Brazilian Consensus on Sleep-Focused Speech-Language-Hearing Sciences - 2023 Brazilian Sleep Association

 

 Permissions and Reprints

Abstract

Introduction This consensus aimed to develop a structured document presenting the role of sleep-focused Speech-Language-Hearing (SPH) Sciences (SPHS). The recommendations were based on the expertise of specialists and on evidence in the literature, aiming to guide the coverage of this area and the consequent improvement in the quality of the professionals' approach.

Methods A Delphi method was conducted with 49 SLH pathologists (SLHP), four sleep physicians, one dentist, one physical therapist, and one methodologist. Four Delphi panel rounds were conducted in Google Forms. The items were analyzed based on the panelists' percentage of agreement; consensuses were reached when ⅔ (66.6%) of valid responses were on a same on a same answer (either “agree” or “disagree”).

Results Participants voted on 102 items. The mean consensus rate was 89.9% ± 10.9%. The essential topics were the importance of professional training, the SLH diagnosis, and the SLH treatment of sleep disorders. It was verified that all fields of the SLHS are related to the area of sleep; that sleep-focused SLH pathologists (SLHP) are the responsible for assessing, indicating, and conducting specific orofacial myofunctional therapy for sleep-disordered breathing alone or in combination with other treatments; that SLHP are included in interdisciplinary teams in the area of sleep in public and private services.

Discussion The Brazilian consensus on sleep-focused SLHS is a landmark in this area. This consensus described the scope of action of sleep-focused SLHP and systematized recommendations being useful as a reference for the professional practice in the area of sleep.

Authors' contributions (Credit statements)

LMSP, GNP, and EMGB: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, validation, writing-original draft, writing-review and editing. MA, TCAC, LFD, GLF, ELBVP, and EZ: validation, resources, writing-review and editing. MTB, CCC, VI, GRL, SRPS: conceptualization, investigation, writing-original draft, and review.

Publication History

Received: 20 September 2023

Accepted: 21 September 2023

Article published online:
23 October 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

