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Arslan E, Şevgin Ö. The effects of Aerobic and oropharyngeal exercises on sleep quality of patients with obstructive sleep Apnoea syndrome: a randomized controlled study. Sleep Breath 2024:10.1007/s11325-024-03157-3. [PMID: 39302514 DOI: 10.1007/s11325-024-03157-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 08/07/2024] [Accepted: 08/30/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE Our objective was to examine the effect of co-treatment of aerobic and oropharyngeal exercises on daytime sleepiness, sleep quality, fatigue severity, and life quality in patients with obstructive sleep apnea (OSA) syndrome. METHODS This study was conducted as a randomized controlled trial with individuals aged 18 to 65 diagnosed with OSA at the Sleep Polyclinic and Research Hospital in Turkey between September 2023 and December 2023. The exercise group (n = 12) followed an eight-week oropharyngeal exercise program and the combined exercise group (n = 13) followed an aerobic exercise in addition to oropharyngeal exercises. The control group (n = 15) did not receive any exercise. Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), Modified Medical Research Council (mMRC) Dyspnoea Scale, Functional Outcomes of Sleep Questionnaire (FOSQ) were used as outcome measures. The protocol is registered with http://clinicaltrials.gov/ (01/September /2023, Clinical Trial, NCT06006520). RESULTS Both exercise programs were effective in improving daytime sleepiness, sleep quality, fatigue severity, and life quality. The mMRC dyspnoea scale, FOSQ, and PSQI scores did not differ between groups pre-and post-intervention. Participants receiving oropharyngeal exercise therapy showed a significant reduction in ESS and FSS scores compared to the combination treatment group. CONCLUSION A comprehensive program of oropharyngeal exercises produced better changes in fatigue severity and daytime sleepiness in moderate to severe OSA patients compared to the combination of aerobic and oropharyngeal exercises.
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Affiliation(s)
- Eda Arslan
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Üsküdar University, Istanbul, Turkey
| | - Ömer Şevgin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Üsküdar University, Saray Neighborhood Ahmet Tevfik İleri Street Nu:5 Ümraniye, Istanbul, Turkey.
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Gabada R, Yadav V, Nikhade D. Transformative Physiotherapy Approach in an 80-Year-Old Female: A Case Report of Managing Obstructive Sleep Apnea for Improved Quality of Life. Cureus 2024; 16:e57481. [PMID: 38707025 PMCID: PMC11066711 DOI: 10.7759/cureus.57481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Obstructive sleep apnea (OSA) presents a significant challenge to patients' overall health and well-being, characterized by upper airway collapse during sleep leading to fragmented and non-restorative sleep patterns. This case report describes an 80-year-old female patient presenting with breathlessness, obesity (BMI: 43 kg/m2), sleep disturbances, fatigue, attention deficits, reduced chest compliance, and a history of type 2 diabetes mellitus. Clinical findings revealed ongoing sleep disruptions, worsening breathlessness, progressive weakness, and decreased oxygen saturation levels. The therapeutic intervention involved a comprehensive physiotherapy program targeting respiratory muscle training, lung function improvement, peripheral muscle strengthening, and relaxation exercises. The discussion highlights studies supporting physiotherapeutic interventions such as thoracic extension exercises, neuromuscular stimulation, and oropharyngeal exercises for managing OSA symptoms. Overall, this case underscores the importance of tailored physiotherapy interventions in addressing the multifaceted challenges of OSA, aiming to improve patient outcomes and quality of life.
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Affiliation(s)
- Rishika Gabada
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Vaishnavi Yadav
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Dhanshri Nikhade
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Huang Z, Huang D, Liu F, Liang J, Zhao Z, Lu H, Xu Y, Qiu Y, Li S. Modified oropharyngeal muscle training and scientific vocalization are effective in treating mild-to-moderate obstructive sleep apnea hypoventilation syndrome in adults. Acta Otolaryngol 2023; 143:989-995. [PMID: 38164829 DOI: 10.1080/00016489.2023.2288283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Obstructive Sleep Apnea-hypopnea Syndrome (OSAHS) has become a major public health challenge globally. Most patients have a concomitant voice disorder. The existing treatment methods have problems.Aims/Objectives: This study investigates the therapeutic effect of adding scientific vocalization to oropharyngeal muscle training on OSAHS patients. MATERIAL AND METHODS A total of 30 patients were selected from September 2020 to October 2022. They underwent overnight polysomnography (PSG) and were identified as having mild to moderate obstructive sleep apnea hypoventilation syndrome. They were then chosen for a three-month period of modified oropharyngeal muscle training combined with scientific vocalization. RESULTS Out of the 30 selected patients, 26 patients completed the training. Results showed a significant changes in multiple sleep-related indicators. he clinical outcomes were as follows: 7 cases were cured, 13 cases were effective, and 6 cases were ineffective. The overall effective rate was 76.92%. CONCLUSIONS AND SIGNIFICANCE The combination of oropharyngeal muscle training and scientific vocalization for the treatment of mild to moderate OSAHS in adults significantly improves several measures used in the treatment of the condition. The method is easy to learn, effective, safe to use, and affordable. It provides more options for the treatment of OSAHS.
