title: Myofunctional therapy improves adherence to continuous positive airway pressure treatment.
abstract: OBJECTIVE
  Few studies have investigated myofunctional therapy in patients with obstructive sleep apnea syndrome (OSAS). The objective of this study was to evaluate the effect of myofunctional therapy on continuous positive airway pressure (CPAP) adherence.
  
  
  METHODS
  The study was registered at ClinicalTrials.gov (NCT01289405). Male patients with OSAS were randomly divided into four treatment groups: placebo, patients undergoing placebo myofunctional therapy (N = 24); myofunctional therapy, undergoing myofunctional therapy (N = 27); CPAP, undergoing treatment with CPAP (N = 27); and combined, undergoing CPAP therapy and myofunctional therapy (N = 22). All patients underwent evaluations before and after 3 months of treatment evaluation and after 3 weeks of washout. Evaluations included Epworth sleepiness scale (ESS), polysomnography, and myofunctional evaluation.
  
  
  RESULTS
  The 100 men had a mean age of 48.1 ± 11.2 years, body mass index of 27.4 ± 4.9 kg/m2, ESS score of 12.7 ± 3.0, and apnea-hypopnea index (AHI) of 30.9 ± 20.6. All treated groups (myofunctional therapy, CPAP, and combined myofunctional therapy with CPAP) showed decreased ESS and snoring, and the myofunctional therapy group maintained this improvement after the "washout" period. AHI reduction occurred in all treated groups and was more significant in CPAP group. The myofunctional therapy and combined groups showed improvement in tongue and soft palate muscle strength when compared with the placebo group. The association of myofunctional therapy to CPAP (combined group) showed an increased adherence to CPAP compared with the CPAP group.
  
  
  CONCLUSIONS
  Our results suggest that in patients with OSAS, myofunctional therapy may be considered as an adjuvant treatment and an intervention strategy to support adherence to CPAP.
authors.affiliation: Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleao de Barros 925, São Paulo, SP, 04024-002, Brazil. gidiaferia@hotmail.com.
authors.forename: Giovana
authors.identifier: http://orcid.org/0000-0002-7967-3560
authors.initials: G
authors.lastname: Diaféria
authors.affiliation: Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleao de Barros 925, São Paulo, SP, 04024-002, Brazil.
authors.forename: Rogerio
authors.initials: R
authors.lastname: Santos-Silva
authors.affiliation: Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleao de Barros 925, São Paulo, SP, 04024-002, Brazil.
authors.forename: Eveli
authors.initials: E
authors.lastname: Truksinas
authors.affiliation: Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleao de Barros 925, São Paulo, SP, 04024-002, Brazil.|Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Fernanda L M
authors.initials: FLM
authors.lastname: Haddad
authors.affiliation: Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleao de Barros 925, São Paulo, SP, 04024-002, Brazil.
authors.forename: Renata
authors.initials: R
authors.lastname: Santos
authors.affiliation: Departamento de Fonoaudiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Silvana
authors.initials: S
authors.lastname: Bommarito
authors.affiliation: Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Luiz C
authors.initials: LC
authors.lastname: Gregório
authors.affiliation: Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleao de Barros 925, São Paulo, SP, 04024-002, Brazil.
authors.forename: Sergio
authors.initials: S
authors.lastname: Tufik
authors.affiliation: Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleao de Barros 925, São Paulo, SP, 04024-002, Brazil.
authors.forename: Lia
authors.initials: L
authors.lastname: Bittencourt
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D045422:Continuous Positive Airway Pressure; D006801:Humans; D008297:Male; D008875:Middle Aged; D020247:Myofunctional Therapy; D010349:Patient Compliance; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000628:therapy*
keywords: Continuous positive airway pressure; Myofunctional therapy; Obstructive sleep apnea; Polysomnography; Treatment