• References

• 1 Sistema de Conselhos de Fonoaudiologia. Fonoaudiologia na Educação. Setembro de 2018 Disponível em https://www.fonoaudiologia.org.br/wp-content/uploads/2019/09/documentofonoaudiologianaeducacao-1.pdf
  PubMed
• 2 Mlima BPS, Garcia VL, Amaral EM. Speech therapists/ audiologists professional activities in Primary Health Care in Brazil: expert consensus. Distúrb Comun 2021; 33 (04) 751-761
  Google Scholar
• 3 Borrego MCM, Behlau M. A mapping of the Speech Language Pathology practice pathway in verbal expressivity in the work of communicative competence. CoDAS 2018; 30 (06) e20180054
  PubMedGoogle Scholar
• 4 Brandão L, Fonseca RP, Ortiz KZ. et al. A Neuropsicologia como especialidade na Fonoaudiologia: consenso de fonoaudiólogos brasileiros. Distúrb Comun 2016;28(02):
  Google Scholar
• 5 Buysse DJ. Sleep health: can we define it? Does it matter?. Sleep 2014; 37 (01) 9-17
  CrossrefPubMedGoogle Scholar
• 6 Riemann D. Sleep hygiene, insomnia and mental health. J Sleep Res 2018; 27 (01) 3
  CrossrefPubMedGoogle Scholar
• 7 Bianchini EMG, Kayamori F. Sono: uma especialidade multidisciplinar - Atuação do Fonoaudiólogo. In: Pinto Junior LR, Rêgo AFB, Pinheiro GL. editors Sono: atualização terapêutica. Rio de Janeiro: Atheneu; 2023: 39-51
  Google Scholar
• 8 Drager LF, Lorenzi-Filho G, Cintra FD. et al. 1° Posicionamento Brasileiro sobre o impacto dos distúrbios de sono nas doenças cardiovasculares da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol 2018; 111: 290-340
  PubMedGoogle Scholar
• 9 Morris GO, Williams HL, Lubin A. Misperception and disorientation during sleep deprivation. AMA Arch Gen Psychiatry 1960; 2 (03) 247-254
  CrossrefGoogle Scholar
• 10 May J, Kline P. Measuring the effects upon cognitive abilities of sleep loss during continuous operations. Br J Psychol 1987; 78 (Pt 4): 443-455
  CrossrefPubMedGoogle Scholar
• 11 Horne JA. Sleep loss and “divergent” thinking ability. Sleep 1988; 11 (06) 528-536
  CrossrefPubMedGoogle Scholar
• 12 Conselho Federal de Fonoaudiologia. Resolução CFFa n° 146/1996. Dispõe sobre a concessão de título de especialista no âmbito do Conselho Federal de Fonoaudiologia e dá outras providências.”. 15 de janeiro de 1996. Disponível em: https://www.fonoaudiologia.org.br/resolucoes/resolucoes_html/CFFa_N_148_96.htm
• 13 Resoluções do Conselho Federal de Fonoaudiologia [Internet]. Disponivel em: www.fonoaudiologia.org.br/cffa/index.php/resolucoes
• 14 Bianchini EMG, Kayamori F. Atuação do Fonoaudiólogo, Seção I—Sono: Uma Especialidade Multidisciplinar. In: Rêgo AFB, Pinheiro GL, Pinto Jr LR. organizadores Sono: atualização terapêutica. 1ª ed.. Rio de Janeiro: Atheneu; 2023: 39-51
  Google Scholar
• 15 Guimarães KCC. Alterações no tecido mole de orofaringe em portadores do sono obstrutiva. Jornal Brasileiro de Fonoaudiologia. 1999; 1: 69-75
  Google Scholar
• 16 Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2009; 179 (10) 962-966
  CrossrefPubMedGoogle Scholar
• 17 Ieto V, Kayamori F, Montes MI. et al. Effects of oropharyngeal exercises on snoring: a randomized trial. Chest 2015; 148 (03) 683-691
  CrossrefPubMedGoogle Scholar
• 18 Diaferia G, Badke L, Santos-Silva R, Bommarito S, Tufik S, Bittencourt L. Effect of speech therapy as adjunct treatment to continuous positive airway pressure on the quality of life of patients with obstructive sleep apnea. Sleep Med 2013; 14 (07) 628-635
  CrossrefPubMedGoogle Scholar
• 19 Kayamori F. Efeitos da terapia miofuncional orofacial em pacientes com ronco primário e apneia obstrutiva do sono na anatomia e função da via aérea [Tese]. São Paulo (SP): Faculdade de Medicina da Universidade de São Paulo (FMUSP); 2015. Disponível em: https://teses.usp.br/teses/disponiveis/5/5150/tde-05012016-153030/pt-br.php
