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Camacho, M., Certal, V., Abdullatif, J., Zaghi, S., Ruoff, C. M., Capasso, R., & Kushida, C. A. (2015).

Sleep, 38(5), 669–675. https://doi.org/10.5665/sleep.4652

Abstract:

Objective: To systematically review the literature for articles evaluating myofunctional therapy (MT) as treatment for obstructive sleep apnea (OSA) in children and adults and to perform a meta-analysis on the polysomnographic, snoring, and sleepiness data.

Data Sources: Web of Science, Scopus, MEDLINE, and The Cochrane Library.

Review Methods: The searches were performed through June 18, 2014. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed.

Results: Nine adult studies (120 patients) reported polysomnography, snoring, and/or sleepiness outcomes. The pre- and post-MT apneahypopnea indices (AHI) decreased from a mean ± standard deviation (M ± SD) of 24.5 ± 14.3/h to 12.3 ± 11.8/h, mean difference (MD) −14.26 [95% confidence interval (CI) −20.98, −7.54], P < 0.0001. Lowest oxygen saturations improved from 83.9 ± 6.0% to 86.6 ± 7.3%, MD 4.19 (95% CI 1.85, 6.54), P = 0.0005. Polysomnography snoring decreased from 14.05 ± 4.89% to 3.87 ± 4.12% of total sleep time, P < 0.001, and snoring decreased in all three studies reporting subjective outcomes. Epworth Sleepiness Scale decreased from 14.8 ± 3.5 to 8.2 ± 4.1. Two pediatric studies (25 patients) reported outcomes. In the first study of 14 children, the AHI decreased from 4.87 ± 3.0/h to 1.84 ± 3.2/h, P = 0.004. The second study evaluated children who were cured of OSA after adenotonsillectomy and palatal expansion, and found that 11 patients who continued MT remained cured (AHI 0.5 ± 0.4/h), whereas 13 controls had recurrent OSA (AHI 5.3 ± 1.5/h) after 4 y.

Conclusion: Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 50% in adults and 62% in children. Lowest oxygen saturations, snoring, and sleepiness outcomes improve in adults. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments.

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Delgado de la Serna, P., Plaza-Manzano, G., Cleland, J., Fernández-de-las-Peñas, C., Martín-Casas, P., &

Díaz-Arribas, M. J. (2019). 

Pain Medicine, 21(3), 613–624. https://doi.org/10.1093/pm/pnz278

Abstract:

Objective. This randomized clinical trial investigated the effects of adding cervico-mandibular manual therapies into an exercise and educational program on clinical outcomes in individuals with tinnitus associated with temporoman- dibular disorders (TMDs).

Methods. Sixty-one patients with tinnitus attributed to TMD were randomized into the physiotherapy and manual therapy group or physiotherapy alone group. All patients received six sessions of physio- therapy treatment including cranio-cervical and temporomandibular joint (TMJ) exercises, self-massage, and patient education for a period of one month. Patients allocated to the manual therapy group also received cervico- mandibular manual therapies targeting the TMJ and cervical and masticatory muscles. Primary outcomes included TMD pain intensity and tinnitus severity. Secondary outcomes included tinnitus-related handicap (Tinnitus Handicap Inventory [THI]), TMD-related disability (Craniofacial Pain and Disability Inventory [CF-PDI]), self-rated quality of life (12-item Short Form Health Survey [SF-12]), depressive symptoms (Beck Depression Inventory [BDI-II]), pressure pain thresholds (PPTs), and mandibular range of motion. Patients were assessed at baseline, one week, three months, and six months after intervention by a blinded assessor.

Results. The adjusted analyses showed better out- comes (all, P < 0.001) in the exercise/education plus manual therapy group (large effect sizes) for TMD pain (g 2 P 1⁄4 0.153), tinnitus severity (g 2 P 1⁄4 0.233), THI (g 2 P 1⁄4 0.501), CF-PDI (g 2 P 1⁄4 0.395), BDI-II (g 2 P 1⁄4 0.194), PPTs (0.363 < g 2 P<0.415), and range of motion (g 2 P 1⁄4 0.350), but similar changes for the SF-12 (P1⁄40.622, g 2 P 1⁄4 0.01) as the exercise/education alone group.

