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Y Chien, c guilleminault, 0442 ADULT SHORT LINGUAL FRENULUM < AND > OBSTRUCTIVE-SLEEP-APNEA LINGUAL FRENULUM & OBSTRUCTIVE-SLEEP-APNEALINGUAL FRENULUM & OBSTRUCTIVE-SLEEP-APNEALINGUAL FRENULUM AND OBSTRUCTIVE-SLEEP-APNEA, Sleep, Volume 40, Issue suppl_1, 28 April 2017, Pages A164–A165, https://doi.org/10.1093/sleepj/zsx050.441
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Abstract
Short lingual frenulum is associated with sucking, swallowing, speech difficulties and sleep-disordered-breathing in children. Relationship between presence of short lingual frenulum and obstructive-sleep-apnea was evaluated
229 adults successively referred for suspicion of OSA and clinically evaluated by the same individual during a 3 months period with determination of presence of abnormal or normal lingual frenulum. Frenulum normalcy was determined with measurement of the “free-tongue” between upper frenulum and tip of tongue and determination of the “Tongue-range-in-motion-ratio” [normal if less than 50% difference with tongue flat in mouth and with tongue tip reaching the incisive papillae]. All subjects had polysomnogram with determination of apnea-hypopnea-index, flow limitation and oxygen saturation drops. Syndromes and patients with major psychiatric problems were eliminated from the investigation.
All subjects [mean age 55.35 ± 17.13years] presented OSA based on clinical evaluation and nocturnal polysomnography with 42.4% been women. There were 105 subjects with short lingual frenulum that had been never diagnosed/treated. Statistical analyses show that compared to patients with OSA and normal lingual frenulum, short lingual frenulum subjects presented similar Epworth-sleepiness-scores, no significant difference in gender distribution, body-mass-index, mean age, clinical symptoms disrupted sleep, daytime sleepiness, headache, daytime fatigue, cognition problems, enlarged inferior nasal turbinates, tonsil size when present. But they had significantly higher frequency of deviated septum (0.001); high and narrow palatal vault (0.0001), maxillary cross-bite (0.001), small mandible (0.0001), overbite (0.001): patients with short frenulum had clear impairment of both maxilla and mandible. Polysomnography showed that subjects with normal frenulum had a significantly higher apnea-hypopnea index (0.045) and lower nadir of oxygen saturation (0.05)
Short lingual frenulum restrict tongue motility early in life and lead to abnormal development of oral cavity, with clear impact on maxillary and secondary mandibular growth, as already observed during childhood Morphologic changes occur slowly during childhood, lead to small upper-airway that favors collapse of upper-airway during sleep and development of obstructive-sleep-apnea at later date. Short lingual frenulum has been reported as a phenotype for pediatric-sleep-apnea Recognition and treatment early in life would avoid occurrence of the syndrome and its co-morbidities.
none.
- phenotype
- body mass index procedure
- congenital abnormality
- obstructive sleep apnea
- fatigue
- headache
- adult
- apnea
- cell motility
- child
- cognition
- deglutition
- lingual frenum
- maxilla
- mental disorders
- mouth
- palate
- polysomnography
- sleep apnea syndromes
- speech disorders
- turbinates
- mandible
- morbidity
- gender
- sleep
- tongue
- tonsil
- drowsiness
- deviated nasal septum
- infant apnea
- oxygen saturation measurement
- daytime sleepiness
- upper respiratory tract
- overjet, dental
- apnea-hypopnea index procedure
- slow shallow breathing
- fluid flow
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