  Google Scholar
• 20 Brasileira de Fonoaudiologia S. Parecer da Atuação Fonoaudiológica nos Distúrbios do Sono. Parecer SBFa 04/2020. Disponível em: https://www.sbfa.org.br/portal2017/pdf/parecer-sobre-a-atuacao-do-fonoaudiologo-na-area-do-sono.pdf
• 21 Associação Brasileira de Motricidade Orofacial. Parecer técnico sobre a Atuação do fonoaudiólogo na área da Medicina do Sono. Parecer ABRAMO 01 / 2020. Disponível em: http://www.abramofono.com.br/wp-content/uploads/2020/11/PARECER-SOBRE-ATENDIMENTO-EM-DISTURBIOS-DO-SONO-ABRAMO-2020.pdf
• 22 Associação Brasileira do Sono. Parecer da Atuação da Fonoaudiologia na área do Sono. Disponível em: https://absono.com.br/wp-content/uploads/2021/03/parecer_abs-fonoaudiologia-sono-2021.pdf
• 23 Conselho Federal de Fonoaudiologia. Resolução CFFa n° 611/2021, Dispõe sobre a regulamentação da atuação do fonoaudiólogo na área do sono e dá outras providências. 26 de março de 2021. Disponível em https://www.fonoaudiologia.org.br/resolucoes/resolucoes_html/CFFa_N_611_21.htm
• 24 Jünger S, Payne SA, Brine J, Radbruch L, Brearley SG. Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological systematic review. Palliat Med 2017; 31 (08) 684-706
  CrossrefPubMedGoogle Scholar
• 25 Moher D, Schulz KF, Simera I, Altman DG. Guidance for developers of health research reporting guidelines. PLoS Med 2010; 7 (02) e1000217
  CrossrefPubMedGoogle Scholar
• 26 McPherson S, Reese C, Wendler MC. Methodology Update: Delphi Studies. Nurs Res 2018; 67 (05) 404-410
  CrossrefPubMedGoogle Scholar
• 27 Barrett D, Heale R. What are Delphi studies?. Evid Based Nurs 2020; 23 (03) 68-69
  CrossrefPubMedGoogle Scholar
• 28 Diamond IR, Grant RC, Feldman BM. et al. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol 2014; 67 (04) 401-409
  CrossrefPubMedGoogle Scholar
• 29 Humphrey-Murto S, Wood TJ, Gonsalves C, Mascioli K, Varpio L. The Delphi Method. Acad Med 2020; 95 (01) 168
  CrossrefPubMedGoogle Scholar
• 30 Niederberger M, Spranger J. Delphi Technique in Health Sciences: A Map. Front Public Health 2020; 8: 457
  CrossrefPubMedGoogle Scholar
• 31 Spranger J, Homberg A, Sonnberger M, Niederberger M. Reporting guidelines for Delphi techniques in health sciences: A methodological review. Z Evid Fortbild Qual Gesundhwes 2022; 172: 1-11
  CrossrefPubMedGoogle Scholar
• 32 Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One 2011; 6 (06) e20476
  CrossrefPubMedGoogle Scholar
• 33 Corrêa CC, Kayamori F, Weber SAT, Bianchini EMG. Scientific production of Brazilian speech language pathologists in sleep medicine. Sleep Sci 2018; 11 (03) 183-210
  Article in Thieme ConnectPubMedGoogle Scholar
• 34 Conselho Federal de Fonoaudiologia. Resolução CFFa n° 374/2009. Dispõe sobre a aprovação da 3ª edição da Classificação Brasileira de Procedimentos em Fonoaudiologia - CBPFa. 21 de novembro de 2009. Disponível em: http://www.fonoaudiologia.org.br/resolucoes/resolucoes_html/CFFa_N_374_09.htm
• 35 Bagnall AD, Dorrian J, Fletcher A. Some vocal consequences of sleep deprivation and the possibility of “fatigue proofing” the voice with Voicecraft® voice training. J Voice 2011; 25 (04) 447-461
  CrossrefPubMedGoogle Scholar
• 36 Harrison Y, Horne JA. Sleep deprivation affects speech. Sleep 1997; 20 (10) 871-877
  CrossrefPubMedGoogle Scholar
• 37 Dionne G, Touchette E, Forget-Dubois N. et al. Associations between sleep-wake consolidation and language development in early childhood: a longitudinal twin study. Sleep 2011; 34 (08) 987-995
  CrossrefPubMedGoogle Scholar
