Top

European Archives of Oto-Rhino-Laryngology

Published in:

01-04-2018 | Review Article

Oropharyngeal and tongue exercises (myofunctional therapy) for snoring: a systematic review and meta-analysis

Authors: Macario Camacho, Christian Guilleminault, Justin M. Wei, Sungjin A. Song, Michael W. Noller, Lauren K. Reckley, Camilo Fernandez-Salvador, Soroush Zaghi

Published in: European Archives of Oto-Rhino-Laryngology | Issue 4/2018

Abstract

Purpose

Oropharyngeal and tongue exercises (myofunctional therapy) have been shown to improve obstructive sleep apnea. However, to our knowledge, a systematic review has not been performed for snoring. The study objective is to perform a systematic review, with a meta-analysis, dedicated to snoring outcomes after myofunctional therapy.

Methods

PubMed/MEDLINE and three other databases were searched through November 25, 2017. Two authors independently searched the literature. Eligibility (1) patients: children or adults with snoring, (2) intervention: oropharyngeal and/or tongue exercises, (3) comparison: pre and post-treatment data for snoring, (4) outcomes: snoring frequency and snoring intensity, (5) study design: publications of all study designs.

Results

A total of 483 articles were screened, 56 were downloaded in their full text form, and nine studies reported outcomes related to snoring. There were a total of 211 patients (all adults) in these studies. The snoring intensity was reduced by 51% in 80 patients from pre-therapy to post-therapy visual analog scale values of 8.2 ± 2.1 (95% CI 7.7, 8.7) to 4.0 ± 3.7 (95% CI 3.2, 4.8). Berlin questionnaire snoring intensity reduced by 36% in 34 patients from 2.5 ± 1.0 (95% CI 2.2, 2.8) to 1.6 ± 0.8 (95% CI 1.3, 1.9). Finally, time spent snoring during sleep was reduced by 31% in 60 patients from 26.3 ± 18.7% (95% CI 21.6, 31.0) to 18.1 ± 20.5% (95% CI 12.9, 23.3) of total sleep time.

Conclusions

This systematic review demonstrated that myofunctional therapy has reduced snoring in adults based on both subjective questionnaires and objective sleep studies.

Available only for authorised users

Abdullatif J, Certal V, Zaghi S, Song SA, Chang ET, Gillespie MB, Camacho M (2016) Maxillary expansion and maxillomandibular expansion for adult OSA: a systematic review and meta-analysis. J Cranio-Maxillo-Fac Surg 44(5):574–578. https://doi.org/10.1016/j.jcms.2016.02.001 CrossRef

Camacho M, Certal V, Capasso R (2013) Comprehensive review of surgeries for obstructive sleep apnea syndrome. Braz J Otorhinolaryngol 79(6):780–788. https://doi.org/10.5935/1808-8694.20130139 CrossRefPubMed

Camacho M, Li D, Kawai M, Zaghi S, Teixeira J, Senchak AJ, Brietzke SE, Frasier S, Certal V (2016) Tonsillectomy for adult obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope. https://doi.org/10.1002/lary.25931

Riaz M, Certal V, Nigam G, Abdullatif J, Zaghi S, Kushida CA, Camacho M (2015) Nasal expiratory positive airway pressure devices (provent) for OSA: a systematic review and meta-analysis. Sleep Disord 2015:734798. https://doi.org/10.1155/2015/734798 CrossRefPubMedPubMedCentral

Certal V, Nishino N, Camacho M, Capasso R (2013) Reviewing the systematic reviews in OSA surgery. Otolaryngol Head Neck Surg. 149 (6):817–829. https://doi.org/10.1177/0194599813509959

Certal VF, Zaghi S, Riaz M, Vieira AS, Pinheiro CT, Kushida C, Capasso R, Camacho M (2015) Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 125(5):1254–1264. https://doi.org/10.1002/lary.25032 CrossRefPubMed

Kumar AR, Guilleminault C, Certal V, Li D, Capasso R, Camacho M (2014) Nasopharyngeal airway stenting devices for obstructive sleep apnoea: a systematic review and meta-analysis. J Laryngol Otol:1–9. https://doi.org/10.1017/s0022215114003119

Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, Kushida CA (2015) Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep 38(5):669–675. https://doi.org/10.5665/sleep.4652 CrossRefPubMedPubMedCentral

Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097 CrossRefPubMedPubMedCentral

10.

