Obstructive Sleep Apnea: Focus on Myofunctional Therapy

Overview

Journal Nat Sci Sleep

Publisher Dove Medical Press

Date 2018 Sep 21

PMID 30233265

Citations 36

Authors

Claudia Maria de Felicio

Franciele Voltarelli da Silva Dias

Luciana Vitaliano Voi Trawitzki

Affiliations

Soon will be listed here.

Abstract

Purpose: Orofacial 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.

Methods: We 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.

Results: Eleven 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.

Conclusion: The 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.

Citing Articles

Comprehensive analysis of orofacial motor skills in children with obstructive sleep apnea.

da Silva Dias F, Trawitzki L, Garcia D, Eckeli A, Valera F, Anselmo-Lima W Sleep Breath. 2024; 29(1):8.

PMID: 39589627 DOI: 10.1007/s11325-024-03178-y.

Comparative Study of Myofascial Exercise and the Voluntary Breathing Technique on the Apnea-Hypopnea Index Among Adolescents.

Yelkur P, Manivel R, Chandrasekhar V, Mohammed S, Narayan K Cureus. 2024; 16(7):e64483.

PMID: 39139327 PMC: 11319656. DOI: 10.7759/cureus.64483.

Effects of different treatments for obstructive sleep apnea on temporomandibular joint: a randomized clinical trial.

Attia A, Awad S, Mansour M, Baz H, Zahran K, Saleh A BMC Oral Health. 2024; 24(1):931.

PMID: 39129005 PMC: 11317010. DOI: 10.1186/s12903-024-04623-w.

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

Studart-Pereira L, Bianchini E, Assis M, Bussi M, de Castro Correa C, Cunha T Sleep Sci. 2024; 16(Suppl 2):489-506.

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Research trends and hotspots regarding treatment of obstructive sleep apnea.

Yang X, Wen Y, Xie S, Chen J, Liu Y, Zhou J Front Neurol. 2023; 14:1268639.

PMID: 37920837 PMC: 10618364. DOI: 10.3389/fneur.2023.1268639.

References

Clark H . Neuromuscular treatments for speech and swallowing: a tutorial. Am J Speech Lang Pathol. 2003; 12(4):400-15. DOI: 10.1044/1058-0360(2003/086). View

Shahar E, Whitney C, Redline S, Lee E, Newman A, Nieto F . Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001; 163(1):19-25. DOI: 10.1164/ajrccm.163.1.2001008. View

Prikladnicki A, Martinez D, Brunetto M, Fiori C, Lenz M, Gomes E . Diagnostic performance of cheeks appearance in sleep apnea. Cranio. 2017; 36(4):214-221. DOI: 10.1080/08869634.2017.1376426. View

Hirata R, Schorr F, Kayamori F, Takachi Moriya H, Romano S, Insalaco G . Upper Airway Collapsibility Assessed by Negative Expiratory Pressure while Awake is Associated with Upper Airway Anatomy. J Clin Sleep Med. 2016; 12(10):1339-1346. PMC: 5033735. DOI: 10.5664/jcsm.6184. View

Eckert D, Lo Y, Saboisky J, Jordan A, White D, Malhotra A . Sensorimotor function of the upper-airway muscles and respiratory sensory processing in untreated obstructive sleep apnea. J Appl Physiol (1985). 2011; 111(6):1644-53. PMC: 3233889. DOI: 10.1152/japplphysiol.00653.2011. View

Chervin R, Dillon J, Bassetti C, Ganoczy D, Pituch K . Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep. 1998; 20(12):1185-92. DOI: 10.1093/sleep/20.12.1185. View

Steele C, Alsanei W, Ayanikalath S, Barbon C, Chen J, Cichero J . The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia. 2014; 30(1):2-26. PMC: 4342510. DOI: 10.1007/s00455-014-9578-x. View

. Oral appliances for obstructive sleep apnea: an evidence-based analysis. Ont Health Technol Assess Ser. 2012; 9(5):1-51. PMC: 3377505. View

Schievano D, Rontani R, Berzin F . Influence of myofunctional therapy on the perioral muscles. Clinical and electromyographic evaluations. J Oral Rehabil. 1999; 26(7):564-9. DOI: 10.1046/j.1365-2842.1999.00410.x. View

10.

Villa M, Rizzoli A, Rabasco J, Vitelli O, Pietropaoli N, Cecili M . Rapid maxillary expansion outcomes in treatment of obstructive sleep apnea in children. Sleep Med. 2015; 16(6):709-16. DOI: 10.1016/j.sleep.2014.11.019. View

11.

Duran J, Esnaola S, Rubio R, Iztueta A . Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med. 2001; 163(3 Pt 1):685-9. DOI: 10.1164/ajrccm.163.3.2005065. View

12.

Marcus C . Sleep-disordered breathing in children. Am J Respir Crit Care Med. 2001; 164(1):16-30. DOI: 10.1164/ajrccm.164.1.2008171. View

13.

Vinha P, Eckeli A, Faria A, Xavier S, De Mello-Filho F . Effects of surgically assisted rapid maxillary expansion on obstructive sleep apnea and daytime sleepiness. Sleep Breath. 2015; 20(2):501-8. DOI: 10.1007/s11325-015-1214-y. View

14.

Diaferia G, Santos-Silva R, Truksinas E, Haddad F, Santos R, Bommarito S . Myofunctional therapy improves adherence to continuous positive airway pressure treatment. Sleep Breath. 2016; 21(2):387-395. DOI: 10.1007/s11325-016-1429-6. View

15.

Braga A, Grechi T, Eckeli A, Vieira B, Itikawa C, Kupper D . Predictors of uvulopalatopharyngoplasty success in the treatment of obstructive sleep apnea syndrome. Sleep Med. 2013; 14(12):1266-71. DOI: 10.1016/j.sleep.2013.08.777. View

16.

Drager L, Bortolotto L, Lorenzi M, Figueiredo A, Krieger E, Lorenzi-Filho G . Early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med. 2005; 172(5):613-8. DOI: 10.1164/rccm.200503-340OC. View

17.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

18.

Miller A . The neurobiology of swallowing and dysphagia. Dev Disabil Res Rev. 2008; 14(2):77-86. DOI: 10.1002/ddrr.12. View

19.

Arens R, McDonough J, Costarino A, Mahboubi S, Maislin G, Schwab R . Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2001; 164(4):698-703. DOI: 10.1164/ajrccm.164.4.2101127. View

20.

Kim E, Choi J, Kim K, Kim T, Lee S, Lee H . The impacts of open-mouth breathing on upper airway space in obstructive sleep apnea: 3-D MDCT analysis. Eur Arch Otorhinolaryngol. 2010; 268(4):533-9. DOI: 10.1007/s00405-010-1397-6. View