• 38 Merlo S, Briley PM. Sleep problems in children who stutter: Evidence from population data. J Commun Disord 2019; 82: 105935
  CrossrefPubMedGoogle Scholar
• 39 Mason GM, Lokhandwala S, Riggins T, Spencer RMC. Sleep and human cognitive development. Sleep Med Rev 2021; 57: 101472 DOI: 10.1016/j.smrv.2021.101472.
  CrossrefPubMedGoogle Scholar
• 40 Kurdziel L, Duclos K, Spencer RMC. Sleep spindles in midday naps enhance learning in preschool children. Proc Natl Acad Sci U S A 2013; 110 (43) 17267-17272 DOI: 10.1073/pnas.1306418110.
  CrossrefPubMedGoogle Scholar
• 41 Diekelmann S, Born J. The memory function of sleep. Nat Rev Neurosci 2010; 11 (02) 114-126 DOI: 10.1038/nrn2762.
  CrossrefPubMedGoogle Scholar
• 42 Harding R, Schaughency E, Haszard JJ. et al. Sleep-Related Breathing Problem Trajectories Across Early Childhood and Academic Achievement-Related Performance at Age Eight. Front Psychol 2021; 12: 661156 DOI: 10.3389/fpsyg.2021.661156.
  CrossrefPubMedGoogle Scholar
• 43 Di Mauro P, Cocuzza S, Maniaci A. et al. The Effect of Adenotonsillectomy on Children's Behavior and Cognitive Performance with Obstructive Sleep Apnea Syndrome: State of the Art. Children (Basel) 2021; 8 (10) 921 DOI: 10.3390/children8100921.
  CrossrefPubMedGoogle Scholar
• 44 Steffani JA, Pelinson NA, Gemelli MCD, Cetolin SF. Legal basis to designation of audiologists as experts in the Labor Courts in Santa Catarina. Rev CEFAC 2016; 18 (03) 688-694
  Google Scholar
• 45 Udholm N, Rex CE, Fuglsang M, Lundbye-Christensen S, Bille J, Udholm S. Obstructive sleep apnea and road traffic accidents: a Danish nationwide cohort study. Sleep Med 2022; 96: 64-69
  CrossrefPubMedGoogle Scholar
• 46 Rodenstein D. Sleep apnea: traffic and occupational accidents–individual risks, socioeconomic and legal implications. Respiration 2009; 78 (03) 241-248
  CrossrefPubMedGoogle Scholar
• 47 Morsy NE, Farrag NS, Zaki NFW. et al. Obstructive sleep apnea: personal, societal, public health, and legal implications. Rev Environ Health 2019; 34 (02) 153-169
  CrossrefPubMedGoogle Scholar
• 48 Nofzinger EA, Wettstein RM. Homicidal behavior and sleep apnea: a case report and medicolegal discussion. Sleep 1995; 18 (09) 776-782
  CrossrefPubMedGoogle Scholar
• 49 Diaféria G, Santos-Silva R, Truksinas E. et al. Myofunctional therapy improves adherence to continuous positive airway pressure treatment. Sleep Breath 2017; 21 (02) 387-395
  CrossrefPubMedGoogle Scholar
• 50 Rueda JR, Mugueta-Aguinaga I, Vilaró J, Rueda-Etxebarria M. Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database Syst Rev 2020; 11 (11) CD013449 DOI: 10.1002/14651858.
  CrossrefGoogle Scholar
• 51 de Castro Corrêa C, José MR, Andrade EC. et al. Sleep quality and communication aspects in children. Int J Pediatr Otorhinolaryngol 2017; 100: 57-61
  CrossrefPubMedGoogle Scholar
• 52 Guilleminault C, Huang Y-S, Quo S. Apraxia in children and adults with obstructive sleep apnea syndrome. Sleep 2019; 42 (12) zsz168
  CrossrefPubMedGoogle Scholar
• 53 Chuang L-C, Hervy-Auboiron M, Huang YS. et al. Rééducation myofonctionnelle orofaciale et prise en charge multidisciplinaire des troubles respiratoires obstructifs du sommeil-Un entretien avec Lichuan Chuang, Michèle Hervy-Auboiron, Yu-Shu Huang, Esther Mandelbaum Gonçalves Bianchini, Carlos O'Connor Reina, Audrey Yoon. Rev Orthop Dento Faciale 2021; 55 (04) 477-499
  CrossrefGoogle Scholar
• 54 Holding BC, Sundelin T, Lekander M, Axelsson J. Sleep deprivation and its effects on communication during individual and collaborative tasks. Sci Rep 2019; 9 (01) 3131
  CrossrefPubMedGoogle Scholar
