Language in children with obstructive sleep apnea

Author(s)

Camila de Castro Corrêa

• Document type: Doctoral Thesis
• Press: Botucatu. 2019-04-16.
• Institution: Universidade Estadual Paulista (Unesp). Faculdade de Medicina. Botucatu
• Defense date: 2019-03-15
• Advisor: Luciana Paula Maximino; Silke Anna Theresa Weber

Abstract

INTRODUCTION Obstructive Sleep Apnea (OSA) in the pediatric population could cause consequences due to intermittent hypoxemia, transient hypercapnia, and frequent arousals. As an example are the cardiovascular repercussions, alteration in growth, reduced attention, memory capacity, impact on learning and quality of life. The literature is scarce regarding the investigation of oral language in children with OSA. AIM To analyze receptive and expressive oral language in children with Obstructive Sleep Apnea (OSA). METHODS The present thesis was developed in three stages, each being composed of specific methods, contained in articles presented throughout this document. 1 st stage - Literature Investigation: The review of the literature investigated publications of studies related to oral language disorders in children with OSA, focusing on the possible relationship of OSA and language disorders, on which oral language protocols were used and on which were the most frequently applied protocols of quality of life in the Brazilian population. 2 nd stage - Clinical Investigation: 52 children, both genders, with and without respiratory complaints, aged from 4 to 11 years, were submitted to the clinical evaluation applying protocols for the investigation of: hearing, expressive oral language (phonology, syntax, expressive semantics and pragmatic) and receptive language (instruction comprehension and receptive semantics) and aspects of orofacial myology. 3 rd phase - Analysis by the Sleep Clinical Record: The study sample of 52 children were submitted to a screening for OSA by the Sleep Clinical Record protocol. RESULTS 1 st stage - Literature Investigation: The review of the literature found only few studies which investigated oral language in children, indicating possible disorders in some language levels. The studies mostly performed timely investigations, not considering all levels of oral language, applying different protocols, what made a comparison difficult. The most used protocols in Brazil to investigate quality of life were the OSA-18 and OSD-6 questionnaires. 2 nd stage - Clinical Investigation: The evaluation of the middle ear showed a high frequency of tympanometric alterations. Regarding deleterious oral habits, there was a greater occurrence and persistence of the history of pacifier and bottle use in the OSA group, the use and persistence of the bottle use showed a positive correlation to the OSA severity When evaluation of the respiratory functions, the OSA group presented decreased nasal permeability in relation to the children without OSA. The language evaluation expressed a worse performance for the OSA Group regarding phonology, syntax, expressive and receptive semantics, being significant for the phonological level. It is worth mentioning that there was a 10 high occurrence of language alteration in at least one communicative level ofboth groups 3 rd phase - Analysis by the Sleep Clinical Record: In partnership with Sapienza Università di Roma, the sleep clinical record questionnaire was applied to the OSA children and it was verified that the Brazilian OSA children presented a higher SCR score when compared to Italian children. In addition, the orofacial myofunctional evaluation associated tothe SCR increased the sensitivity and specificity of this protocol to identify children at risk for OSA. CONCLUSION In this pioneer study, the possibility of oral language alteration in children with OSA was verified, besides pointing out a large gap in language performance in children in general. The present study allowed to integrate not only the joint performance of different professions, but also investigated the communication of the child with OSA in a broad way, considering the different language levels as well as the auditory and orofacial muscles and functions. (AU)

• FAPESP's process: 16/05659-9 - Language in children with obstructive sleep apnea
• Grantee: Camila de Castro Corrêa
• Support Opportunities: Scholarships in Brazil - Doctorate