title: Methods for increasing upper airway muscle tonus in treating obstructive sleep apnea: systematic review.
abstract: OBJECTIVE
  Treatment of obstructive sleep apnea (OSA) using methods for increasing upper airway muscle tonus has been controversial and poorly reported. Thus, a review of the evidence is needed to evaluate the effectiveness of these methods.
  
  
  METHODS
  The design used was a systematic review of randomized controlled trials.
  
  
  METHODS
  Data sources are from the Cochrane Library, Medline, Embase and Scielo, registries of ongoing trials, theses indexed at Biblioteca Regional de Medicina/Pan-American Health Organization of the World Health Organization and the reference lists of all the trials retrieved.
  
  
  METHODS
  This was a review of randomized or quasi-randomized double-blind trials on OSA. Two reviewers independently applied eligibility criteria. One reviewer assessed study quality and extracted data, and these processes were checked by a second reviewer. The primary outcome was a decrease in the apnea/hypopnea index (AHI) of below five episodes per hour. Other outcomes were subjective sleep quality, sleep quality measured by night polysomnography, quality of life measured subjectively and adverse events associated with the treatments.
  
  
  RESULTS
  Three eligible trials were included. Two studies showed improvements through the objective and subjective analyses, and one study showed improvement of snoring, but not of AHI while the subjective analyses showed no improvement. The adverse events were reported and they were not significant.
  
  
  CONCLUSIONS
  There is no accepted scientific evidence that methods aiming to increase muscle tonus of the stomatognathic system are effective in reducing AHI to below five events per hour. Well-designed randomized controlled trials are needed to assess the efficacy of such methods.
authors.affiliation: Department of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil. juspelta@hotmail.com
authors.forename: Juliana Spelta
authors.initials: JS
authors.lastname: Valbuza
authors.forename: Márcio Moysés
authors.initials: MM
authors.lastname: de Oliveira
authors.forename: Cristiane Fiquene
authors.initials: CF
authors.lastname: Conti
authors.forename: Lucila Bizari F
authors.initials: LB
authors.lastname: Prado
authors.forename: Luciane Bizari Coin
authors.initials: LB
authors.lastname: de Carvalho
authors.forename: Gilmar Fernandes
authors.initials: GF
authors.lastname: do Prado
mesh_terms: D000403:Airway Resistance / Q000502:physiology; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007821:Laryngeal Muscles / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009129:Muscle Tonus / Q000502:physiology*; D010156:Palatal Muscles / Q000503:physiopathology*; D010609:Pharyngeal Muscles / Q000503:physiopathology*; D016032:Randomized Controlled Trials as Topic; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D014059:Tongue / Q000503:physiopathology*