Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea.
Level 1 - systematic review of randomized trials
Cochrane systematic review and meta-analysis of randomized controlled trials
PubMed 33141943 · doi:10.1002/14651858.CD013449.pub2
What was done
A Cochrane systematic review searched trials registers through May 1, 2020, to evaluate randomized controlled trials of myofunctional therapy (oropharyngeal mouth and throat exercises) for obstructive sleep apnoea (OSA) in adults and children. Primary outcomes assessed using GRADE were daytime sleepiness, morbidity, and mortality; secondary outcomes included sleep quality, Apnoea-Hypopnoea Index (AHI), snoring, and adverse events.
What was found
Nine RCTs with 347 total participants were included (69 women, 13 children; adult mean age 46–51 years; duration 2–4 months). - Compared to sham therapy in adults, myofunctional therapy probably reduced daytime sleepiness (Epworth Sleepiness Scale [ESS] MD -4.52 points, 95% CI -6.67 to -2.36; 2 studies, n=82; moderate certainty), may improve sleep quality (MD -3.90, 95% CI -6.31 to -1.49; 1 study, n=31; low certainty), may reduce AHI (MD -13.20 points, 95% CI -18.48 to -7.93; 2 studies, n=82; low certainty), and probably reduced subjective snoring intensity slightly (MD -1.9 points, 95% CI -3.69 to -0.11; 1 study, n=51; moderate certainty), with very uncertain snoring frequency effects (SMD -0.53, 95% CI -1.03 to -0.03; 2 studies, n=67; very low certainty). - Compared to waiting list, it may reduce ESS (MD -3.00, 95% CI -5.47 to -0.53) and AHI (MD -6.20, 95% CI -11.94 to -0.46; 1 study, n=25; low certainty). - Compared to CPAP, it showed no clear difference in daytime sleepiness (MD 0.30, 95% CI -1.65 to 2.25) but higher AHI (MD 9.60 points higher, 95% CI 2.46 to 16.74; 1 study, n=54; low certainty). - Compared to standard medical treatment, it may reduce ESS (MD -6.40, 95% CI -9.82 to -2.98) and improve sleep quality (MD -3.10, 95% CI -5.12 to -1.08; 1 study, n=26; low certainty). - In children, combined with nasal washing vs nasal washing alone, it showed little to no difference in AHI (MD 3.00, 95% CI -0.26 to 6.26; 1 study, n=13; low certainty). - No included trials reported accidents, cardiovascular outcomes, mortality, or adverse events.
Why it matters
Oropharyngeal exercises offer a non-invasive, low-cost option that improves daytime sleepiness and apnoea severity in adults with OSA. However, it is less effective than standard CPAP therapy at normalizing apnoea-hypopnoea frequency.
Limits
Evidence certainty was low to moderate due to small trial sample sizes (individual comparisons had 13 to 97 participants), incomplete outcome reporting, and lack of assessor blinding for subjective outcomes. Trials were short (2–4 months), included few women and children, and did not assess long-term clinical endpoints or adverse events.
Cited by
- partial Targeted exercises for the back of the throat and tongue muscles can dramatically open airways to resolve sleep apnea.