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Affiliation(s)
- Zuofeng Huang
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) Nanshan District of Shenzhen, Shenzhen, China
| | - Danlin Huang
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) Nanshan District of Shenzhen, Shenzhen, China
| | - Fei Liu
- Department of Medical Imaging, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) Nanshan District of Shenzhen, Shenzhen, China
| | - Junyi Liang
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) Nanshan District of Shenzhen, Shenzhen, China
| | - Zhimin Zhao
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) Nanshan District of Shenzhen, Shenzhen, China
| | - Hui Lu
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) Nanshan District of Shenzhen, Shenzhen, China
| | - Ying Xu
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) Nanshan District of Shenzhen, Shenzhen, China
| | - Yingwei Qiu
- Department of Medical Imaging, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) Nanshan District of Shenzhen, Shenzhen, China
| | - Shuo Li
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) Nanshan District of Shenzhen, Shenzhen, China
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Randerath W, Verbraecken J, de Raaff CAL, Hedner J, Herkenrath S, Hohenhorst W, Jakob T, Marrone O, Marklund M, McNicholas WT, Morgan RL, Pepin JL, Schiza S, Skoetz N, Smyth D, Steier J, Tonia T, Trzepizur W, van Mechelen PH, Wijkstra P. European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea. Eur Respir Rev 2021; 30:30/162/210200. [PMID: 34853097 PMCID: PMC9489103 DOI: 10.1183/16000617.0200-2021] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/01/2021] [Indexed: 12/12/2022] Open
Abstract
Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced in clinical practice, while other approaches have been refined or reconsidered. In this European Respiratory Society (ERS) guideline on non-continuous positive airway pressure (CPAP) therapies for OSA, we present recommendations determined by a systematic review of the literature. It is an update of the 2011 ERS statement on non-CPAP therapies, advanced into a clinical guideline. A multidisciplinary group of experts, including pulmonary, surgical, dentistry and ear–nose–throat specialists, methodologists and patient representatives considered the most relevant clinical questions (for both clinicians and patients) relating to the management of OSA. Eight key clinical questions were generated and a systematic review was conducted to identify published randomised clinical trials that answered these questions. We used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the quality of the evidence and the strength of recommendations. The resulting guideline addresses gastric bypass surgery, custom-made dual-block mandibular advancement devices, hypoglossal nerve stimulation, myofunctional therapy, maxillo-mandibular osteotomy, carbonic anhydrase inhibitors and positional therapy. These recommendations can be used to benchmark quality of care for people with OSA across Europe and to improve outcomes. OSA-patients who refuse/don't adhere to CPAP can profit from established/emerging treatment options. High scientific evidence is lacking. Patients’ values/preference may weigh heavy in the decision for non-CPAP options, while health inequity is a concern.https://bit.ly/3o0tJeP
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Affiliation(s)
- Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany .,Co-shared first authorship
| | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium.,Co-shared first authorship
| | | | - Jan Hedner
- Dept of Sleep Medicine, Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Simon Herkenrath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
| | | | - Tina Jakob
- Evidence-based Oncology, Dept I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Oreste Marrone
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Palermo, Italy
| | - Marie Marklund
- Dept of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Walter T McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland.,Dept of Respiratory and Sleep Medicine, St Vincent's Hospital Group, Dublin, Ireland
| | - Rebecca L Morgan
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Sofia Schiza
- Sleep Disorders Unit, Dept of Respiratory Medicine, Medical School, University of Crete, Greece
| | - Nicole Skoetz
- Evidence-based Oncology, Dept I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dan Smyth
- European Lung Foundation, Sheffield, UK.,Sleep Disorder Support Foundation, Dublin, Ireland