• 55 Rodriguez JC, Dzierzewski JM, Alessi CA. Sleep problems in the elderly. Med Clin North Am 2015; 99 (02) 431-439
  CrossrefPubMedGoogle Scholar
• 56 Leite Filho CA, Silva FFD, Pradella-Hallinan M, Xavier SD, Miranda MC, Pereira LD. Auditory behavior and auditory temporal resolution in children with sleep-disordered breathing. Sleep Med 2017; 34: 90-95
  CrossrefPubMedGoogle Scholar
• 57 Matsumura E, Matas CG, Magliaro FCL. et al. Evaluation of peripheral auditory pathways and brainstem in obstructive sleep apnea. Rev Bras Otorrinolaringol (Engl Ed) 2016; 84 (01) 51-57
  Google Scholar
• 58 Matsumura E, Matas CG, Sanches SGG. et al. Severe obstructive sleep apnea is associated with cochlear function impairment. Sleep Breath 2018; 22 (01) 71-77
  CrossrefPubMedGoogle Scholar
• 59 Pedreño RM, Matsumura E, Silva LAF. et al. Influence of obstructive sleep apnea on auditory event-related potentials. Sleep Breath 2022; 26 (01) 315-323
  CrossrefPubMedGoogle Scholar
• 60 Guimarães MASV, de Andrada MA. Relação entre sono e voz: percepção de indivíduos adultos disfônicos e não disfônicos. Distúrb Comun 2007; 19 (01) 93-102
  Google Scholar
• 61 Solé-Casals J, Munteanu C, Martín OC. et al. Detection of severe obstructive sleep apnea through voice analysis. Appl Soft Comput 2014; 23: 346-354
  CrossrefGoogle Scholar
• 62 Rocha BR, Behlau M. The influence of sleep disorders on voice quality. J Voice 2018; 32 (06) 771.e1-771.e13
  CrossrefPubMedGoogle Scholar
• 63 Roy N, Merrill RM, Pierce J, Sundar KM. Voice disorders in obstructive sleep apnea: Prevalence, risk factors, and the role of CPAP. Ann Otol Rhinol Laryngol 2019; 128 (03) 249-262
  CrossrefPubMedGoogle Scholar
• 64 Jacobs MM, Merlo S, Briley PM. Sleep duration, insomnia, and stuttering: The relationship in adolescents and young adults. J Commun Disord 2021; 91: 106106
  CrossrefPubMedGoogle Scholar
• 65 Merlo S, Jacobs MM, Briley PM. Symptoms of Obstructive Sleep Apnea in Young Adults Who Stutter. Perspect ASHA Spec Interest Groups 2022; 7 (05) 1391-1404
  CrossrefGoogle Scholar
• 66 de Luccas GR, Berretin-Felix G. Swallowing disorders in patients with obstructive sleep apnea: a critical literature review. Sleep Sci 2021; 14 (Spec 1): 79-85
  Article in Thieme ConnectPubMedGoogle Scholar
• 67 Campanholo MAT, Caparroz FA, Stefanini R. et al. Dysphagia in patients with moderate and severe obstructive sleep apnea. Rev Bras Otorrinolaringol (Engl Ed) 2021; 87 (04) 422-427
  Google Scholar
• 68 Studart-Pereira L. Abordagem fonoaudiológica na apneia obstrutiva do sono em adultos. In: Picinato-Pirola M, Ramos VF, Tanigute CC, Silva ASG, Marchesan IQ, Tessitore A, Silva HJ, Berretin-Felix G. organizadores Terapia em Motricidade Orofacial: como eu faço. São José dos Campos, SP: Pulso Editorial; 2019: 86-100
  Google Scholar
• 69 Folha GA, Valera FCP, de Felício CM. Validity and reliability of a protocol of orofacial myofunctional evaluation for patients with obstructive sleep apnea. Eur J Oral Sci 2015; 123 (03) 165-172
  CrossrefPubMedGoogle Scholar
• 70 de Felício CM, da Silva Dias FV, Trawitzki LVV. Obstructive sleep apnea: focus on myofunctional therapy. Nat Sci Sleep 2018; 10: 271-286
  CrossrefPubMedGoogle Scholar
• 71 Kayamori F, Rabelo FAW, Nazario D, Thuller ER, Bianchini EMG. Myofunctional assessment for obstructive sleep apnea and the association with patterns of upper airway collapse: a preliminary study. Sleep Sci 2022; 15 (01) 95-104
  Article in Thieme ConnectPubMedGoogle Scholar
• 72 Chaves Junior CM, Dal-Fabbro C, Bruin VMSd, Tufik S, Bittencourt LRA. Consenso brasileiro de ronco e apneia do sono: aspectos de interesse aos ortodontistas. Dental Press J Orthod 2011; 16: e1-e10
