Speech Therapy Now Part of University Hospitals' Multidisciplinary Care for Sleep Disorders

Innovations in Ear, Nose & Throat | Summer 2024

Sleep disorders — particularly obstructive sleep apnea (OSA) — require a comprehensive and collaborative approach for effective diagnosis and treatment. At the University Hospitals Ear, Nose & Throat Institute, a multidisciplinary team provides personalized care for patients with sleep-related breathing disorders.

Collaborative Care Paradigm

The UH ENT Institute employs a patient-centered approach, recognizing that sleep disorders are complex and often require multiple interventions. This paradigm shift from a single-specialty focus to a multi-specialty model allows for:

• Comprehensive evaluations of each patient's unique needs
• Shared decision-making between patients and health care providers
• Tailored treatment plans that may combine various therapies
• Improved patient education and support.
• Enhanced care coordination and continuity

Patients enter the care pathway through various points, including primary care, referrals, sleep clinics or other specialties. Seamless patient navigation ensures coordination among departments, allowing patients to receive comprehensive care regardless of their initial point of contact.

Novel Speech Therapy Protocols

New to the University Hospitals sleep disorders program is the integration of speech-language services. “There is a lot of overlap in our patient populations,” says Lindsay Zombek, CCC-SLP, Supervisor for Speech-Language Pathology at the UH ENT Institute. “We were approached by our sleep medicine group because they were looking for alternative treatment modalities for patients unable to benefit fully from standard treatment approaches.”

Speech-language experts at University Hospitals have developed protocols based on current research. “There is some precedent established for the use of myofunctional and oral motor exercises to strengthen the musculature in the throat and help prevent airway closures,” Zombek says. “We appreciate this opportunity to work more closely with the sleep medicine specialists to improve the lives of people negatively impacted by disordered sleep.”

A high incidence of swallowing disorders and dysphagia exists in patients with OSA. “According to research, anywhere from 16 to 78 percent of this population has some level of dysphagia,” Zombek says. “Collaborating with sleep medicine enables our speech-language pathologists to address multiple areas of challenge for these patients.”

Initiating Treatment

Sleep medicine specialists make the initial diagnosis of OSA and identify patients who could benefit from speech-language services. During the initial appointment, a therapist completes a thorough oral motor assessment and utilizes a patient questionnaire to understand each individual’s sleep challenges and their impact on daily living. A separate screening for dysphagia is also administered.

Oropharyngeal exercises are introduced, along with education on anatomy and physiology and the rationale and goals of treatment. The expectation is that individuals will commit to completing the exercises at least six days a week for three months.

“Sometimes, we’ll add expiratory and respiratory muscle strength training devices known as breathers,” Zombek says. “Once we ensure patients understand and can complete the exercises, we follow up every one to two weeks and evaluate progress at around the three-month mark before transitioning patients to a maintenance program they can continue on their own.”

Sleep Surgery Expertise

For patients requiring additional intervention, the multidisciplinary team collaborates to determine the most appropriate treatment approach, including surgery. Renowned sleep surgeon Thomaz Fleury Curado, MD, PhD, offers advanced surgical procedures for OSA, including functional and cosmetic nasal surgery, soft tissue procedures such as uvulopalatoplasty, tongue base surgery, hypoglossal nerve stimulation and skeletal procedures such as palatal expansion (DOME), maxillomandibular advancement surgery (MMA) and genioplasty. 

Dr. Fleury receives referrals from his colleagues in sleep medicine, outside ENT or oral maxillofacial surgeons, and dental specialists. Patients are thoroughly evaluated and educated before considering surgical options, optimizing outcomes and patient satisfaction.

By fostering close collaboration among specialties, the UH ENT Institute at University Hospitals provides comprehensive, patient-centered care for individuals with sleep disorders. This novel integrated approach allows for more effective diagnosis, treatment and long-term management of complex sleep-related airway issues.

For more information about available treatments for sleep apnea, call 440-753-8673.

Contributing Expert: 
Lindsay Zombek, CCC-SLP
Supervisor for Speech-Language Pathology
University Hospitals Ear, Nose & Throat Institute