Conclusions. This clinical trial found that application of cervico-mandibular man- ual therapies in combination with exercise and education resulted in better outcomes than application of exercise/ education alone in individuals with tinnitus attributed to TMD.

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Beddis, H., Pemberton, M., & Davies, S. (2018).

British Dental Journal, 225(6), 497–501. https://doi.org/10.1038/sj.bdj.2018.757

Abstract:

Bruxism is characterised by clenching or grinding of the teeth due to contraction of the masseter, temporalis and other jaw muscles. Bruxism may lead to masticatory muscle hypertrophy, tooth surface loss, fracture of restorations or teeth, hypersensitive or painful teeth and loss of periodontal support. Sleep bruxism has previously been viewed as a dysfunctional movement or pathological condition, whereas it is now accepted as a centrally controlled condition with various systemic risk factors. It has been postulated that sleep bruxism may have a protective role during sleep, for example in relation to airway maintenance or in stimulating saliva flow. A diagnosis of sleep bruxism may be made via patient report and clinical interview, clinical examination, intraoral appliances or recording of muscle activity. Bruxism in itself does not require treatment: management is only indicated where problems arise as a result of bruxism. Oral appliances primarily aim to protect the dentition from damage caused by clenching/grinding, although they may reduce muscle activity. Irreversible occlusal adjustments have no basis in evidence in the management of bruxism. Behavioural strategies include biofeedback, relaxation and improvement of sleep hygiene. Administration of botulinum toxin (Botox) to the masticatory muscles appears to reduce the frequency of bruxism, but concerns have been raised regarding possible adverse effects. Dentists should be aware of the potential aetiology, pathophysiology and management strategies of sleep bruxism.

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‌Diaféria, G., Santos-Silva, R., Truksinas, E., Haddad, F. L. M., Santos, R., Bommarito, S., Gregório, L. C., Tufik, S., &

Bittencourt, L. (2017). 

Sleep & Breathing = Schlaf & Atmung, 21(2), 387–395. https://doi.org/10.1007/s11325-016-1429-6

Abstract:

Purpose: Few studies have investigated myofunctional therapy in patients with obstructive sleep apnea syndrome (OSAS). The objective of this study was to evaluate the effect of myofunctional therapy on continuous positive airway pressure (CPAP) adherence.

Methods: The study was registered at ClinicalTrials.gov (NCT01289405). Male patients with OSAS were randomly divided into four treatment groups: placebo, patients undergoing placebo myofunctional therapy (N = 24); myofunctional therapy, undergoing myofunctional therapy (N = 27); CPAP, undergoing treatment with CPAP (N = 27); and combined, undergoing CPAP therapy and myofunctional therapy (N = 22). All patients underwent evaluations before and after 3 months of treatment evaluation and after 3 weeks of washout. Evaluations included Epworth sleepiness scale (ESS), polysomnography, and myofunctional evaluation.

Results: The 100 men had a mean age of 48.1 ± 11.2 years, body mass index of 27.4 ± 4.9 kg/m2, ESS score of 12.7 ± 3.0, and apnea-hypopnea index (AHI) of 30.9 ± 20.6. All treated groups (myofunctional therapy, CPAP, and combined myofunctional therapy with CPAP) showed decreased ESS and snoring, and the myofunctional therapy group maintained this improvement after the "washout" period. AHI reduction occurred in all treated groups and was more significant in CPAP group. The myofunctional therapy and combined groups showed improvement in tongue and soft palate muscle strength when compared with the placebo group. The association of myofunctional therapy to CPAP (combined group) showed an increased adherence to CPAP compared with the CPAP group.

Conclusions: Our results suggest that in patients with OSAS, myofunctional therapy may be considered as an adjuvant treatment and an intervention strategy to support adherence to CPAP.

Keywords: Continuous positive airway pressure; Myofunctional therapy; Obstructive sleep apnea; Polysomnography; Treatment.

