that the IOPI is a useful tool for evaluating tongue collapse for the topographic diagnosis of obstructive sleep apnea/hypopnea syndrome patients.

The effect of tongue elevation muscle training in patients with obstructive sleep apnea: A randomized controlled trial

Poncin W, Correvon N, Tam J, Borel JC, Berger M, Liistro G, Mwenge B, Heinzer R, Contal O. The effect of tongue elevation muscle training in patients with obstructive sleep apnea: A randomized controlled trial. J Oral Rehabil. 2022 Nov;49(11):1049-1059. doi: 10.1111/joor.13369. Epub 2022 Sep 21. PMID: 36081312; PMCID: PMC9826101.

https://pubmed.ncbi.nlm.nih.gov/36081312/

The study employed a multicenter randomized controlled trial recruiting adults diagnosed with moderate OSA who presented low adherence to C-PAP. The intervention group completed 6 weeks of tongue exercise (strength and endurance) with the IOPI. The control group completed a 6 weeks sham training protocol. Daytime sleepiness measured by the Epworth Sleepiness Scale and tongue endurance significantly improved in the intervention group. In the intervention group, 75% of participants had a decrease in daytime sleepiness that exceeded the minimal clinically important difference.

Myofunctional Therapy App for Severe Apnea–Hypopnea Sleep Obstructive Syndrome: Pilot Randomized Controlled Trial

Baptista Jardin P, Casado Morente JC, Garcia Iriarte MT, Plaza G. Myofunctional Therapy App for Severe Apnea-Hypopnea Sleep Obstructive Syndrome: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth. 2020 Nov 9;8(11):e23123. doi: 10.2196/23123. PMID: 33093013; PMCID: PMC7683258.

https://pubmed.ncbi.nlm.nih.gov/33093013/

This randomized trial enrolled 40 patients with severe obstructive sleep apnea-hypopnea syndrome (OSAHS) into two groups. One group received a myofunctional intervention, and one group served as the control. After the intervention, 28 patients remained. No significant changes were observed in the control group. The intervention group showed significant improvements. When tongue strength, measured with the IOPI, improved from a mean of 39.83 to 59.06, the Apnea-Hypoxic Index decreased by 53.4%, and the oxygen desaturation index decreased by 46.5%.

To help you achieve the greatest level of success for your patients, we continue to provide you with the necessary Purchasing Advocacy tools, as well as clinical support.

Our Purchasing Advocacy tools can be found on our Medical Professionals page. Here you will find our IOPI Dysphagia Cost Tool as well as a ready-to-use Benefits of IOPI for Dysphagia PowerPoint. Just populate it with information specific to your patient’s needs.

You also have clinical support at your fingertips. Our clinical consultant, Ed M. Bice, M.Ed., CCC-SLP, is available to mentor through the advocacy process to assess and report the estimated cost of dysphagia to your facility. You can reach Ed for a patient consultation or clinical question by calling (844) 844-IOPI or emailing ed@iopimedical.com.

To access our IOPI Dysphagia Cost Tool, the Benefits of IOPI for Dysphagia PowerPoint, and tips on advocating for your patients, please visit: https://iopimedical.com/purchasing-advocacy/