Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea: (Review)

José Ramón Rueda; Iranzu Mugueta-Aguinaga; Jordi Vilaró; Mikel Rueda-Etxebarria

doi:10.1002/14651858.CD013449.pub2

Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea: (Review)

Título traducido de la contribución: Terapia miofuncional (ejercicios orofaríngeos) para la apnea obstructiva del sueño: (Revisión)

José Ramón Rueda^*
, Iranzu Mugueta-Aguinaga
, Jordi Vilaró
, Mikel Rueda-Etxebarria

^*Autor/a de correspondencia de este trabajo

Departamento de Nutrición Humana y Dietética y Farmacia

Producción científica: Artículo en revista indizada › Recensión › revisión exhaustiva

60 Citas (Web of Science)

Resumen

Antecedentes
La apnea obstructiva del sueño (AOS) es un síndrome que se caracteriza por episodios de apnea (cese completo de la respiración) o hipopnea (respiración insuficiente) durante el sueño. Los síntomas clásicos de la enfermedad (como ronquidos, descanso insatisfactorio y somnolencia diurna) los experimentan principalmente los hombres, las mujeres notifican síntomas más inespecíficos como baja energía o fatiga, cansancio, insomnio inicial y cefalea matinal. La AOS se asocia con un mayor riesgo de lesiones laborales, enfermedades metabólicas, enfermedades cardiovasculares, mortalidad e implicación en accidentes de tráfico.
La presión positiva continua de las vías respiratorias (del inglés CPAP) (administrada por una máquina que utiliza un tubo y una mascarilla o mascarilla nasal para suministrar una presión de aire continua y estable) se considera la primera opción de tratamiento para la mayoría de personas con AOS. No obstante, la adherencia al tratamiento a menudo es subóptima. La terapia miofuncional podría ser una alternativa para muchos pacientes. Consiste en combinaciones de ejercicios orofaríngeos, es decir, de boca y garganta. Estas combinaciones suelen incluir ejercicios isotónicos e isométricos en los que participan varios músculos y zonas de la boca, la faringe y el tracto respiratorio superior, para trabajar en funciones como hablar, respirar, soplar, chupar, masticar y tragar.
Objetivos
Evaluar los efectos beneficiosos y perjudiciales de la terapia miofuncional (ejercicios orofaríngeos) para el tratamiento de la apnea obstructiva del sueño.
Métodos de búsqueda
Se identificaron ensayos controlados aleatorizados (ECA) en el Registro de Ensayos del Grupo Cochrane de Vías respiratorias (Cochrane Airways Group) (fecha de la última búsqueda: 1 de mayo de 2020). Se encontraron otros ensayos en registros de ensayos clínicos de Internet.
Criterios de selección
Se incluyeron ECA que reclutaron a niños y adultos con diagnóstico de AOS.
Obtención y análisis de los datos
Se utilizaron los procedimientos metodológicos estándar previstos por Cochrane. La confianza en la evidencia se evaluó mediante las recomendaciones GRADE. Los desenlaces principales fueron la somnolencia diurna, la morbilidad y la mortalidad.
Resultados principales
Se encontraron nueve estudios elegibles para la inclusión en esta revisión y nueve en curso. Los nueve ECA incluidos analizaron a un total de 347 participantes, 69 de los cuales eran mujeres y 13 niños. La edad media de los adultos osciló entre 46 y 51 años, las puntuaciones de somnolencia diurna entre ocho y 14 y la gravedad de la afección entre AOS leve y grave. La duración de los estudios varió entre dos y cuatro meses.
Ninguno de los ensayos evaluó los desenlaces de accidentes, enfermedades cardiovasculares ni de mortalidad. Se buscaron datos sobre episodios adversos, pero ninguno de los estudios incluidos informó acerca de ellos.
