ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Myofunctional Therapy May Reduce the Severity of Moderate Obstructive Sleep Apnea
Clinical Question In patients diagnosed with moderate obstructive sleep apnea, does myofunctional therapy improve symptoms compared with no treatment?
Clinical Bottom Line Myofunctional therapy may reduce OSAS symptoms and severity in patients with moderate OSAS, however, post treatment AHI values averaged 13.7 which is still in the upper mild range.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19234106Guimaraes KC/2009N=31; diagnosis of moderate OSAS (AHI of 15-29.9 events/hour); between 25 and 65 years of age; predominantly middle-aged, overweight males.RCT
Key resultsAfter 3 months of treatment consisting of 30 min daily exercises for the musculature of the soft palate, the tongue and the face as well as exercises involving breathing, speech, swallowing and chewing, the treatment group showed changes in many of the measured categories. The apnea-hypopnea index (AHI) decreased from 22.4± 4.8 to 13.7 ±8.5 events/hr (p=.007). There was also improvement in other sleep apnea indicators and symptoms such as a reduction in neck circumference (from 39.6 ± 3.6 to 38.5 ± 4.0 with p=.01), a decrease in the Epworth Sleepiness Scale (14 ± 5 to 8 ±6) and a reduction in snoring frequency and intensity. In contrast, there were no significant changes in any of the measured categories in the control group.
Evidence Search ("Sleep Apnea, Obstructive"[Mesh]) AND "Myofunctional Therapy"[Mesh]
Comments on
The Evidence
In this RCT, the control and treatment groups were chosen with the same criteria and were similar at the start. The subjects and the analyzer were both blinded, recall bias was unlikely and there were no competing interests reported by the authors. It should be noted that because the therapy for the treatment group integrated many different exercises, the authors could not determine what effect each specific exercise had on the overall treatment outcome. Also of note is that the subjects started out as having moderate OSAS (defined in the study as an AHI between 15 and 29.9 events/hr), and though treatment decreased their AHI by 39%, it was still in the “high mild range” at 13.7 events per hour .
Applicability Though this study does support the use of oropharyngeal exercises to reduce moderate OSAS symptoms, a 2011 publication, PMID 21406515, done by a European Respiratory Society task force, concluded that more evidence is needed before oropharyngeal exercise can be recommended as an effective treatment. When evaluating the applicability of the therapies tested in this study, factors that should be taken into consideration include the need for patient compliance (30 minutes of exercises daily), the improvement but not elimination of symptoms and the relevancy of each of the exercises tested in the final treatment outcome. A review on the study done by Guimaraes (2009 issue of the American Journal of Respiratory and Critical Care Medicine with PMID 19423718) looked at the specific exercises done and analyzed how much each could have contributed to successful remodeling of the oropharyngeal airway. They concluded that the exercises targeting soft palate function and lateral pharyngeal wall motion as well as the exercises to improve tongue strength had reasonable mechanisms to contribute to upper airway remodeling.
Specialty/Discipline (General Dentistry)
Keywords Myofunctional therapy Sleep apnea, obstructive
ID# 2482
Date of submission: 05/07/2013spacer
E-mail lamison@livemail.uthscsa.edu
Author Tessia Lamison
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author John D. Rugh, PhD
Faculty mentor/Co-author e-mail rugh@uthscsa.edu
Basic Science Rationale
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Comments on the CAT
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