Orofacial Myofunctional Therapy in Obstructive Sleep Apnea Syndrome: A Pathophysiological Perspective.

Davide Padovani,Gabriel Roisman,Michel Petitjean,Andrea De Vito,Giulio Romano Filograna Pignatelli,Venkata Koka,Winfried Randerath

doi:10.3390/medicina57040323

Abstract

Obstructive sleep apnea (OSA) syndrome is a multi-factorial disorder. Recently identified pathophysiological contributing factors include airway collapsibility, poor pharyngeal muscle responsiveness, a low arousal threshold, and a high loop gain. Understanding the pathophysiology is of pivotal importance to select the most effective treatment option. It is well documented that conventional treatments (continuous positive airway pressure (CPAP), upper airway surgery, and dental appliance) may not always be successful in the presence of non-anatomical traits, especially in mild to moderate OSA. Orofacial myofunctional therapy (OMT) consists of isotonic and isometric exercises targeted to oral and oropharyngeal structures, with the aim of increasing muscle tone, endurance, and coordinated movements of pharyngeal and peripharyngeal muscles. Recent studies have demonstrated the efficacy of OMT in reducing snoring, apnea–hypopnea index, and daytime sleepiness, and improving oxygen saturations and sleep quality. Myofunctional therapy helps to reposition the tongue, improve nasal breathing, and increase muscle tone in pediatric and adult OSA patients. Studies have shown that OMT prevents residual OSA in children after adenotonsillectomy and helps adherence in CPAP-treated OSA patients. Randomized multi-institutional studies will be necessary in the future to determine the effectiveness of OMT in a single or combined modality targeted approach in the treatment of OSA. In this narrative review, we present up-to-date literature data, focusing on the role of OSA pathophysiology concepts concerning pharyngeal anatomical collapsibility and muscle responsiveness, underlying the response to OMT in OSA patients.

Highlights

Obstructive sleep apnea (OSA) is an increasingly common form of sleep-disordered breathing (SDB), with an incidence of 15% in men and 5% in women in adult age and characterized by repetitive collapse or obstruction of the pharyngeal airway during sleep.According to the Wisconsin sleep cohort study in the United States, the estimated prevalence of moderate to severe OSA increased by 14% to 55% over the past two decades [1].Obesity is a high-risk factor, with an incidence of OSA in 50% of the obese population.Aging is an independent risk factor, with 50% of elderly men having a respiratory disturbance index (RDI) above 13/h [2]
We focused our selection criteria mainly on original articles, evaluating the entirety of information and concepts expressed to collect the most important and thorough aspects of up-to-date myofunctional therapy applied to adult OSA patients, focusing on the role of up-to-date OSA pathophysiology concepts concerning pharyngeal anatomical collapsibility and muscle responsiveness
OSA is defined as a multi-factorial disorder, characterized by four contributing phenotypes: airway collapsibility, poor pharyngeal muscle responsiveness, a low arousal threshold (AT), which contributes to unstable ventilatory control, and a high loop gain (LG) or a hypersensitive ventilatory control feedback loop [6,7,8,9] (Table 1)

Summary

Introduction

Obstructive sleep apnea (OSA) is an increasingly common form of sleep-disordered breathing (SDB), with an incidence of 15% in men and 5% in women in adult age and characterized by repetitive collapse or obstruction of the pharyngeal airway during sleep.According to the Wisconsin sleep cohort study in the United States, the estimated prevalence of moderate to severe OSA increased by 14% to 55% over the past two decades [1].Obesity is a high-risk factor, with an incidence of OSA in 50% of the obese population.Aging is an independent risk factor, with 50% of elderly men having a respiratory disturbance index (RDI) above 13/h [2]. Obstructive sleep apnea (OSA) is an increasingly common form of sleep-disordered breathing (SDB), with an incidence of 15% in men and 5% in women in adult age and characterized by repetitive collapse or obstruction of the pharyngeal airway during sleep. Obesity is a high-risk factor, with an incidence of OSA in 50% of the obese population. Aging is an independent risk factor, with 50% of elderly men having a respiratory disturbance index (RDI) above 13/h [2]. The clinical picture of OSA may include one or more symptoms, including snoring, nocturnal polyuria, excessive daytime sleepiness, morning headache, fatigue, neurocognitive deficits, personality alterations, reduced libido, irritability, depressive symptoms, and anxiety [3]. Excessive daytime sleepiness is frequent and increases the risk of vehicle crashes and occupational accidents [4]

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