En adultos, en comparación con un tratamiento simulado, la terapia miofuncional: probablemente reduce la somnolencia diurna (Epworth Sleepiness Scale [ESS], DM [diferencia de medias] ‐4,52 puntos; intervalo de confianza [IC] del 95% ‐6,67 a ‐2,36; dos estudios, 82 participantes; evidencia de certeza moderada); podría aumentar la calidad del sueño (DM ‐3,90; IC del 95%: ‐6,31 a ‐1,49; un estudio, 31 participantes; evidencia de certeza baja); podría dar lugar a poca o ninguna reducción del índice de apnea‐hipopnea (IAH, DM ‐13,20 puntos; IC del 95%: ‐18,48 a ‐7,93; dos estudios, 82 participantes; evidencia de certeza baja); podría tener poco o ningún efecto sobre la frecuencia de ronquidos, pero la evidencia es muy incierta (diferencia de medias estandarizada [DME] ‐0,53 puntos; IC del 95%: ‐1,03 a ‐0,03; dos estudios, 67 participantes; evidencia de certeza muy baja); y es probable que reduzca ligeramente la intensidad subjetiva de los ronquidos(DM ‐1,9 puntos; IC del 95%: ‐3,69 a ‐0,11; un estudio, 51 participantes; evidencia de certeza moderada).
En comparación con la lista de espera, la terapia miofuncional podría: reducir la somnolencia diurna (ESS, cambio en la DM desde el inicio ‐3,00 puntos; IC del 95%: ‐5,47 a ‐0,53; un estudio, 25 participantes; evidencia de certeza baja); dar lugar a poca o ninguna diferencia en la calidad del sueño (DM ‐0,70 puntos; IC del 95%: ‐2,01 a 0,61; un estudio, 25 participantes; evidencia de certeza baja) y reducir el IAH (DM ‐6,20 puntos; IC del 95%: ‐11,94 a ‐0,46; un estudio, 25 participantes; evidencia de certeza baja).
En comparación con la CPAP, la terapia miofuncional podría suponer poca o ninguna diferencia en la somnolencia diurna (DM 0,30 puntos; IC del 95%: ‐1,65 a 2,25; un estudio, 54 participantes; evidencia de certeza baja) y podría aumentar el IAH (DM 9,60 puntos; IC del 95%: 2,46 a 16,74; un estudio, 54 participantes; evidencia de certeza baja).
En comparación con la CPAP más terapia miofuncional, la terapia miofuncional sola podría suponer poca o ninguna diferencia en la somnolencia diurna (DM 0,20 puntos; IC del 95%: ‐2,56 a 2,96; un estudio, 49 participantes; evidencia de certeza baja); y podría aumentar el IAH (DM 10,50 puntos; IC del 95%: 3,43 a 17,57; un estudio, 49 participantes; evidencia de certeza baja).
En comparación con los ejercicios respiratorios más tira nasal dilatadora, la terapia miofuncional podría suponer poca o ninguna diferencia en la somnolencia diurna (DM 0,20 puntos; IC del 95%: ‐2,46 a ‐2,86; un estudio, 58 participantes; evidencia de certeza baja); es probable que aumente ligeramente la calidad del sueño (‐1,94 puntos; IC del 95%: ‐3,17 a ‐0,72; dos estudios, 97 participantes; evidencia de certeza moderada); y podría suponer poca o ninguna diferencia en el IAH (DM ‐3,80 puntos; IC del 95%: ‐9,05 a 1,45; un estudio, 58 participantes; evidencia de certeza baja).
En comparación con el tratamiento médico estándar, la terapia miofuncional podría reducir la somnolencia diurna (DM ‐6,40 puntos; IC del 95%: ‐9,82 a ‐2,98; un estudio, 26 participantes; evidencia de certeza baja) y podría aumentar la calidad del sueño (DM ‐3,10 puntos; IC del 95%: ‐5,12 a ‐1,08; un estudio, 26 participantes; evidencia de certeza baja).
En los niños, en comparación con los lavados nasales solos, la terapia miofuncional y al lavado nasal podrían suponer poca o ninguna diferencia en el IAH (DM 3,00; IC del 95%: ‐0,26 a 6,26; un estudio, 13 participantes; evidencia de certeza baja).
Conclusiones de los autores
En comparación con un tratamiento simulado, es probable que la terapia miofuncional reduzca la somnolencia diurna y podría aumentar la calidad del sueño a corto plazo. La certeza de la evidencia para todas las comparaciones varía de moderada a muy baja, principalmente debido a la falta de cegamiento de los evaluadores de los desenlaces subjetivos, los datos incompletos de los desenlaces y la imprecisión. Se necesitan más estudios. En los estudios futuros se deberá ocultar la asignación a los evaluadores de los desenlaces. Los nuevos ensayos deberían incluir a más participantes, incluyendo más mujeres y niños, y tener períodos de tratamiento y seguimiento más largos.

