de Felício Cláudia Maria, da Silva Dias Franciele Voltarelli, Trawitzki Luciana Vitaliano Voi
Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil,
Craniofacial Research Support Center, University of São Paulo (USP), Ribeirão Preto, Brazil,
Nat Sci Sleep. 2018 Sep 6;10:271-286. doi: 10.2147/NSS.S141132. eCollection 2018.
Orofacial myofunctional therapy (OMT) is a modality of treatment for children and adults with obstructive sleep apnea (OSA) to promote changes in the musculature of the upper airways. This review summarizes and discusses the effects of OMT on OSA, the therapeutic programs employed, and their possible mechanisms of action.
We conducted an online literature search using the databases MEDLINE/PubMed, EMBASE, and Web of Science. Search terms were "obstructive sleep apnea" in combination with "myofunctional therapy" OR "oropharyngeal exercises" OR "speech therapy". We considered original articles in English and Portuguese containing a diagnosis of OSA based on polysomnography (PSG). The primary outcomes of interest for this review were objective measurement derived from PSG and subjective sleep symptoms. The secondary outcome was the evaluation of orofacial myofunctional status.
Eleven studies were included in this review. The studies reviewed reveal that several benefits of OMT were demonstrated in adults, which include significant decrease of apnea-hypopnea index (AHI), reduced arousal index, improvement in subjective symptoms of daytime sleepiness, sleep quality, and life quality. In children with residual apnea, OMT promoted a decrease of AHI, increase in oxygen saturation, and improvement of orofacial myofunctional status. Few of the studies reviewed reported the effects of OMT on the musculature.
The present review showed that OMT is effective for the treatment of adults in reducing the severity of OSA and snoring, and improving the quality of life. OMT is also successful for the treatment of children with residual apnea. In addition, OMT favors the adherence to continuous positive airway pressure. However, randomized and high-quality studies are still rare, and the effects of treatment should also be analyzed on a long-term basis, including measures showing if changes occurred in the musculature.
口面部肌功能治疗（OMT）是一种用于治疗患有阻塞性睡眠呼吸暂停（OSA）的儿童和成人的治疗方式，以促进上呼吸道肌肉组织的变化。本综述总结并讨论了OMT对OSA的影响、所采用的治疗方案及其可能的作用机制。
我们使用MEDLINE/PubMed、EMBASE和科学网数据库进行了在线文献检索。检索词为“阻塞性睡眠呼吸暂停”与“肌功能治疗”或“口咽锻炼”或“言语治疗”的组合。我们纳入了以多导睡眠图（PSG）为基础诊断为OSA的英文和葡萄牙文原创文章。本综述关注的主要结局是源自PSG的客观测量结果和主观睡眠症状。次要结局是对口面部肌功能状态的评估。
本综述纳入了11项研究。所综述的研究表明，OMT在成人中显示出多种益处，包括呼吸暂停低通气指数（AHI）显著降低、觉醒指数降低、白天嗜睡、睡眠质量和生活质量的主观症状得到改善。在有残余呼吸暂停的儿童中，OMT促进了AHI降低、血氧饱和度升高以及口面部肌功能状态改善。所综述的研究中很少有报告OMT对肌肉组织的影响。
本综述表明，OMT对治疗成人OSA的严重程度和打鼾有效，并能改善生活质量。OMT对治疗有残余呼吸暂停的儿童也很成功。此外，OMT有助于坚持持续气道正压通气治疗。然而，随机且高质量的研究仍然很少，治疗效果也应进行长期分析，包括显示肌肉组织是否发生变化的指标。