  CrossrefGoogle Scholar
• 73 Dos Santos ER, da Silva JHC, Lima AMJ, Studart-Pereira LM. Prevalence of predictive factors for obstructive sleep apnea in university students. Sleep Sci 2022; 15 (Spec 1): 234-238
  Article in Thieme ConnectPubMedGoogle Scholar
• 74 Studart-Pereira LM, de Figueiredo Pessoa LS, Castelo Branco MP. Fonoaudiologia e os distúrbios respiratórios do sono nas diferentes fases da vida. In: Araújo AN, Lucena JA, Studart-Pereira L. organizadores Relatos de Experiências em Fonoaudiologia. Recife, PE: Editora UFPE; 2020: 141-162
  Google Scholar
• 75 Krakauer L, Manzi SB, Frazão Y, Ieto V. Sleep speech-language therapy: considerations on two cases of elderly individuals with severe obstructive sleep apnea. Sleep Sci 2020; 13 (Suppl. 01) 1-118
  PubMedGoogle Scholar
• 76 Suzuki M, Okamoto T, Akagi Y. et al. Efficacy of oral myofunctional therapy in middle-aged to elderly patients with obstructive sleep apnoea treated with continuous positive airway pressure. J Oral Rehabil 2021; 48 (02) 176-182
  CrossrefPubMedGoogle Scholar
• 77 Mezzomo CL, Machado PG. Pacheco AdB, Gonçalves BFdT, Hoffmann CF. The implications of class II angle and class II type skeletal disproportion on the myofunctional aspect. Rev CEFAC 2011; 13: 728-734
  Google Scholar
• 78 Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol 2013; 62 (07) 569-576
  CrossrefPubMedGoogle Scholar
• 79 da Silva NC, da Silva GPJT, Onofri SMM, Pinato L. Obstructive sleep apnea and orofacial myofunctional aspects in obesity. Sleep Breath 2022; •••: 1-8
  Google Scholar
• 80 Sperger T, Araujo ACF, Soares CFP. Effect of myofunctional therapy on snoring in obese patients: a randomized trial. Sleep Sci 2022; 15 (04) 421-428
  Article in Thieme ConnectPubMedGoogle Scholar
• 81 Tomanchieviez M, da Silva Garcia TV, Canterji MB, Vidor DCGM. The role of speech therapist in the patient care team for bariatric surgery. International Journal of Medical and Surgical Sciences. 2020; 7 (03) 1-13
  CrossrefGoogle Scholar
• 82 Carberry JC, Amatoury J, Eckert DJ. Personalized management approach for OSA. Chest 2018; 153 (03) 744-755
  CrossrefPubMedGoogle Scholar
• 83 Pevernagie DA, Gnidovec-Strazisar B, Grote L. et al. On the rise and fall of the apnea-hypopnea index: A historical review and critical appraisal. J Sleep Res 2020; 29 (04) e13066
  CrossrefPubMedGoogle Scholar
• 84 Eckert DJ. Phenotypic approaches to obstructive sleep apnoea - New pathways for targeted therapy. Sleep Med Rev 2018; 37: 45-59
  CrossrefPubMedGoogle Scholar
• 85 Saboisky JP, Butler JE, Luu BL, Gandevia SC. Neurogenic changes in the upper airway of obstructive sleep apnoea. Curr Neurol Neurosci Rep 2015; 15 (04) 12
  CrossrefPubMedGoogle Scholar
• 86 Kim AM, Keenan BT, Jackson N. et al. Tongue fat and its relationship to obstructive sleep apnea. Sleep 2014; 37 (10) 1639-1648
  CrossrefPubMedGoogle Scholar
• 87 Camacho M, Certal V, Abdullatif J. et al. Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep 2015; 38 (05) 669-675
  CrossrefPubMedGoogle Scholar
• 88 Krekeler BN, Rowe LM, Connor NP. Dose in exercise-based dysphagia therapies: A scoping review. Dysphagia 2021; 36 (01) 1-32
  CrossrefPubMedGoogle Scholar
• 89 Braga APG, Sovinski SRP. O uso da fotobiomodulação dos casos de ronco e apneia obstrutiva do sono. In: Mouffron V, Alves GA, Motta AR, Silva HJ. organizadores Fotobiomodulação aplicada à fonoaudiologia. Pró-Fono; 2022
  Google Scholar
• 90 Moon JH, Jung J-H, Won YS, Cho H-Y, Cho K. Effects of expiratory muscle strength training on swallowing function in acute stroke patients with dysphagia. J Phys Ther Sci 2017; 29 (04) 609-612