| | - Jörg Steier
- Lane Fox Unit and Sleep Disorders Centre at Guy's & St Thomas' NHS Foundation Trust, Centre for Human & Applied Physiological Sciences, King's College London, London, UK
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Wojciech Trzepizur
- Dept of Respiratory and Sleep Medicine, Angers University hospital, Angers, France
| | | | - Peter Wijkstra
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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O’Connor-Reina C, Ignacio Garcia JM, Rodriguez Alcala L, Rodríguez Ruiz E, Garcia Iriarte MT, Casado Morente JC, Baptista P, Plaza G. Improving Adherence to Myofunctional Therapy in the Treatment of Sleep-Disordered Breathing. J Clin Med 2021; 10:5772. [PMID: 34945068 PMCID: PMC8707643 DOI: 10.3390/jcm10245772] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/04/2021] [Accepted: 12/08/2021] [Indexed: 12/31/2022] Open
Abstract
Myofunctional therapy (MT) is used to treat sleep-disordered breathing. However, MT has low adherence-only ~10% in most studies. We describe our experiences with MT delivered through a mobile health app named Airway Gym®, which is used by patients who have rejected continuous positive airway pressure and other therapies. We compared ear, nose, and throat examination findings, Friedman stage, tongue-tie presence, tongue strength measured using the Iowa oral performance instrument (IOPI), and full polysomnography before and after the 3 months of therapy. Participants were taught how to perform the exercises using the app at the start. Telemedicine allowed physicians to record adherence to and accuracy of the exercise performance. Fifty-four patients were enrolled; 35 (64.8%) were adherent and performed exercises for 15 min/day on five days/week. We found significant changes (p < 0.05) in the apnoea-hypopnoea index (AHI; 32.97 ± 1.8 to 21.9 ± 14.5 events/h); IOPI score (44.4 ± 11.08 to 49.66 ± 10.2); and minimum O2 saturation (80.91% ± 6.1% to 85.09% ± 5.3%). IOPI scores correlated significantly with AHI after the therapy (Pearson r = 0.4; p = 0.01). The 19 patients who did not adhere to the protocol showed no changes. MT based on telemedicine had good adherence, and its effect on AHI correlated with IOPI and improvement in tongue-tie.
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Affiliation(s)
- Carlos O’Connor-Reina
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain; (C.O.-R.); (L.R.A.); (J.C.C.M.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | | | - Laura Rodriguez Alcala
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain; (C.O.-R.); (L.R.A.); (J.C.C.M.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | - Elisa Rodríguez Ruiz
- Pulmonology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain; (J.M.I.G.); (E.R.R.)
| | | | - Juan Carlos Casado Morente
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain; (C.O.-R.); (L.R.A.); (J.C.C.M.)
| | - Peter Baptista
- Otorhinolaryngology Department, Clínica Universitaria de Navarra, 31008 Pamplona, Spain;
| | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28942 Madrid, Spain
- Otorhinolaryngology Department, Hospital Sanitas la Zarzuela, 28942 Madrid, Spain
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Meghpara S, Chohan M, Bandyopadhyay A, Kozlowski C, Casinas J, Kushida C, Camacho M. Myofunctional therapy for OSA: a meta-analysis. Expert Rev Respir Med 2021; 16:285-291. [PMID: 34753369 DOI: 10.1080/17476348.2021.2001332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Myofunctional therapy (MT) improves obstructive sleep apnea (OSA) in patients. AREAS COVERED We systematically reviewed publications to evaluate MT as a treatment for OSA. We identified relevant articles and performed a meta-analysis on apnea-hypopnea index (AHI) scores, lowest oxygen saturation (LSAT), and Epworth Sleepiness Scale (ESS). Search databases were retained as primary data sources with the search performed through 18 June 2021. EXPERT OPINION Fifteen studies with 237 patients provided OSA outcomes before and after MT, which were analyzed for this meta-analysis. The mean AHI scores decreased from 28.0 ± 16.2/h to 18.6 ± 13.1/h. The AHI standard mean difference (SMD) is -1.34 (large effect) [95% CI -0.84, -1.85], (P < 0.00001). LSAT (197 patients) improved from 83.18 ± 6.10% to 85.13 ± 7.01%. The LSAT SMD is 0.44 [95% CI 0.75, 0.12], (P < 0.007). Sleepiness measured via ESS (156 patients) demonstrated a decrease from 12.71 ± 5.73 to 8.78 ± 5.80. The ESS SMD is -1.0 [95% CI -0.50, -1.50], (P < 0.0001).
