title: Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  To systematically review the literature for articles evaluating myofunctional therapy (MT) as treatment for obstructive sleep apnea (OSA) in children and adults and to perform a meta-analysis on the polysomnographic, snoring, and sleepiness data.
  
  
  METHODS
  Web of Science, Scopus, MEDLINE, and The Cochrane Library.
  
  
  METHODS
  The searches were performed through June 18, 2014. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed.
  
  
  RESULTS
  Nine adult studies (120 patients) reported polysomnography, snoring, and/or sleepiness outcomes. The pre- and post-MT apneahypopnea indices (AHI) decreased from a mean ± standard deviation (M ± SD) of 24.5 ± 14.3/h to 12.3 ± 11.8/h, mean difference (MD) -14.26 [95% confidence interval (CI) -20.98, -7.54], P < 0.0001. Lowest oxygen saturations improved from 83.9 ± 6.0% to 86.6 ± 7.3%, MD 4.19 (95% CI 1.85, 6.54), P = 0.0005. Polysomnography snoring decreased from 14.05 ± 4.89% to 3.87 ± 4.12% of total sleep time, P < 0.001, and snoring decreased in all three studies reporting subjective outcomes. Epworth Sleepiness Scale decreased from 14.8 ± 3.5 to 8.2 ± 4.1. Two pediatric studies (25 patients) reported outcomes. In the first study of 14 children, the AHI decreased from 4.87 ± 3.0/h to 1.84 ± 3.2/h, P = 0.004. The second study evaluated children who were cured of OSA after adenotonsillectomy and palatal expansion, and found that 11 patients who continued MT remained cured (AHI 0.5 ± 0.4/h), whereas 13 controls had recurrent OSA (AHI 5.3 ± 1.5/h) after 4 y.
  
  
  CONCLUSIONS
  Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 50% in adults and 62% in children. Lowest oxygen saturations, snoring, and sleepiness outcomes improve in adults. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments.
authors.affiliation: Department of Psychiatry, Division of Sleep Medicine, Stanford Hospital and Clinics, Redwood City, CA.
authors.forename: Macario
authors.initials: M
authors.lastname: Camacho
authors.affiliation: Department of Otorhinolaryngology/ Sleep Medicine Centre, Hospital CUF Porto; CINTESIS, Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal.
authors.forename: Victor
authors.initials: V
authors.lastname: Certal
authors.affiliation: Department of Otorhinolaryngology, Hospital Bernardino Rivadavia, Buenos Aires, Argentina.
authors.forename: Jose
authors.initials: J
authors.lastname: Abdullatif
authors.affiliation: Department of Head and Neck Surgery, University of California, Los Angeles, CA.
authors.forename: Soroush
authors.initials: S
authors.lastname: Zaghi
authors.affiliation: Department of Psychiatry, Division of Sleep Medicine, Stanford Hospital and Clinics, Redwood City, CA.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Ruoff
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, CA.
authors.forename: Robson
authors.initials: R
authors.lastname: Capasso
authors.affiliation: Department of Psychiatry, Division of Sleep Medicine, Stanford Hospital and Clinics, Redwood City, CA.
authors.forename: Clete A
authors.initials: CA
authors.lastname: Kushida
mesh_terms: D000233:Adenoidectomy; D000328:Adult; D002648:Child; D006801:Humans; D020247:Myofunctional Therapy; D010100:Oxygen / Q000378:metabolism; D010155:Palatal Expansion Technique; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D012894:Sleep Stages / Q000502:physiology; D012913:Snoring / Q000503:physiopathology; D014068:Tonsillectomy
chemical_list: D010100:Oxygen
keywords: exercise therapy/methods; myofunctional therapy/methods; obstructive sleep apnea; sleep apnea syndromes