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Lin, H.-Y., Chang, C.-J., Chiang, C.-C., Su, P.-L., Lin, C.-Y., & Hung, C.-H. (2020). 

Journal of the Formosan Medical Association, 119(12), 1781–1790. https://doi.org/10.1016/j.jfma.2020.01.011

Abstract:

Background: Critically compromised by upper airway anatomical impaired properties, obstructive sleep apnea (OSA) can be categorized into different phenotypic traits, mainly including oropharyngeal muscle dysfunction. The upper airway muscle strength training was targeted on oropharyngeal muscle dysfunction by re-educating the oropharyngeal muscles to maintain the upper airway patency. OSA was characterized with multilevel collapsibility of the upper airway; however, the programs are still inconsistent and the effects are unknown. Therefore, the purpose of this study was to investigate the effects of a comprehensive physical therapy on OSA.

Methods: Fifteen subjects with newly diagnosed moderate or severe OSA (AHI ≥ 15) were randomized into intervention and control groups. The intervention group underwent a 12-week-intervention of hospital based physical therapy, while the control group was kept on waiting for 12 weeks. Polysomnography (PSG) data, oropharyngeal and respiratory muscle performance were measured before and after intervention.

Results: In intervention group (n = 8), AHI was significantly improved (from 46.96 ± 19.45 to 32.78 ± 10.78 events/h, p = 0.017); in control group (n = 7), AHI was significantly increased (from 35.77 ± 17.49 to 42.96 ± 17.32 events/h, p = 0.043). While the control group remained no change between pre- and post- intervention, the intervention group demonstrated that other PSG outcomes significantly improved, including arousal index (46.04 ± 18.9 versus 32.98 ± 8.35/h), mean SpO2 (92.88 ± 2.1 versus 94.13 ± 1.46%), and oxygen desaturation index (ODI) (31.13 ± 19.48 versus 20.57 ± 7.83/h).

Conclusion: This comprehensive physical therapy can be prescribed for the significant clinical improvement on sleep apnea for the patients with moderate and severe OSA.

Keywords: Obstructive sleep apnea; Oropharyngeal muscle dysfunction; Physical therapy; Upper airway muscle exercise.

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Nee, R. J., & Butler, D. (2006). 

Physical Therapy in Sport, 7(1), 36–49. https://doi.org/10.1016/j.ptsp.2005.10.002

Abstract:

Peripheral neuropathic pain is the term used to describe situations where nerve roots or peripheral nerve trunks have been injured by mechanical and/or chemical stimuli that exceeded the physical capabilities of the nervous system. Clinical manifestations of peripheral neuropathic pain are often discussed in terms of positive and negative symptoms. Positive symptoms reflect an abnormal level of excitability in the nervous system and include pain, paresthesia, dysesthesia, and spasm. Negative symptoms indicate reduced impulse conduction in the neural tissues and include hypoesthesia or anesthesia and weakness. It is proposed that conservative management incorporating neurodynamic and neurobiology education, nonneural tissue interventions, and neurodynamic mobilization techniques can be effective in addressing musculoskeletal presentations of peripheral neuropathic pain. While a small amount of clinical evidence lends some support to this proposal, much more clinical research is necessary to identify those patients with peripheral neuropathic pain that will respond most favorably to neurodynamic mobilization techniques and clarify specific treatment parameters that will be most effective. Regardless of the results of this future research, conservative care will always need to be based on sound clinical reasoning so that interventions can be individualized to address the nuances of each patient's presentation of peripheral neuropathic pain.

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Zaghi, S., Valcu‐Pinkerton, S., Jabara, M., Norouz‐Knutsen, L., Govardhan, C., Moeller, J., Sinkus, V., Thorsen, R.

S., Downing, V., Camacho, M., Yoon, A., Hang, W. M., Hockel, B., Guilleminault, C., & Liu, S. Y. (2019). 