Título traducido de la contribución	Terapia miofuncional (ejercicios orofaríngeos) para la apnea obstructiva del sueño: (Revisión)
Idioma original	Inglés
Número de artículo	CD013449
Páginas (desde-hasta)	1-81
Número de páginas	82
Publicación	Cochrane Database of Systematic Reviews
Volumen	2020
N.º	11
DOI	https://doi.org/10.1002/14651858.CD013449.pub2
Estado	Publicada - 3 nov 2020

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@article{03d913024c124400b595e24ac1b2795c,

title = "Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea: (Review)",

abstract = "Background: Obstructive sleep apnoea (OSA) is a syndrome characterised by episodes of apnoea (complete cessation of breathing) or hypopnoea (insufficient breathing) during sleep. Classical symptoms of the disease — such as snoring, unsatisfactory rest and daytime sleepiness — are experienced mainly by men; women report more unspecific symptoms such as low energy or fatigue, tiredness, initial insomnia and morning headaches. OSA is associated with an increased risk of occupational injuries, metabolic diseases, cardiovascular diseases, mortality, and being involved in traffic accidents. Continuous positive airway pressure (CPAP) - delivered by a machine which uses a hose and mask or nosepiece to deliver constant and steady air pressure- is considered the first treatment option for most people with OSA. However, adherence to treatment is often suboptimal. Myofunctional therapy could be an alternative for many patients. Myofunctional therapy consists of combinations of oropharyngeal exercises - i.e. mouth and throat exercises. These combinations typically include both isotonic and isometric exercises involving several muscles and areas of the mouth, pharynx and upper respiratory tract, to work on functions such as speaking, breathing, blowing, sucking, chewing and swallowing. Objectives: To evaluate the benefits and harms of myofunctional therapy (oropharyngeal exercises) for the treatment of obstructive sleep apnoea. Search methods: We identified randomised controlled trials (RCTs) from the Cochrane Airways Trials Register (date of last search 1 May 2020). We found other trials at web-based clinical trials registers. Selection criteria: We included RCTs that recruited adults and children with a diagnosis of OSA. Data collection and analysis: We used standard methodological procedures expected by Cochrane. We assessed our confidence in the evidence by using GRADE recommendations. Primary outcomes were daytime sleepiness, morbidity and mortality. Main results: We found nine studies eligible for inclusion in this review and nine ongoing studies. The nine included RCTs analysed a total of 347 participants, 69 of them women and 13 children. The adults' mean ages ranged from 46 to 51, daytime sleepiness scores from eight to 14, and severity of the condition from mild to severe OSA. The studies' duration ranged from two to four months. None of the studies assessed accidents, cardiovascular diseases or mortality outcomes. We sought data about adverse events, but none of the included studies reported these. In adults, compared to sham therapy, myofunctional therapy: probably reduces daytime sleepiness (Epworth Sleepiness Scale (ESS), MD (mean difference) -4.52 points, 95\% Confidence Interval (CI) -6.67 to -2.36; two studies, 82 participants; moderate-certainty evidence); may increase sleep quality (MD -3.90 points, 95\% CI -6.31 to -1.49; one study, 31 participants; low-certainty evidence); may result in a large reduction in Apnoea-Hypopnoea Index (AHI, MD -13.20 points, 95\% CI -18.48 to -7.93; two studies, 82 participants; low-certainty