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

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    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

    Article  Google Scholar 

  2. 2.

    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

    Article  PubMed  Google Scholar 

  3. 3.

    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

    Google Scholar 

  4. 4.

    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

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    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

  6. 6.

    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

    Article  PubMed  Google Scholar 

  7. 7.

    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

  8. 8.

    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

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    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

    Article  PubMed  PubMed Central  Google Scholar 

  10. 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

    Google Scholar 

  11. 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

    Google Scholar 

  12. 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

    Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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. 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

    Article  Google Scholar 

  17. 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

    Article  Google Scholar 

  18. 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)

    Google Scholar 

  19. 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):485–491

    CAS  Article  PubMed  Google Scholar 

  20. 20.

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

    CAS  PubMed  Google Scholar 

  21. 21.

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

    CAS  Article  PubMed  Google Scholar 

  22. 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

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was received for this research.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Macario Camacho.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria, educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required. There is no additional need for informed consent as no identifying information is included in this article.

Additional information

The views expressed in this abstract/manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (TIF 990 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Camacho, M., Guilleminault, C., Wei, J.M. et al. Oropharyngeal and tongue exercises (myofunctional therapy) for snoring: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 275, 849–855 (2018). https://doi.org/10.1007/s00405-017-4848-5

Download citation

Keywords

  • Snoring
  • Myofunctional therapy
  • Systematic review
  • Meta-analysis