Effectiveness of myofunctional therapy combined with breathing exercises in the treatment of obstructive sleep apnea

Abstract Background 'OSA' is a common sleep-related breathing disorder that predominates among males. It is a disorder defined by frequent attacks of upper airway collapse during sleep. The aim of this study was to assess the effectiveness of a combined rehabilitative approach integrating orofacial myofunctional therapy (OMT) and simple breathing exercises in the treatment of obstructive sleep apnea (OSA) and to analyze the results by the level of airway collapse. Methods This pre-post-intervention study included 35 adults (25 females and 10 males) with mild to severe OSA. The mean age of participants was 46.6 ± 8.6 years. Participants underwent comprehensive assessments, including history taking, physical examinations focusing on neck circumference (NC) and body mass index (BMI), full-night polysomnography (PSG), awake fiber-optic nasoendoscopy with 'Muller’s maneuver (MM), and drug-induced sleep endoscopy (DISE)'. The intervention involved a 3-month structured OMT program focusing on the tongue, soft palate, and pharyngeal musculature in addition to breathing exercises. The patients were attending weekly supervised sessions and practicing at home multiple times daily. Post-intervention polysomnography and awake fiber-optic nasoendoscopic examination with Muller’s Maneuver (MM) assessed improvements in OSA-related parameters. Results Fiber-optic nasoendoscopic examination with Muller’s maneuver (MM) revealed that 57% of cases showed a single level collapse at 'the retropalatal level' and 43% showed multiple-level collapse of the airway mainly at the retropalatal and retroglossal levels. Comparison between pre- and post-intervention assessment parameters revealed that' neck circumference, Epworth Sleepiness Scale (ESS) score, apnea–hypopnea index (AHI), oxygen desaturation index (ODI), and the degree of collapse at the retropalatal level' were significantly lower, and sleep efficiency was significantly higher post-intervention, indicating improvement of these parameters. Significant negative correlations were found between the improvement of AHI and both age and baseline ODI. Conclusion This study provides strong evidence for the effectiveness of orofacial myofunctional exercises combined with breathing exercises in treatment of patients with OSA. Improvements were noted in both subjective and objective parameters, particularly the reductions of AHI, ODI, and the collapse degree at the retropalatal level.