Laryngoscope Investigative Otolaryngology, 4(5), 489–496. https://doi.org/10.1002/lio2.297

Abstract:

Background: Ankyloglossia is a condition of altered tongue mobility due to the presence of restrictive tissue between the undersurface of the tongue and the floor of mouth. Potential implications of restricted tongue mobility (such as mouth breathing, snoring, dental clenching, and myofascial tension) remain underappreciated due to limited peer-reviewed evidence. Here, we explore the safety and efficacy of lingual frenuloplasty and myofunctional therapy for the treatment of these conditions in a large and diverse cohort of patients with restricted tongue mobility.

Methods: Four hundred twenty consecutive patients (ages 29 months to 79 years) treated with myofunctional therapy and lingual frenuloplasty for indications of mouth breathing, snoring, dental clenching, and/or myofascial tension were surveyed. All procedures were performed by a single surgeon using a scissors and suture technique. Safety and efficacy was assessed >2 months postoperatively by means of patient-reported outcome measures.

Results: In all, 348 surveys (83% response rate) were completed showing 91% satisfaction rate and 87% rate of improvement in quality of life through amelioration of mouth breathing (78.4%), snoring (72.9%), clenching (91.0%), and/or myofascial tension (77.5%). Minor complications occurred in <5% of cases including complaints of prolonged pain or bleeding, temporary numbness of the tongue-tip, salivary gland issues, minor wound infection or inflammation, and need for revision to excise scar tissue. There were no major complications.

Conclusion: Lingual frenuloplasty with myofunctional therapy is safe and potentially effective for the treatment of mouth breathing, snoring, clenching, and myofascial tension in appropriately selected patient candidates. Further studies with objective measures are merited.

Level of evidence: 3.

Keywords: Lingual frenuloplasty; ankyloglossia; frenectomy; lingual frenum; myofunctional therapy; orofacial myology; tongue and orofacial exercises; tongue‐tie.

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González-Sánchez, B., Pablo García Monterey, Valle, del, Elisa María Garrido-Ardila, Rodríguez-Mansilla, J., & María Jiménez-Palomares. (2023).

Journal of Clinical Medicine, 12(12), 4156–4156. https://doi.org/10.3390/jcm12124156

Abstract:

Temporomandibular disorders (TMDs) encompass a diverse array of conditions affecting both the structure and function of the jaw. The aetiology of TMDs is multifactorial and may arise from muscular and joint disorders, degenerative processes, or a combination of various symptoms. The objective of this review was to analyse the physiotherapy treatment techniques used for the management of temporomandibular disorders. This review also aimed to compare the effectiveness of the differenttreatment methods used and identify the dysfunctions for which physiotherapy interventions are applied as the main treatment. A systematic literature review was conducted using the PubMed, ScienceDirect, Dialnet, and PEDro databases. After applying the inclusion criteria, 15 out of 656 articles were included. The application of different physiotherapy techniques, both alone and in combination, is effective in controlling the primary symptoms of TMD in patients. These symptoms include pain, functionality, and quality of life. The use of physiotherapy as a conservative intervention method for TMDs is supported by sufficient scientific evidence. The combination of different therapies within physiotherapy achieves the best results in treatment. Therapeutic exercise protocols, in combination with manual therapy techniques, are the most commonly utilized method for addressing TMDs and thus provide the best results according to the analysed studies.

Keywords: physical therapy modalities; temporomandibular joint; temporomandibular joint disorders; therapeutics.

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Mediano, O., Romero-Peralta, S., Resano, P., Cano-Pumarega, I., Sánchez-de-la-Torre, M., Castillo-García, M., Martínez-Sánchez, A. B., Ortigado, A., & García-Río, F. (2019).

Journal of Clinical Medicine, 8(10), 1754. https://doi.org/10.3390/jcm8101754

Abstract:

Obstructive sleep apnea (OSA) is characterized by repetitive episodes of upper airway obstruction caused by a loss of upper airway dilator muscle tone during sleep and an inadequate compensatory response by these muscles in the context of an anatomically compromised airway. The genioglossus (GG) is the main upper airway dilator muscle. Currently, continuous positive airway pressure is the first-line treatment for OSA. Nevertheless, problems related to poor adherence have been described in some groups of patients. In recent years, new OSA treatment strategies have been developed to improve GG function. (A) Hypoglossal nerve electrical stimulation leads to significant improvements in objective (apnea-hypopnea index, or AHI) and subjective measurements of OSA severity, but its invasive nature limits its application. (B) A recently introduced combination of drugs administered orally before bedtime reduces AHI and improves the responsiveness of the GG. (C) Finally, myofunctional therapy also decreases AHI, and it might be considered in combination with other treatments. Our objective is to review these therapies in order to advance current understanding of the prospects for alternative OSA treatments.