evidence); may have little to no effect in reduction of snoring frequency but the evidence is very uncertain (Standardised Mean Difference (SMD) -0.53 points, 95\% CI -1.03 to -0.03; two studies, 67 participants; very low-certainty evidence); and probably reduces subjective snoring intensity slightly (MD -1.9 points, 95\% CI -3.69 to -0.11 one study, 51 participants; moderate-certainty evidence). Compared to waiting list, myofunctional therapy may: reduce daytime sleepiness (ESS, change from baseline MD -3.00 points, 95\% CI -5.47 to -0.53; one study, 25 participants; low-certainty evidence); result in little to no difference in sleep quality (MD -0.70 points, 95\% CI -2.01 to 0.61; one study, 25 participants; low-certainty evidence); and reduce AHI (MD -6.20 points, 95\% CI -11.94 to -0.46; one study, 25 participants; low-certainty evidence). Compared to CPAP, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.30 points, 95\% CI -1.65 to 2.25; one study, 54 participants; low-certainty evidence); and may increase AHI (MD 9.60 points, 95\% CI 2.46 to 16.74; one study, 54 participants; low-certainty evidence). Compared to CPAP plus myofunctional therapy, myofunctional therapy alone may result in little to no difference in daytime sleepiness (MD 0.20 points, 95\% CI -2.56 to 2.96; one study, 49 participants; low-certainty evidence) and may increase AHI (MD 10.50 points, 95\% CI 3.43 to 17.57; one study, 49 participants; low-certainty evidence). Compared to respiratory exercises plus nasal dilator strip, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.20 points, 95\% CI -2.46 to 2.86; one study, 58 participants; low-certainty evidence); probably increases sleep quality slightly (-1.94 points, 95\% CI -3.17 to -0.72; two studies, 97 participants; moderate-certainty evidence); and may result in little to no difference in AHI (MD -3.80 points, 95\% CI -9.05 to 1.45; one study, 58 participants; low-certainty evidence). Compared to standard medical treatment, myofunctional therapy may reduce daytime sleepiness (MD -6.40 points, 95\% CI -9.82 to -2.98; one study, 26 participants; low-certainty evidence) and may increase sleep quality (MD -3.10 points, 95\% CI -5.12 to -1.08; one study, 26 participants; low-certainty evidence). In children, compared to nasal washing alone, myofunctional therapy and nasal washing may result in little to no difference in AHI (MD 3.00, 95\% CI -0.26 to 6.26; one study, 13 participants; low-certainty evidence). Authors' conclusions: Compared to sham therapy, myofunctional therapy probably reduces daytime sleepiness and may increase sleep quality in the short term. The certainty of the evidence for all comparisons ranges from moderate to very low, mainly due to lack of blinding of the assessors of subjective outcomes, incomplete outcome data and imprecision. More studies are needed. In future studies, outcome assessors should be blinded. New trials should recruit more participants, including more women and children, and have longer treatment and follow-up periods.",

author = "Rueda, \{Jos{\'e} Ram{\'o}n\} and Iranzu Mugueta-Aguinaga and Jordi Vilar{\'o} and Mikel Rueda-Etxebarria",

note = "Publisher Copyright: Copyright {\textcopyright} 2020 The Cochrane Collaboration. Published by John Wiley \& Sons, Ltd.",

year = "2020",

month = nov,

day = "3",

doi = "10.1002/14651858.CD013449.pub2",

language = "English",

volume = "2020",

pages = "1--81",

journal = "Cochrane Database of Systematic Reviews",

issn = "1465-1858",

publisher = "John Wiley and Sons Ltd",

number = "11",

}

TY - JOUR

T1 - Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea

T2 - (Review)

