Skip to main content

Myofunctional therapy improves adherence to continuous positive airway pressure treatment



Few studies have investigated myofunctional therapy in patients with obstructive sleep apnea syndrome (OSAS). The objective of this study was to evaluate the effect of myofunctional therapy on continuous positive airway pressure (CPAP) adherence.


The study was registered at (NCT01289405). Male patients with OSAS were randomly divided into four treatment groups: placebo, patients undergoing placebo myofunctional therapy (N = 24); myofunctional therapy, undergoing myofunctional therapy (N = 27); CPAP, undergoing treatment with CPAP (N = 27); and combined, undergoing CPAP therapy and myofunctional therapy (N = 22). All patients underwent evaluations before and after 3 months of treatment evaluation and after 3 weeks of washout. Evaluations included Epworth sleepiness scale (ESS), polysomnography, and myofunctional evaluation.


The 100 men had a mean age of 48.1 ± 11.2 years, body mass index of 27.4 ± 4.9 kg/m2, ESS score of 12.7 ± 3.0, and apnea-hypopnea index (AHI) of 30.9 ± 20.6. All treated groups (myofunctional therapy, CPAP, and combined myofunctional therapy with CPAP) showed decreased ESS and snoring, and the myofunctional therapy group maintained this improvement after the “washout” period. AHI reduction occurred in all treated groups and was more significant in CPAP group. The myofunctional therapy and combined groups showed improvement in tongue and soft palate muscle strength when compared with the placebo group. The association of myofunctional therapy to CPAP (combined group) showed an increased adherence to CPAP compared with the CPAP group.


Our results suggest that in patients with OSAS, myofunctional therapy may be considered as an adjuvant treatment and an intervention strategy to support adherence to CPAP.

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

Fig. 1
Fig. 2


  1. Schwab RJ, Gefter WB, Hoffman EA, Gupta KB, Pack AI (1993) Dynamic upper airway imaging during awake respiration in normal subjects and patients with sleep disordered breathing. Am Rev Respir Dis 148(5):1385–1400

    CAS  Article  PubMed  Google Scholar 

  2. Mezzanotte WS, Tangel DJ, White DP (1992) Waking genioglossal electromyogram in sleep apnea patients versus normal controls (a neuromuscular compensatory mechanism). J Clin Invest 89:1571–1579

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. Weaver TE, Sawyer AM (2010) Adherence to continuous positive airway pressure treatment for obstructive sleep apnoea: implications for future interventions. Indian J Med Res 131:245–258

    PubMed  PubMed Central  Google Scholar 

  4. Guimarães 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

    Article  PubMed  Google Scholar 

  5. Diaferia G, Badke L, Santos-Silva R, Bommarito S, Tufik S, Bittencourt L (2013) Effect of speech therapy as adjunct treatment to continuous positive airway pressure on the quality of life of patients with obstructive sleep apnea. Sleep Med 14(7):628–635

    Article  PubMed  Google Scholar 

  6. Smith I, Nadig V, Lasserson TJ (2009) Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines for adults with obstructive sleep apnoea. (2):CD007736

  7. Weaver T, Grunstein RR (2008) Adherence to continuous positive airway pressure therapy: to challenge to effective treatment. Proc Am Thorac Soc 5(2):173–178

    Article  PubMed  PubMed Central  Google Scholar 

  8. American Academy of Sleep Medicine (2005) International Classification of Sleep Disorders. 2nd edition: diagnostic and coding manual (ICSD-2). Westchester, IL

    Google Scholar 

  9. Johns MW (1991) A new method of measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545.

  10. Allanson JE, O’Hara P, Farkas, LG, Nair, RC (1993) Anthropometric craniofacial pattern profiles in Down syndrome. Am J Med Genet 47:748–752.

  11. Felício CM, Ferreira CLP (2008) Protocol of orofacial myofunctional evaluation with scores. Int J Pediatr Otorhinolaryngol 72(3):367–375

    Article  PubMed  Google Scholar 

  12. Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Bethesda: National Institute of Neurological Diseases and Blindness. Neurological Information Network (Publication no. 204).

  13. American Sleep Disorders Association (ASDA) (1992) EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 15(2):173–184

    Google Scholar 

  14. American Academy of Sleep Medicine (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine Task Force. Sleep 22(5):667–689

    Article  Google Scholar 

  15. Cunali PA, Almeida FR, Santos CD, Valdrichi NY, Nascimento LS, Dal-Fabbro C, Tufik S, Bittencourt LRA (2011) Mandibular exercises improve mandibular advancement device therapy for obstructive sleep apnea. Sleep Breath 15:717–727

    Article  PubMed  Google Scholar 

  16. Fujiu M, Logemann J (1996) Effect of a tongue-holding maneuver on posterior pharyngeal wall movement during deglutition. Am J Speech Lang Pathol 5:23–30

    Article  Google Scholar 

  17. Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA (1997) Speech and swallowing rehabilitation for head and neck cancer patients. Oncology 11(5):651–664

    CAS  PubMed  Google Scholar 

  18. Furkin AM, Santini CS (1999) Disfagias orofaríngeas. [Oropharyngeal dysphagia]. São Paulo: Pró Fono.

  19. Ferraz MCA (2001) Manual Prático de Motricidade Oral: Avaliação e tratamento. [Practical Manual of Oral Motor Function: Evaluation and treatment]. Rio de Janeiro: Revinter.