Keywords: Genioglossus muscle, sleep apnea, pharmacological treatment, hypoglossal nerve electrical stimulation, myofunctional therapy

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Aboussouan, L. S., Bhat, A., Coy, T., & Kominsky, A. (2023).

Cleveland Clinic Journal of Medicine, 90(12), 755–765. https://doi.org/10.3949/ccjm.90a.23032

Abstract:

Treatment options for obstructive sleep apnea include positive airway pressure and alternatives such as behavioral interventions, oral appliances, nasal expiratory positive airway pressure, negative pressure interventions, and surgical procedures. Certain drugs are also promising. An important aspect of the treatment includes troubleshooting the reasons for poor adherence to positive airway pressure treatment, discussing alternatives based either on individual preference or on phenotypic characterization of the sleep apnea, and managing expectations.

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Ferrillo, M., Giudice, A., Marotta, N., Fortunato, F., Venere, D. D., Ammendolia, A., Fiore, P., & Sire, A. de. (2022).

International Journal of Molecular Sciences, 23(20). https://doi.org/10.3390/ijms232012164

Abstract:

Temporomandibular disorders (TMD) are a group of musculoskeletal diseases affecting masticatory muscles and temporomandibular joints (TMJ). In this context, the chronic TMD could be considered as a condition with chronic primary orofacial pain, presenting as myofascial TMD pain or TMJ arthralgia. In this context, myogenous TMD may present overlapping features with other disorders, such as fibromyalgia and primary headaches, characterized by chronic primary pain related to dysfunction of the central nervous system (CNS), probably through the central sensitization. This phenomenon could be defined as an amplified response of the CNS to sensory stimuli and peripheral nociceptive, characterized by hyperexcitability in the dorsal horn neurons in the spinal cord, which ascend through the spinothalamic tract. The main objectives of the management of TMD patients are: decreasing pain, increasing TMJ function, and reducing the reflex masticatory muscle spasm/pain. The first-line treatments are physical therapy, pharmacological drugs, occlusal splints, laser therapy, extracorporeal shockwave therapy, transcutaneous electrical nerve stimulation, and oxygen-ozone therapy. Although all these therapeutic approaches were shown to have a positive impact on the central sensitization of TMD pain, there is still no agreement on this topic in the scientific literature. Thus, in this comprehensive review, we aimed at evaluating the evidence on pain management and rehabilitation for the central sensitization in TMD patients.

Keywords: central sensitization; myofascial pain; pain; rehabilitation; temporomandibular disorders.

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Koka, V., De Vito, A., Roisman, G., Petitjean, M., Filograna Pignatelli, G. R., Padovani, D., & Randerath, W. (2021).

Medicina, 57(4), 323. https://doi.org/10.3390/medicina57040323

Abstract:

Obstructive sleep apnea (OSA) syndrome is a multi-factorial disorder. Recently identified pathophysiological contributing factors include airway collapsibility, poor pharyngeal muscle responsiveness, a low arousal threshold, and a high loop gain. Understanding the pathophysiology is of pivotal importance to select the most effective treatment option. It is well documented that conventional treatments (continuous positive airway pressure (CPAP), upper airway surgery, and dental appliance) may not always be successful in the presence of non-anatomical traits, especially in mild to moderate OSA. Orofacial myofunctional therapy (OMT) consists of isotonic and isometric exercises targeted to oral and oropharyngeal structures, with the aim of increasing muscle tone, endurance, and coordinated movements of pharyngeal and peripharyngeal muscles. Recent studies have demonstrated the efficacy of OMT in reducing snoring, apnea-hypopnea index, and daytime sleepiness, and improving oxygen saturations and sleep quality. Myofunctional therapy helps to reposition the tongue, improve nasal breathing, and increase muscle tone in pediatric and adult OSA patients. Studies have shown that OMT prevents residual OSA in children after adenotonsillectomy and helps adherence in CPAP-treated OSA patients. Randomized multi-institutional studies will be necessary in the future to determine the effectiveness of OMT in a single or combined modality targeted approach in the treatment of OSA. In this narrative review, we present up-to-date literature data, focusing on the role of OSA pathophysiology concepts concerning pharyngeal anatomical collapsibility and muscle responsiveness, underlying the response to OMT in OSA patients.

