Podcast: Myofunctional therapy (oropharyngeal - mouth and throat - exercises) for people with obstructive sleep apnoea

Obstructive sleep apnoea is a sleeping disorder that stops a person's breathing for periods during the night. Several treatments have been suggested and a new Cochrane Review for one of these, myofunctional therapy, was published in November 2020. Here's Emma Dennett, Managing Editor from the Cochrane Airways Group to tell us about the condition and the therapy, and the review's findings.

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Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. Obstructive sleep apnoea is a sleeping disorder that stops a person's breathing for periods during the night. Several treatments have been suggested and a new Cochrane Review for one of these, myofunctional therapy, was published in November 2020. Here's Emma Dennett, Managing Editor from the Cochrane Airways Group to tell us about the condition and the therapy, and the review's findings.

Emma: Obstructive sleep apnoea is a common condition, which can cause snoring, unsatisfactory rest, daytime sleepiness, low energy or fatigue, tiredness, initial insomnia and morning headaches. It's associated with an increased risk of occupational injuries, metabolic and cardiovascular diseases, mortality and being involved in traffic crashes.
The first treatment option for most people is continuous positive airway pressure, or CPAP, but adherence is often poor. A CPAP machine uses a hose and mask or nosepiece to deliver constant and steady air pressure, but those who use it often describe it as uncomfortable and report nasal congestion and abdominal bloating. They can also feel claustrophobic and, because the machine is noisy, it can disturb bed partners.
Myofunctional therapy is an alternative to this. It teaches people daily exercises to strengthen their tongue and throat muscles. These combinations of exercises cover several muscles and areas of the mouth and throat, and involve working on functions such as speaking, breathing, blowing, sucking, chewing and swallowing.
The review was done to investigate its effects and found nine randomised trials, with a total of 347 participants, 69 of whom were women. The evidence suggests that, compared to sham therapy, myofunctional therapy probably reduces daytime sleepiness and may increase sleep quality in the short term. However, it may have little to no effect on snoring frequency although it probably reduces subjective snoring intensity slightly in adults.
There are only 13 children in the review, all of whom were in a single, Italian study that suggests little to no difference in a measure of the number of episodes of apnoea and hypopnoea for a combination of myofunctional therapy and nasal washing compared to nasal washing alone.
In summary, although some of the findings of the research done to date look promising, we need new, larger trials, that include more women and children, have longer treatment and follow-up, and blind patients to which treament they are receiving. These future studies should also include participants with different levels of severity to permit adequate assessment of the impact of myofunctional therapy in those with mild, moderate and severe obstructive sleep apnoea.

Monaz: If you would like to find out more about the current research and the effects of this treatment on a variety of sleep-related outcomes, it's available in full online. If you go to Cochrane Library dot com and type in a search for 'Myofunctional therapy for sleep apnoea', you'll find it and any future updates if the new research gets done.

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