  20. Krakauer LH, Di Francesco RC, Marchesan IQ (2003) Respiração oral: abordagem interdisciplinary [Mouth breathing: an interdisciplinary approach]. São José dos Campos, Pulso

    Google Scholar 

  21. Carvalho GD (2003) S.O.S. Respirador bucal—uma visão funcional e clínica da amamentação. [S.O.S. Mouth breather—a functional and clinical view of breastfeeding.]. Editora Lovise, São Paulo

    Google Scholar 

  22. Burger RCP, Caixeta EC, Dininno CQMS (2012) A relação entre apnéia do sono, ronco e respiração oral. [Relationship between sleep apnea, snoring and oral respiration.]. Rev.CEFAC [online journal]

  23. Ieto V, Kayamori F, Montes MI, Hirata RP, Gregório 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

    Article  PubMed  Google Scholar 

  24. Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, Boehlecke B, Brown TM, Coleman J Jr, Friedman L, Kapen S, Kapur VK, Kramer M, Lee-Chiong T, Owens J, Pancer JP, Swick TJ, Wise MS, American Academy of Sleep Medicine (2006) Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 29(3):375–380

    Article  PubMed  Google Scholar 

  25. Dantas DAS, Mauad T, Silva LFF, Lorenzi-Filho G, Formigoni GGS, Cahali MB (2012) The extracellular matrix of the lateral pharyngeal wall in obstructive sleep apnea. Sleep 35(4):483–490

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ackel-D’Elia C, da Silva AC, Santos Silva R, Truksinas E, Sousa BS, Tufik S, De Mello MT, Bittencourt LRA (2012) Effects of exercise training associated with continuous positive airway pressure treatment in patients with obstructive sleep apnea syndrome. Sleep Breath 16(3):723–735

    Article  PubMed  Google Scholar 

  27. Akashiba T, Kosaka N, Yamamoto H, Ito D, Saito O, Horie T (2001) Optimal continuous positive airway pressure in patients with obstructive sleep apnoea: role of craniofacial structure. Respir Med 95:393–397

    CAS  Article  PubMed  Google Scholar 

  28. Zonato AI, Bittencourt LRA, Martinho FL, Gregório LC, Tufik S (2006) Upper airway surgery: the effect on nasal continuous positive airway pressure titration on obstructive sleep apnea patients. Eur Arch Otorhinolaryngol 263(5):481–486

    Article  PubMed  Google Scholar 

  29. Nakata S, Noda A, Yagi H, Yanagi E, Mimura T, Okada T, Misawa H, Nakashima T (2005) Nasal resistance for determinant factor of nasal surgery in CPAP failure patients with obstructive sleep apnea syndrome. Rhinology 43(4):296–299

    PubMed  Google Scholar 

  30. Puhan MA, Suarez A, Lo Cascio C, Zahn A, Heitz M, Braendli O (2006) Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ 332(7536):266–270

    Article  PubMed  PubMed Central  Google Scholar 

  31. Randerath WJ, Galetke W, Domanski U, Weitkunat R, Ruhle K (2004) Tongue-muscle training by intraoral electrical neurostimulation in patients with obstructive sleep apnea. Sleep 27(2):254–259

    Article  PubMed  Google Scholar 

  32. Ojay A, Ernst E (2000) Can singing exercises reduce snoring? A pilot study. Complement Ther Med 8(3):151–156

    CAS  Article  PubMed  Google Scholar 

Download references


The present study received financial support from the Research Incentive Fund Association (Associação Fundo de Incentivo à Pesquisa—AFIP) and the São Paulo Research Foundation (Fundação de Amparo à Pesquisa do Estado de São Paulo—FAPESP) (no. 07/50525-1 for R. Santos-Silva, and CEPID number 98/14303-3 for S. Tufik). S. Tufik and L.R.A. Bittencourt received research grants from the National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico—CNPq).

Authors’ contributions

GD, RS-S, ET, FLMH, RS, SB, LCG, ST, and LB (1) contributed substantially to the conception and design, acquisition of data or analysis and interpretation of data; (2) drafted the article or revised it critically for important intellectual content; and (3) approved the final version for publication.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Giovana Diaféria.

Ethics declarations

The study was approved by the research ethics committee of the Universidade Federal de São Paulo—UNIFESP (CEP 2002/08) and registered at (NCT01289405). All patients gave written informed consent.

Conflict of interest

The authors declare that they have no conflict of interest.

Financial support

This study was funded by the Associação Fundo de Incentivo à Pesquisa—AFIP Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Diaféria, G., Santos-Silva, R., Truksinas, E. et al. Myofunctional therapy improves adherence to continuous positive airway pressure treatment. Sleep Breath 21, 387–395 (2017).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Obstructive sleep apnea
  • Treatment
  • Myofunctional therapy
  • Continuous positive airway pressure
  • Polysomnography