Baz H, Elshafey M, Elmorsy S, Abu-Samra M (2012) The role of oral myofunctional therapy in managing patients with mild to moderate obstructive sleep apnea. PAN Arab J Rhinol 2(1):17–22

11.

Berreto e Silva Pitta D, Farias Pessoa A, Sampaio AL, Nonato Rodrigues R, Guiot Tavares M, Tavares P (2007) Oral myofunctional therapy applied on two cases of severe obstructive sleep apnea. Intl Arch Otorhinolaryngol 11(3):350–354

12.

Diaferia G, Santos-Silva R, Truksinas E, Haddad FL, Santos R, Bommarito S, Gregorio LC, Tufik S, Bittencourt L (2016) Myofunctional therapy improves adherence to continuous positive airway pressure treatment. Sleep Breath (Schlaf & Atmung). https://doi.org/10.1007/s11325-016-1429-6

13.

Guimaraes KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G (2009) Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med 179(10):962–966. https://doi.org/10.1164/rccm.200806-981OC CrossRefPubMed

14.

Ieto V, Kayamori F, Montes MI, Hirata RP, Gregorio MG, Alencar AM, Drager LF, Genta PR, Lorenzi-Filho G (2015) Effects of oropharyngeal exercises on snoring: a randomized trial. Chest 148(3):683–691. https://doi.org/10.1378/chest.14-2953 CrossRefPubMed

15.

Kayamori F (2015) The effects of myofunctional and orofascial therapy in patients with primary snoring and obstructive sleep apnea and anatomy and airway function. Doctoral thesis, Faculdade de Medicina, pp 1–116

16.

Nemati S, Gerami H, Soltanipour S, Saberi A, Moghadam SK, Setva F (2015) The effects of oropharyngeal-lingual exercises in patients with primary snoring. Eur Arch Oto-Rhino-Laryngol 272 (4):1027–1031. https://doi.org/10.1007/s00405-014-3382-y CrossRef

17.

Verma RK, Johnson JJ, Goyal M, Banumathy N, Goswami U, Panda NK (2016) Oropharyngeal exercises in the treatment of obstructive sleep apnoea: our experience. Sleep Breath (Schlaf Atmung) 20(4):1193–1201. https://doi.org/10.1007/s11325-016-1332-1 CrossRef

18.

Mohamed AS, Sharshar RS, Elkolaly RM, Serageldin SM (2016) Upper airway muscle exercises outcome in patients with obstructive sleep apnea syndrome. Egypt J Chest Dis Tuberc. https://doi.org/10.1016/j.ejcdt.2016.08.014 (Epub ahead of print)

19.

Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131(7):485–491CrossRefPubMed

20.

Lim PV, Curry AR (1999) A new method for evaluating and reporting the severity of snoring. J Laryngol Otol 113(4):336–340PubMed

21.

Friberg D (1999) Heavy snorer’s disease: a progressive local neuropathy. Acta oto-laryngologica 119(8):925–933CrossRefPubMed

22.

Engelke W, Engelhardt W, Mendoza-Gartner M, Decco O, Barrirero J, Knosel M (2010) Functional treatment of snoring based on the tongue-repositioning manoeuvre. Eur J Orthod 32(5):490–495. https://doi.org/10.1093/ejo/cjp135 CrossRefPubMed

Title: Oropharyngeal and tongue exercises (myofunctional therapy) for snoring: a systematic review and meta-analysis
Authors: Macario Camacho
Christian Guilleminault
Justin M. Wei
Sungjin A. Song
Michael W. Noller
Lauren K. Reckley
Camilo Fernandez-Salvador
Soroush Zaghi
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 4/2018
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-017-4848-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Oropharyngeal and tongue exercises (myofunctional therapy) for snoring: a systematic review and meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2018

Calculation of indirect costs of associated with postoperative caregiver absences after pediatric tonsil surgery

Indicators for imaging in periorbital cellulitis secondary to rhinosinusitis

Middle ear microvascularization: an “in vivo” endoscopic anatomical study

Reply to the letter concerning “Revision adenoidectomy in children: a population-based cohort study in Taiwan”

Evaluation of the success of obstructive sleep apnea surgery using criteria based on long-term symptoms and incident hypertension

A comparison of Dysphonia Severity Index and Acoustic Voice Quality Index measures in differentiating normal and dysphonic voices