  CrossrefPubMedGoogle Scholar
• 91 Desjardins M, Halstead L, Simpson A, Flume P, Bonilha HS. Respiratory muscle strength training to improve vocal function in patients with presbyphonia. J Voice 2022; 36 (03) 344-360
  CrossrefPubMedGoogle Scholar
• 92 Silva AS. Análise morfofuncional da Via Aérea Superior durante exercícios orofaríngeos para reabilitação nos distúrbios respiratórios do sono. [Dissertação]. Pontifícia Universidade Católica de Saõ Paulo PUC-SP. São Paulo, 2020. Disponível em: https://repositorio.pucsp.br/jspui/handle/handle/22988
• 93 da Silva AS, Rabelo FAW, Thuller ER, Kayamori F, Bianchini EMG. Morphofunctional analysis of the upper airway during oropharyngeal exercises for sleep-disordered breathing. Sleep Sci 2022; 15 (Special): 80-81
  PubMedGoogle Scholar
• 94 Silva DBE, Corrêa CC. Fonoaudiologia, gerontologia e apneia obstrutiva do sono: relato de caso. Audiol Commun Res 2021; 26: 1-7 (ACR)
  Google Scholar
• 95 Erturk N, Calik-Kutukcu E, Arikan H. et al. The effectiveness of oropharyngeal exercises compared to inspiratory muscle training in obstructive sleep apnea: A randomized controlled trial. Heart Lung 2020; 49 (06) 940-948
  CrossrefPubMedGoogle Scholar
• 96 Yingjuan M, Siang WH, Leong Alvin TK, Poh HP. Positional therapy for positional obstructive sleep apnea. Sleep Med Clin 2019; 14 (01) 119-133
  CrossrefPubMedGoogle Scholar
• 97 Chen Y-H, Wu M-F, Wen C-Y. et al. Interactions between Obstructive Sleep Apnea Syndrome Severity, Obesity, Sex Difference and Attention-Deficit/Hyperactivity Disorder on Health-Related Quality of Life: A Non-Interventional Prospective Observational Study. Biomedicines 2022; 10 (07) 1576 DOI: 10.3390/biomedicines10071576.
  CrossrefPubMedGoogle Scholar
• 98 Koka V, De Vito A, Roisman G. et al. Orofacial myofunctional therapy in obstructive sleep apnea syndrome: A pathophysiological perspective. Medicina (Kaunas) 2021; 57 (04) 323
  CrossrefPubMedGoogle Scholar
• 99 Silva FV, Medeiros APM, Borges CGP. et al. Avaliação da mastigação de pacientes com síndrome da apneia obstrutiva do Sono. In: 19° CONGRESSO BRASILEIRO DE FONOAUDIOLOGIA, 2011, Local: São Paulo. 2011, BR. Brasília.
  Google Scholar
• 100 Menezes VAd, Cavalcanti LL, Albuquerque TCd, Garcia AFG, Leal RB. Respiração bucal no contexto multidisciplinar: percepção de ortodontistas da cidade do Recife. Dental Press J Orthod 2011; 16: 84-92
  CrossrefGoogle Scholar
• 101 Berretin-Felix G, Rosa RR. Motricidade Orofacial e Reabilitação oral protética. In: Marchesan IQ, Silva HJ, Tomé MC. organizadores Tratado de especialidades em fonoaudiologia. São Paulo: Guanabara Koogan; 2014: 694-707
  Google Scholar
• 102 de Felício CM, de Oliveira MM, da Silva MA. Effects of orofacial myofunctional therapy on temporomandibular disorders. Cranio 2010; 28 (04) 249-259
  CrossrefPubMedGoogle Scholar
• 103 Matsumura E. Caracterização do vazamento de ar pela boca e o efeito da terapia miofuncional orofacial em pacientes com apneia obstrutiva do sono tratados com pressão positiva contínua na via aérea e máscara nasal [tese]. São Paulo: Faculdade de Medicina, Universidade de São Paulo; 2023
  Google Scholar
• 104 Conselho Federal de Fonoaudiologia. Resolução CFFa n° 640/2021. Dispõe sobre a aprovação da atualização do Código de Ética da Fonoaudiologia, e dá outras providências. 03 de dezembro de 2021. Disponível em: http://fonoaudiologia.org.br/legislac%cc%a7a%cc%83o/codigo-de-etica/
• 105 Frange C, Franco AM, Brasil E. et al. Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines. Sleep Sci 2022; 15 (04) 515-573
  Article in Thieme ConnectPubMedGoogle Scholar

• Supplementary Material