Myofunctional Therapy to Treat Osa: Review and Meta-analysis

669 Myofunctional Therapy for OSA—Camacho et al. INTRODUCTION Several medical and surgical treatment modalities exist as treatment for obstructive sleep apnea (OSA).1–3 Four pathophysiological traits seen in patients with OSA are: the passive critical closing pressure of the upper airway (Pcrit), arousal threshold, loop gain, and muscle responsiveness (PALM) with categories of 1, 2, 2a, 2b, and 3.4 It has been demonstrated that patients in four of five PALM categories will benefit from anatomic interventions.4 Because the dilator muscles of the upper airway play a critical role in maintaining an open airway during sleep, researchers have explored exercises and other airway training (singing, didgeridoo, instrument playing) that target oral cavity and oropharyngeal structures as a method to treat OSA.5–7 Myofunctional therapy (MT) and proper tongue positioning in the oral cavity have been described since 1918 to improve mandibular growth, nasal breathing, and facial 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 MetaAnalysis (PRISMA) statement was followed. Results: Nine adult studies (120 patients) reported polysomnography, snoring, and/or sleepiness outcomes. The preand post-MT apneahypopnea 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.