Keywords: apnea; myofunctional therapy; oral motor exercises; oropharyngeal exercises; sleep-disordered breathing.

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Shaffer, S. M., & Naze, G. S. (2022).

Journal of Manual & Manipulative Therapy, 1–10. https://doi.org/10.1080/10669817.2022.2124617

Abstract:

Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.

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Attanasio, G., Leonardi, A., Arangio, P., Minni, A., Covelli, E., Pucci, R., Russo, F., Elio De Seta, Carlo Di Paolo, & Cascone, P. (2015).

Journal of Cranio-Maxillofacial Surgery, 43(5), 724–727. https://doi.org/10.1016/j.jcms.2015.02.009

Abstract:

The present study was designed to verify the correlation between tinnitus and temporomandibular joint dysfunction.86 consecutive patients were enrolled in the study, all affected by subjective tinnitus without hearing impairment, from both genders, age between 18 and 60 years old.

The final number of patients included in the study was 55. All patients received a temporo-mandibular joint examination. All the patients were asked to rate the severity of their symptoms before and after treatment using a VAS scale and the Tinnitus Handicap Inventory (THI) and they followed a standardized protocol for the investigation of tinnitus. All the subjects were monitored by the same researcher and they underwent the same splint treatment. The comparison between pre- and posttreatment phase scores showed in patients with predisposition of TMD and with TMD a statistically significant decrease of THI and VAS values. The characteristics of tinnitus and the degree of response to treatment confirmed the relationship between tinnitus and TMD. The authors believe that, when the most common causes of tinnitus, such as otologic disorders and neurological diseases are excluded, it is correct to evaluate the functionality of the temporo-mandibular joint and eventually treat its pathology to obtain tinnitus improvement or even resolution.

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Cima, R. F. F., Mazurek, B., Haider, H., Kikidis, D., Lapira, A., Noreña, A., & Hoare, D. J. (2019).

HNO, 67. https://doi.org/10.1007/s00106-019-0633-7

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Guimarães, K. C., Drager, L. F., Genta, P. R., Marcondes, B. F., & Lorenzi-Filho, G. (2009).

American Journal of Respiratory and Critical Care Medicine, 179(10), 962–966. https://doi.org/10.1164/rccm.200806-981oc

Abstract

Rationale: Upper airway muscle function plays a major role in maintenance of the upper airway patency and contributes to the genesis of obstructive sleep apnea syndrome (OSAS). Preliminary results suggested that oropharyngeal exercises derived from speech therapy may be an effective treatment option for patients with moderate OSAS.

Objectives: To determine the impact of oropharyngeal exercises in patients with moderate OSAS.

Methods: Thirty-one patients with moderate OSAS were randomized to 3 months of daily ( approximately 30 min) sham therapy (n = 15, control) or a set of oropharyngeal exercises (n = 16), consisting of exercises involving the tongue, soft palate, and lateral pharyngeal wall.