AU - Rueda, José Ramón

AU - Mugueta-Aguinaga, Iranzu

AU - Vilaró, Jordi

AU - Rueda-Etxebarria, Mikel

PY - 2020/11/3

Y1 - 2020/11/3

N2 - Background: Obstructive sleep apnoea (OSA) is a syndrome characterised by episodes of apnoea (complete cessation of breathing) or hypopnoea (insufficient breathing) during sleep. Classical symptoms of the disease — such as snoring, unsatisfactory rest and daytime sleepiness — are experienced mainly by men; women report more unspecific symptoms such as low energy or fatigue, tiredness, initial insomnia and morning headaches. OSA is associated with an increased risk of occupational injuries, metabolic diseases, cardiovascular diseases, mortality, and being involved in traffic accidents. Continuous positive airway pressure (CPAP) - delivered by a machine which uses a hose and mask or nosepiece to deliver constant and steady air pressure- is considered the first treatment option for most people with OSA. However, adherence to treatment is often suboptimal. Myofunctional therapy could be an alternative for many patients. Myofunctional therapy consists of combinations of oropharyngeal exercises - i.e. mouth and throat exercises. These combinations typically include both isotonic and isometric exercises involving several muscles and areas of the mouth, pharynx and upper respiratory tract, to work on functions such as speaking, breathing, blowing, sucking, chewing and swallowing. Objectives: To evaluate the benefits and harms of myofunctional therapy (oropharyngeal exercises) for the treatment of obstructive sleep apnoea. Search methods: We identified randomised controlled trials (RCTs) from the Cochrane Airways Trials Register (date of last search 1 May 2020). We found other trials at web-based clinical trials registers. Selection criteria: We included RCTs that recruited adults and children with a diagnosis of OSA. Data collection and analysis: We used standard methodological procedures expected by Cochrane. We assessed our confidence in the evidence by using GRADE recommendations. Primary outcomes were daytime sleepiness, morbidity and mortality. Main results: We found nine studies eligible for inclusion in this review and nine ongoing studies. The nine included RCTs analysed a total of 347 participants, 69 of them women and 13 children. The adults' mean ages ranged from 46 to 51, daytime sleepiness scores from eight to 14, and severity of the condition from mild to severe OSA. The studies' duration ranged from two to four months. None of the studies assessed accidents, cardiovascular diseases or mortality outcomes. We sought data about adverse events, but none of the included studies reported these. In adults, compared to sham therapy, myofunctional therapy: probably reduces daytime sleepiness (Epworth Sleepiness Scale (ESS), MD (mean difference) -4.52 points, 95% Confidence Interval (CI) -6.67 to -2.36; two studies, 82 participants; moderate-certainty evidence); may increase sleep quality (MD -3.90 points, 95% CI -6.31 to -1.49; one study, 31 participants; low-certainty evidence); may result in a large reduction in Apnoea-Hypopnoea Index (AHI, MD -13.20 points, 95% CI -18.48 to -7.93; two studies, 82 participants; low-certainty evidence); may have little to no effect in reduction of snoring frequency but the evidence is very uncertain (Standardised Mean Difference (SMD) -0.53 points, 95% CI -1.03 to -0.03; two studies, 67 participants; very low-certainty evidence); and probably reduces subjective snoring intensity slightly (MD -1.9 points, 95% CI -3.69 to -0.11 one study, 51 participants; moderate-certainty evidence). Compared to waiting list, myofunctional therapy may: reduce daytime sleepiness (ESS, change from baseline MD -3.00 points, 95% CI -5.47 to -0.53; one study, 25 participants; low-certainty evidence); result in little to no difference in sleep quality (MD -0.70 points, 95% CI -2.01 to 0.61; one study, 25 participants; low-certainty evidence); and reduce AHI (MD -6.20 points, 95% CI -11.94 to -0.46; one study, 25 participants; low-certainty evidence). Compared to CPAP, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.30 points, 95% CI -1.65 to 2.25; one study, 54 participants; low-certainty evidence); and may increase AHI (MD 9.60 points, 95% CI 2.46 to 16.74; one study, 54 participants; low-certainty evidence). Compared to CPAP plus myofunctional therapy, myofunctional therapy alone may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.56 to 2.96; one study, 49 participants; low-certainty evidence) and may increase AHI (MD 10.50 points, 95% CI 3.43 to 17.57; one study, 49 participants; low-certainty evidence). Compared to respiratory exercises plus nasal dilator strip, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.46 to 2.86; one study, 58 participants; low-certainty evidence); probably increases sleep quality slightly (-1.94 points, 95% CI -3.17 to -0.72; two studies, 97 participants; moderate-certainty evidence); and may result in little to no difference in AHI (MD -3.80 points, 95% CI -9.05 to 1.45; one study, 58 participants; low-certainty evidence). Compared to standard medical treatment, myofunctional therapy may reduce daytime sleepiness (MD -6.40 points, 95% CI -9.82 to -2.98; one study, 26 participants; low-certainty evidence) and may increase sleep quality (MD -3.10 points, 95% CI -5.12 to -1.08; one study, 26 participants; low-certainty evidence). In children, compared to nasal washing alone, myofunctional therapy and nasal washing may result in little to no difference in AHI (MD 3.00, 95% CI -0.26 to 6.26; one study, 13 participants; low-certainty evidence). Authors' conclusions: Compared to sham therapy, myofunctional therapy probably reduces daytime sleepiness and may increase sleep quality in the short term. The certainty of the evidence for all comparisons ranges from moderate to very low, mainly due to lack of blinding of the assessors of subjective outcomes, incomplete outcome data and imprecision. More studies are needed. In future studies, outcome assessors should be blinded. New trials should recruit more participants, including more women and children, and have longer treatment and follow-up periods.