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Affiliation(s)
- Sanket Meghpara
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI, USA
| | - Moeed Chohan
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Anuja Bandyopadhyay
- Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Conrad Kozlowski
- Department of Sleep Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jameson Casinas
- Department of Osteopathic Medicine Rocky Vista University College of Osteopathic Medicine, Ivins, UT, USA
| | - Clete Kushida
- Department of Psychiatry and Behavioral Sciences, Division Chief of Sleep Medicine, Stanford University, Department of Sleep Medicine, Redwood City, CA, USA
| | - Macario Camacho
- Department of Surgery, Division of Otolaryngology, Tripler Army Medical Center, Honolulu, HI, USA
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7
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The Role of Myofunctional Therapy in Treating Sleep-Disordered Breathing: A State-of-the-Art Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147291. [PMID: 34299742 PMCID: PMC8306407 DOI: 10.3390/ijerph18147291] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/05/2021] [Indexed: 01/14/2023]
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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Çakmakcı S, Özgen Alpaydın A, Özalevli S, Öztura İ, İtil BO. The effect of oropharyngeal exercise in patients with moderate and severe obstructive sleep apnea using CPAP: a randomized controlled study. Sleep Breath 2021; 26:567-574. [PMID: 34169482 DOI: 10.1007/s11325-021-02423-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/21/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is an important public health problem. Beyond common treatment options, solution-oriented options are needed. Oropharyngeal exercise training may be a research area in this respect. This study aimed to evaluate the effects of oropharyngeal exercise (OPE) in addition to continuous positive airway pressure (CPAP) therapy in patients diagnosed with OSA. METHODS Patients with moderate and severe OSA were screened from the electronic database of our hospital and 41 patients (20: exercise group; 21: control group) were included in the study. Each patient was assessed with CPAP usage time, maximal voluntary ventilation (MVV), maximum inspiratory and expiratory pressure (MIP-MEP), neck circumference, body mass index (BMI), waist-hip ratio, Epworth sleepiness score, Pittsburgh sleep quality index (PSQI), and short-form health survey (SF-36) in the first visit. The OPE was prescribed in addition to CPAP for the exercise group and performed by the patients for 3 months. At the end of the third month, groups were re-assessed with the same parameters. RESULTS Most of the patients were men, and the mean age of the study population was 51.9 ± 7.4; the mean apnea-hypopnea index (AHI) in the last polysomnography report was 53.3 ± 27.4. In the exercise group, MVV (p = 0.003), MIP (p = 0.002), MEP (p = 0.024), and SF-36 energy/fatigue (p = 0.020) were observed to increase while the total PSQI score (p = 0.036) decreased. The neck circumference (p = 0.006) and BMI (p = 0.013) were found to be significantly decreased in the exercise group. CONCLUSIONS We found that OPE training may have improved respiratory muscle strength as well as sleep quality and health-related quality of life in the exercise group. OPE along with CPAP therapy may be recommended in moderate and severe OSA patients who are willing to participate.
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Affiliation(s)
- Selin Çakmakcı
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
| | - Aylin Özgen Alpaydın
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Sevgi Özalevli
- Department of Pulmonary Rehabilitation, School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - İbrahim Öztura
- Department of Neurology Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Bahriye Oya İtil
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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Rueda JR, Mugueta-Aguinaga I, Vilaró J, Rueda-Etxebarria M. Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database Syst Rev 2020; 11:CD013449. [PMID: 33141943 PMCID: PMC8094400 DOI: 10.1002/14651858.cd013449.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a syndrome characterised by episodes of apnoea (complete cessation of breathing) or hypopnoea (insufficient breathing) during sleep. Classical symptoms of the disease - such as snoring, unsatisfactory rest and daytime sleepiness - are experienced mainly by men; women report more unspecific symptoms such as low energy or fatigue, tiredness, initial insomnia and morning headaches. OSA is associated with an increased risk of occupational injuries, metabolic diseases, cardiovascular diseases, mortality, and being involved in traffic accidents. Continuous positive airway pressure (CPAP) - delivered by a machine which uses a hose and mask or nosepiece to deliver constant and steady air pressure- is considered the first treatment option for most people with OSA. However, adherence to treatment is often suboptimal. Myofunctional therapy could be an alternative for many patients. Myofunctional therapy consists of combinations of oropharyngeal exercises - i.e. mouth and throat exercises. These combinations typically include both isotonic and isometric exercises involving several muscles and areas of the mouth, pharynx and upper respiratory tract, to work on functions such as speaking, breathing, blowing, sucking, chewing and swallowing. OBJECTIVES To evaluate the benefits and harms of myofunctional therapy (oropharyngeal exercises) for the treatment of obstructive sleep apnoea. SEARCH METHODS We identified randomised controlled trials (RCTs) from the Cochrane Airways Trials Register (date of last search 1 May 2020). We found other trials at web-based clinical trials registers. SELECTION CRITERIA We included RCTs that recruited adults and children with a diagnosis of OSA. