Abstract
Obstructive sleep apnea (OSA) is a common but still underrecognized disorder. A mandibular repositioning appliance (MRA) is used to treat OSA by advancing the mandible and thereby reducing the collapsibility of the upper airway. It has been found that an MRA increases the volume of the upper airway, especially the velopharyngeal area, in OSA patients. We hypothesize that this increase in the velopharyngeal volume is associated with an anterior displacement of the tongue, but likely not with a stretching of the soft tissue connecting the soft palate, lateral pharynx, palatopharyngeal arch, and mandible. Since the function and structure of the genioglossus and hypoglossal nerve are always abnormal in patients with OSA, the tongue does not always move simultaneously with the mandible when an MRA is being used. Oropharyngeal exercises, especially tongue exercises, can improve the quality of life of OSA patients, including reduction of daytime sleepiness and snoring, better quality of sleep, and partial decrease in the AHI. Further, in animal models, tongue exercise is also found to be effective in tongue function recovery and in the remodeling of the hypoglossal nucleus. We suggest that a combination of tongue exercises along with MRA is a promising approach for patients who do not respond to an MRA alone.
Highlights
Obstructive sleep apnea (OSA) is a common but still underrecognized disorder affecting an estimated 2% of middle-aged women and 4% of middle-aged men [1]
During OSA, the upper airway collapse most often results from a combination of anatomic factors plus neuromuscular compensation, a combination that is insufficient during sleep to maintain airway potency [3], but the mechanism itself is still not clear
Oral appliance therapy has been used for OSA patients since it has fewer side effects, provides better tolerance, and offers greater personal satisfaction [9]. e most common type of oral appliance is the mandibular repositioning appliance (MRA), which is usually used to advance the mandible and thereby reduce the collapsibility of the upper airway. e MRA has been effective in mild, moderate, and even severe OSA patients. e mechanism of action, is less predictable than that of Continuous positive airway pressure (CPAP)
Summary
Obstructive sleep apnea (OSA) is a common but still underrecognized disorder affecting an estimated 2% of middle-aged women and 4% of middle-aged men [1]. As a result, changing the tongue position, especially the posterior part, forward and upward is beneficial for increasing the upper airway volume when using an MRA to treat OSA patients. The tongue is more prone to fatigue in patients with OSA and is less stiff than in healthy subjects; this fatigue occurs in the muscle fiber direction, which probably contributes to increased collapsibility of the airway [43] It has been unclear until now whether the hypoglossal axonal damage is homogeneous or not. The exact mechanisms of the oropharyngeal exercises are still not clear, but the exercises are effective in many patients with snoring and mild, moderate, or even severe OSA [49,50,51,52,53] These exercises can promote remodeling of the upper airway if they are performed by the patient with constant and reliable frequency (two or three times a day); lack of such frequency may limit the clinical applicability [54]. A pilot study has found that AHI decreases from 20.9 ± 5.3 to 16.1 ± 5.1 events/h after only one-week tongue training in severe OSA subjects [59]
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