AB - Background: Obstructive sleep apnoea (OSA) is a syndrome characterised by episodes of apnoea (complete cessation of breathing) or hypopnoea (insufficient breathing) during sleep. Classical symptoms of the disease — such as snoring, unsatisfactory rest and daytime sleepiness — are experienced mainly by men; women report more unspecific symptoms such as low energy or fatigue, tiredness, initial insomnia and morning headaches. OSA is associated with an increased risk of occupational injuries, metabolic diseases, cardiovascular diseases, mortality, and being involved in traffic accidents. Continuous positive airway pressure (CPAP) - delivered by a machine which uses a hose and mask or nosepiece to deliver constant and steady air pressure- is considered the first treatment option for most people with OSA. However, adherence to treatment is often suboptimal. Myofunctional therapy could be an alternative for many patients. Myofunctional therapy consists of combinations of oropharyngeal exercises - i.e. mouth and throat exercises. These combinations typically include both isotonic and isometric exercises involving several muscles and areas of the mouth, pharynx and upper respiratory tract, to work on functions such as speaking, breathing, blowing, sucking, chewing and swallowing. Objectives: To evaluate the benefits and harms of myofunctional therapy (oropharyngeal exercises) for the treatment of obstructive sleep apnoea. Search methods: We identified randomised controlled trials (RCTs) from the Cochrane Airways Trials Register (date of last search 1 May 2020). We found other trials at web-based clinical trials registers. Selection criteria: We included RCTs that recruited adults and children with a diagnosis of OSA. Data collection and analysis: We used standard methodological procedures expected by Cochrane. We assessed our confidence in the evidence by using GRADE recommendations. Primary outcomes were daytime sleepiness, morbidity and mortality. Main results: We found nine studies eligible for inclusion in this review and nine ongoing studies. The nine included RCTs analysed a total of 347 participants, 69 of them women and 13 children. The adults' mean ages ranged from 46 to 51, daytime sleepiness scores from eight to 14, and severity of the condition from mild to severe OSA. The studies' duration ranged from two to four months. None of the studies assessed accidents, cardiovascular diseases or mortality outcomes. We sought data about adverse events, but none of the included studies reported these. In adults, compared to sham therapy, myofunctional therapy: probably reduces daytime sleepiness (Epworth Sleepiness Scale (ESS), MD (mean difference) -4.52 points, 95% Confidence Interval (CI) -6.67 to -2.36; two studies, 82 participants; moderate-certainty evidence); may increase sleep quality (MD -3.90 points, 95% CI -6.31 to -1.49; one study, 31 participants; low-certainty evidence); may result in a large reduction in Apnoea-Hypopnoea Index (AHI, MD -13.20 points, 95% CI -18.48 to -7.93; two studies, 82 participants; low-certainty evidence); may have little to no effect in reduction of snoring frequency but the evidence is very uncertain (Standardised Mean Difference (SMD) -0.53 points, 95% CI -1.03 to -0.03; two studies, 67 participants; very low-certainty