Measurements and main results: Anthropometric measurements, snoring frequency (range 0-4), intensity (1-3), Epworth daytime sleepiness (0-24) and Pittsburgh sleep quality (0-21) questionnaires, and full polysomnography were performed at baseline and at study conclusion. Body mass index and abdominal circumference of the entire group were 30.3 +/- 3.4 kg/m(2) and 101.4 +/- 9.0 cm, respectively, and did not change significantly over the study period. No significant change occurred in the control group in all variables. In contrast, patients randomized to oropharyngeal exercises had a significant decrease (P < 0.05) in neck circumference (39.6 +/- 3.6 vs. 38.5 +/- 4.0 cm), snoring frequency (4 [4-4] vs. 3 [1.5-3.5]), snoring intensity (3 [3-4] vs. 1 [1-2]), daytime sleepiness (14 +/- 5 vs. 8 +/- 6), sleep quality score (10.2 +/- 3.7 vs. 6.9 +/- 2.5), and OSAS severity (apnea-hypopnea index, 22.4 +/- 4.8 vs. 13.7 +/- 8.5 events/h). Changes in neck circumference correlated inversely with changes in apnea-hypopnea index (r = 0.59; P < 0.001).

Conclusions: Oropharyngeal exercises significantly reduce OSAS severity and symptoms and represent a promising treatment for moderate OSAS.

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Camacho, M., Guilleminault, C., Wei, J. M., Song, S. A., Noller, M., Reckley, L. K., Camilo Fernandez-Salvador, & Zaghi, S. (2017).

European Archives of Oto-Rhino-Laryngology, 275(4), 849–855. https://doi.org/10.1007/s00405-017-4848-5

Abstract

Purpose: Oropharyngeal and tongue exercises (myofunctional therapy) have been shown to improve obstructive sleep apnea.However, to our knowledge, a systematic review has not been performed for snoring. The study objective is to perform a systematic review, with a meta-analysis, dedicated to snoring outcomes after myofunctional therapy.

Methods: PubMed/MEDLINE and three other databases were searched through November 25, 2017. Two authors independently searched the literature. Eligibility (1) patients: children or adults with snoring, (2) intervention: oropharyngeal and/or tongue exercises, (3) comparison: pre and post-treatment data for snoring, (4) outcomes: snoring frequency and snoring intensity, (5) study design: publications of all study designs.

Results: A total of 483 articles were screened, 56 were downloaded in their full text form, and nine studies reported outcomes related to snoring. There were a total of 211 patients (all adults) in these studies. The snoring intensity was reduced by 51% in 80 patients from pre-therapy to post-therapy visual analog scale values of 8.2 ± 2.1 (95% CI 7.7, 8.7) to 4.0 ± 3.7 (95% CI 3.2, 4.8). Berlin questionnaire snoring intensity reduced by 36% in 34 patients from 2.5 ± 1.0 (95% CI 2.2, 2.8) to 1.6 ± 0.8 (95% CI 1.3, 1.9). Finally, time spent snoring during sleep was reduced by 31% in 60 patients from 26.3 ± 18.7% (95% CI 1.6, 31.0) to 18.1 ± 20.5% (95% CI 12.9, 23.3) of total sleep time.

Conclusions: This systematic review demonstrated that myofunctional therapy has reduced snoring in adults based on both subjective questionnaires and objective sleep studies.

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Carrasco-Llatas, M., O’Connor-Reina, C., & Calvo-Henríquez, C. (2021).

International Journal of Environmental Research and Public Health, 18(14), 7291. https://doi.org/10.3390/ijerph18147291

Abstract

Myofunctional therapy (MFT) may have a role in improving muscle tone and alleviating upper airway collapse in sleep-disordered breathing. The purposes of this state-of-the-art review are to first review systematically the current literature on the effectiveness of MFT in treating sleep-disordered breathing and then to provide an overview of the current understanding of patient selection, side effects, type and duration of exercises, guidance of exercise performance, evaluation of results, and how best to promote adherence. PubMed (Medline), the Cochrane Library, and the EMBASE, Scopus and SciELO databases were checked for relevant studies by three authors, and a total of 23 studies were included. This review focuses only on adults with sleep-disordered breathing. The available evidence shows a positive effect of MFT in reducing sleep apnoea, as measured using polysomnography and clinical variables (including snoring). There is no evidence of the utility of MFT for treating upper airway resistance syndrome, the duration of the effects of MFT, or regarding which MFT protocol is best. Despite these knowledge gaps, the available evidence suggests that MFT is a safe treatment modality.

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