Obstructive sleep apnea: focus on myofunctional therapy

Abstract

PurposeOrofacial myofunctional therapy (OMT) is a modality of treatment for children and adults with obstructive sleep apnea (OSA) to promote changes in the musculature of the upper airways. This review summarizes and discusses the effects of OMT on OSA, the therapeutic programs employed, and their possible mechanisms of action.MethodsWe conducted an online literature search using the databases MEDLINE/PubMed, EMBASE, and Web of Science. Search terms were “obstructive sleep apnea” in combination with “myofunctional therapy” OR “oropharyngeal exercises” OR “speech therapy”. We considered original articles in English and Portuguese containing a diagnosis of OSA based on polysomnography (PSG). The primary outcomes of interest for this review were objective measurement derived from PSG and subjective sleep symptoms. The secondary outcome was the evaluation of orofacial myofunctional status.ResultsEleven studies were included in this review. The studies reviewed reveal that several benefits of OMT were demonstrated in adults, which include significant decrease of apnea–hypopnea index (AHI), reduced arousal index, improvement in subjective symptoms of daytime sleepiness, sleep quality, and life quality. In children with residual apnea, OMT promoted a decrease of AHI, increase in oxygen saturation, and improvement of orofacial myofunctional status. Few of the studies reviewed reported the effects of OMT on the musculature.ConclusionThe present review showed that OMT is effective for the treatment of adults in reducing the severity of OSA and snoring, and improving the quality of life. OMT is also successful for the treatment of children with residual apnea. In addition, OMT favors the adherence to continuous positive airway pressure. However, randomized and high-quality studies are still rare, and the effects of treatment should also be analyzed on a long-term basis, including measures showing if changes occurred in the musculature.

Lingual frenuloplasty with myofunctional therapy: Exploring safety and efficacy in 348 cases

“…Renewed interest for myofunctional therapy was garnered with a series of randomized control trials and cohort studies investigating the role of oropharyngeal exercises, speech therapy, myofascial reeducation, and oronasal rehabilitation for adults and children with sleep‐disordered breathing. Furthermore, a more recent series of meta‐analysis, review articles, books, commentaries, and position statements have catapulted myofunctional therapy to the forefront of the attention within dental and medical communities, albeit not without criticism.…”

“…In this manuscript, we provide safety, efficacy, complication, and satisfaction results for the largest cohort of patients treated with lingual frenuloplasty and myofunctional therapy to date. The benefits attributed to improved oral function, breathing, and release of neck tension are explained by resolution of oromyofascial dysfunction with potential mechanisms of action explored in a recent systematic review …”

New treatments for obstructive sleep apnea in children

“…Orofacial myofunctional therapy or oropharyngeal exercises consist of isometric or isotonic exercise involving the tongue, soft palate, and lateral pharyngeal wall. It works to improve the upper airway muscle function by targeting specific muscles to improve suction, swallowing, chewing, breathing, and speech function . These exercises also target soft palate and tongue function and are adapted from speech pathology .…”

Análisis fenoménico de la técnica neuromuscular funcional como tratamiento para el SAOS

“…Actualmente la principal evidencia referida de la TMO para el SAOS está compuesta por: (a) maniobras de higienización nasal, (b) ejercicios orofaríngeos, (c) intervención de la musculatura de soporte perioral y (d) ejercicios a partir de las funciones estomatognáticas de masticación, deglución y coordinación fonorespiratoria [1,[5][6][7][8]. Desde el punto de vista de composición epistémica, la evidencia apunta a una comprensión de la TMO que abarca desde la función muscular [1,6] hasta las técnicas de facilitación neuromuscular desarrolladas al interior de la fisiología del ejercicio.…”