evidence); and probably reduces subjective snoring intensity slightly (MD -1.9 points, 95% CI -3.69 to -0.11 one study, 51 participants; moderate-certainty evidence). Compared to waiting list, myofunctional therapy may: reduce daytime sleepiness (ESS, change from baseline MD -3.00 points, 95% CI -5.47 to -0.53; one study, 25 participants; low-certainty evidence); result in little to no difference in sleep quality (MD -0.70 points, 95% CI -2.01 to 0.61; one study, 25 participants; low-certainty evidence); and reduce AHI (MD -6.20 points, 95% CI -11.94 to -0.46; one study, 25 participants; low-certainty evidence). Compared to CPAP, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.30 points, 95% CI -1.65 to 2.25; one study, 54 participants; low-certainty evidence); and may increase AHI (MD 9.60 points, 95% CI 2.46 to 16.74; one study, 54 participants; low-certainty evidence). Compared to CPAP plus myofunctional therapy, myofunctional therapy alone may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.56 to 2.96; one study, 49 participants; low-certainty evidence) and may increase AHI (MD 10.50 points, 95% CI 3.43 to 17.57; one study, 49 participants; low-certainty evidence). Compared to respiratory exercises plus nasal dilator strip, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.46 to 2.86; one study, 58 participants; low-certainty evidence); probably increases sleep quality slightly (-1.94 points, 95% CI -3.17 to -0.72; two studies, 97 participants; moderate-certainty evidence); and may result in little to no difference in AHI (MD -3.80 points, 95% CI -9.05 to 1.45; one study, 58 participants; low-certainty evidence). Compared to standard medical treatment, myofunctional therapy may reduce daytime sleepiness (MD -6.40 points, 95% CI -9.82 to -2.98; one study, 26 participants; low-certainty evidence) and may increase sleep quality (MD -3.10 points, 95% CI -5.12 to -1.08; one study, 26 participants; low-certainty evidence). In children, compared to nasal washing alone, myofunctional therapy and nasal washing may result in little to no difference in AHI (MD 3.00, 95% CI -0.26 to 6.26; one study, 13 participants; low-certainty evidence). Authors' conclusions: Compared to sham therapy, myofunctional therapy probably reduces daytime sleepiness and may increase sleep quality in the short term. The certainty of the evidence for all comparisons ranges from moderate to very low, mainly due to lack of blinding of the assessors of subjective outcomes, incomplete outcome data and imprecision. More studies are needed. In future studies, outcome assessors should be blinded. New trials should recruit more participants, including more women and children, and have longer treatment and follow-up periods.

UR - https://www.scopus.com/pages/publications/85095582873

UR - http://hdl.handle.net/20.500.14342/751

UR - https://www.webofscience.com/wos/woscc/full-record/WOS:000595647200037

U2 - 10.1002/14651858.CD013449.pub2

DO - 10.1002/14651858.CD013449.pub2

M3 - Review

C2 - 33141943

AN - SCOPUS:85095582873

SN - 1465-1858

VL - 2020

SP - 1

EP - 81

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

IS - 11

M1 - CD013449

ER -

Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea: (Review)

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