Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review
and Meta-analysis.
Macario Camacho, MD1; Victor Certal, MD2; Jose Abdullatif, MD3; Soroush Zaghi, MD4; Chad M. Ruoff, MD, RPSGT1; Robson Capasso, MD5; Clete A. Kushida, MD, PhD1. Department of Psychiatry, Division of Sleep Medicine, Stanford Hospital and Clinics, Redwood City, CA; 2Department of Otorhinolaryngology/ Sleep Medicine Centre, Hospital CUF Porto; CINTESIS, Center for Research in Health Technologies and information Systems, University of Porto, Porto, Portugal; 3Department of Otorhinolaryngology, hospital Bernardino Rivadavia, Buenos Aires, Argentina; 4Department of Head and Neck Surgery, University of California, Los Angeles, CA; 5Department of Otolaryngology, Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, CArainstorming is more than just a creative exercise; it’s a problem-solving tool. It allows you to think freely, consider multiple perspectives, and explore innovative solutions. The goal isn’t just to generate ideas but to create a pathway from concept to execution.
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 apnea hypopnea 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.
- Keywords: exercise therapy/methods, myofunctional therapy/methods, obstructive sleep apnea, sleep apnea syndromes
- Citation: Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, Kushida CA. Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. SLEEP 2015;38(5):669–675.