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We assessed our confidence in the evidence by using GRADE recommendations. Primary outcomes were daytime sleepiness, morbidity and mortality. MAIN RESULTS We found nine studies eligible for inclusion in this review and nine ongoing studies. The nine included RCTs analysed a total of 347 participants, 69 of them women and 13 children. The adults' mean ages ranged from 46 to 51, daytime sleepiness scores from eight to 14, and severity of the condition from mild to severe OSA. The studies' duration ranged from two to four months. None of the studies assessed accidents, cardiovascular diseases or mortality outcomes. We sought data about adverse events, but none of the included studies reported these. In adults, compared to sham therapy, myofunctional therapy: probably reduces daytime sleepiness (Epworth Sleepiness Scale (ESS), MD (mean difference) -4.52 points, 95% Confidence Interval (CI) -6.67 to -2.36; two studies, 82 participants; moderate-certainty evidence); may increase sleep quality (MD -3.90 points, 95% CI -6.31 to -1.49; one study, 31 participants; low-certainty evidence); may result in a large reduction in Apnoea-Hypopnoea Index (AHI, MD -13.20 points, 95% CI -18.48 to -7.93; two studies, 82 participants; low-certainty evidence); may have little to no effect in reduction of snoring frequency but the evidence is very uncertain (Standardised Mean Difference (SMD) -0.53 points, 95% CI -1.03 to -0.03; two studies, 67 participants; very low-certainty evidence); and probably reduces subjective snoring intensity slightly (MD -1.9 points, 95% CI -3.69 to -0.11 one study, 51 participants; moderate-certainty evidence). Compared to waiting list, myofunctional therapy may: reduce daytime sleepiness (ESS, change from baseline MD -3.00 points, 95% CI -5.47 to -0.53; one study, 25 participants; low-certainty evidence); result in little to no difference in sleep quality (MD -0.70 points, 95% CI -2.01 to 0.61; one study, 25 participants; low-certainty evidence); and reduce AHI (MD -6.20 points, 95% CI -11.94 to -0.46; one study, 25 participants; low-certainty evidence). Compared to CPAP, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.30 points, 95% CI -1.65 to 2.25; one study, 54 participants; low-certainty evidence); and may increase AHI (MD 9.60 points, 95% CI 2.46 to 16.74; one study, 54 participants; low-certainty evidence). Compared to CPAP plus myofunctional therapy, myofunctional therapy alone may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.56 to 2.96; one study, 49 participants; low-certainty evidence) and may increase AHI (MD 10.50 points, 95% CI 3.43 to 17.57; one study, 49 participants; low-certainty evidence). Compared to respiratory exercises plus nasal dilator strip, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.46 to 2.86; one study, 58 participants; low-certainty evidence); probably increases sleep quality slightly (-1.94 points, 95% CI -3.17 to -0.72; two studies, 97 participants; moderate-certainty evidence); and may result in little to no difference in AHI (MD -3.80 points, 95% CI -9.05 to 1.45; one study, 58 participants; low-certainty evidence). Compared to standard medical treatment, myofunctional therapy may reduce daytime sleepiness (MD -6.40 points, 95% CI -9.82 to -2.98; one study, 26 participants; low-certainty evidence) and may increase sleep quality (MD -3.10 points, 95% CI -5.12 to -1.08; one study, 26 participants; low-certainty evidence). In children, compared to nasal washing alone, myofunctional therapy and nasal washing may result in little to no difference in AHI (MD 3.00, 95% CI -0.26 to 6.26; one study, 13 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Compared to sham therapy, myofunctional therapy probably reduces daytime sleepiness and may increase sleep quality in the short term. The certainty of the evidence for all comparisons ranges from moderate to very low, mainly due to lack of blinding of the assessors of subjective outcomes, incomplete outcome data and imprecision. More studies are needed. In future studies, outcome assessors should be blinded. New trials should recruit more participants, including more women and children, and have longer treatment and follow-up periods.
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Affiliation(s)
- José-Ramón Rueda
- Department of Preventive Medicine and Public Health, University of the Basque Country, Leioa, Spain
| | - Iranzu Mugueta-Aguinaga
- Respiratory Physiotherapy Unit, Rehabilitation Service, Pneumology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - Jordi Vilaró
- Department of Health Sciences, Ramon Lull University, Barcelona, Spain
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