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A promising new adjunct therapy is gaining traction for its potential efficacy in improving symptoms of sleep apnoea. Read all about myofunctional therapy – an exercise-based approach targeting the muscles of the mouth and face – including how it works, its clinical applications and patient outcomes.
Obstructive sleep apnoea (OSA) is a common and chronic sleep disorder characterised by repetitive episodes of partial or complete cessation of breathing during sleep, leading to disrupted sleep and decreased oxygen levels.
It is a significant health concern affecting one billion people worldwide and at least one in three Singaporeans.
It is associated with increased risks of:
Reduced workplace productivity
Reduced quality of life
Conventional treatment options for OSA include continuous positive airway pressure (CPAP) therapy, oral appliances, surgery and weight loss, but adherence and effectiveness can vary.
Myofunctional therapy has emerged as a promising adjunctive therapy for OSA management owing to its non-invasive approach.
In this article, we will summarise the current evidence for myofunctional therapy, and discuss its challenges and future directions as an innovative approach for improving OSA outcomes.
Myofunctional therapy is a type of therapy that focuses on exercise for the muscles of the mouth and face, including the tongue, lips and jaw. It is aimed at improving the function and coordination of these muscles – which play a crucial role in breathing, swallowing, speech and overall oral health – to address the underlying causes of OSA.
A common cause of OSA
OSA is characterised by repetitive upper airway collapse during sleep. In up to 36% of OSA patients, poor muscle responsiveness of the upper airway dilator muscles is seen, leading to increased upper airway collapse.
This is where there is little upper airway muscle activity in response to increasing negative pharyngeal pressure generated during obstructive respiratory episodes.1 As demonstrated by Sands et al., enhanced upper airway muscle responsiveness serves as a protective factor against OSA in overweight and obese patients.2
How myofunctional therapy can help
Myofunctional therapy exercises aim to strengthen and retrain upper airway dilator muscles, such as the genioglossus muscle, to improve muscle tone and endurance. This helps in maintaining airway patency during sleep and reducing symptoms of OSA.
Furthermore, many OSA patients mouthbreathe during sleep, which leads to a backward displacement of the tongue and further narrowing of the retroglossal airway, thereby increasing the risk of upper airway collapse.
Myofunctional therapy can be used to improve nasal breathing and encourage lip seal / mouth closure, so as to create a more stabilised upper airway during sleep.
Myofunctional therapy can be used as an adjunctive therapy for OSA management.
It can be used:
To reduce snoring symptoms
As an adjunct to help reduce CPAP pressure and facilitate CPAP use
In postoperative sleep surgery patients, to reduce residual snoring or risk of recurrence
It is typically provided by trained orofacial myofunctional therapists.
Myofunctional therapy is tailored to each individual’s needs and may include a variety of exercises and techniques to improve tongue strength, oral posture and nasal breathing.
It may also be combined with lifestyle modifications, such as dietary changes and sleep hygiene practices, to support overall sleep health.
Myofunctional therapy is typically delivered in a structured programme, and patient compliance and adherence are important for achieving optimal outcomes.
Emerging evidence suggests that myofunctional therapy is effective in improving OSA outcomes, including OSA symptoms and sleep study parameters.
Systematic review and meta-analysis by Camacho et al. demonstrated orofacial myofunctional therapy as an effective treatment method for OSA in:3
However, the limitation of this meta-analysis is that it consists mainly of small cohort studies.
As an adjunct to CPAP usage, myofunctional therapy has been shown in a randomised controlled trial to reduce overall CPAP therapy pressure and improve adherence to CPAP.4
Further research with larger sample sizes, rigorous study designs, and long-term follow-up is needed to better understand the effectiveness of myofunctional therapy and its optimal use in OSA patients.
Our Sleep Units at Singapore General Hospital and Sengkang General Hospital offer myofunctional therapy to OSA patients and/or primary snorers, with the aims of improving their condition and symptoms.
GPs can refer patients by contacting the Sleep Units at:
Singapore General HospitalTel: 6326 6060Email: firstname.lastname@example.org
Sengkang General HospitalTel: 6930 6000Email: email@example.com
Click here to read more about myofunctional therapy and other sample exercises.
Eckert DJ, Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med . 2013 Oct 15;188(8):996-1004.
Sands SA et al, Enhanced upper-airway muscle responsiveness is a distinct feature of overweight/obese individuals without sleep apnea. Am J Respir Crit Care Med . 2014 Oct 15;190(8):930-7.
Camacho M et al, Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Sleep . 2015 May 1;38(5):669-75
Diafera G et al. Myofunctional therapy improves adherence to continuous positive airway pressure treatment. Sleep Breath . 2017 May;21(2):387-395.
Dr Phua Chu Qin is Chief of the Sleep Surgery Service in the Department of Otolaryngology (ENT) - Head & Neck Surgery, Sengkang General Hospital. She is fellowship-trained at the SingHealth Duke-NUS Sleep Centre, one of the largest Sleep Units in Singapore with comprehensive evaluation and treatment services for sleep disorders.
During her sleep surgery fellowship, she obtained accreditation for the da Vinci transoral robotic surgery for sleep apnoea. To provide better care for sleep apnoea patients, Dr Phua undertook further fellowship training in craniofacial surgery (maxillomandibular advancement surgery) for sleep apnoea patients at the Chang Gung Memorial Hospital, a highly sought-after fellowship done in a high-volume surgical centre with over 600 orthognathic surgeries performed yearly.
GPs can call the SingHealth Duke-NUS Sleep Centre for appointments at the following hotlines or click here to visit the website:
Singapore General Hospital: 6326 6060 Changi General Hospital: 6788 3003 Sengkang General Hospital: 6930 6000 KK Women's and Children's Hospital: 6692 2984 National Dental Centre Singapore: 6324 8798 National Neuroscience Institute: 6330 6363