Obstructive Sleep Apnea
Conditions
Keywords
Obstructive sleep apnea, Myofunctional therapy (MFT), Upper airway surgery, Oropharyngeal exercises, Postoperative outcomes, Polysomnography (PSG), Apnea-Hypopnea Index (AHI)
Brief summary
Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent upper airway collapse. While surgery is a common treatment, its success rates are variable. Myofunctional therapy (MFT), a program of targeted oropharyngeal exercises, has emerged as a promising adjunctive treatment to improve surgical outcomes. This study prospectively compared outcomes in adult patients with moderate-to-severe OSA who received postoperative MFT (OP+MFT) versus those who underwent surgery alone (OP). Following surgery, patients were allocated to either the OP+MFT group, which began a 12-week MFT program, or the OP-only group. Polysomnography (PSG) was performed at baseline and at 3 and 12 months post-surgery. The study found that the OP+MFT group showed significantly greater improvements in key sleep parameters, including the Apnea-Hypopnea Index (AHI) and lowest oxygen saturation, compared to the OP group. These benefits were most pronounced at the 3-month follow-up, supporting the conclusion that postoperative MFT is a safe and effective adjunct to surgery for OSA.
Detailed description
Obstructive Sleep Apnea (OSA) is a prevalent condition associated with significant morbidity, including hypertension and cardiovascular disease. The first-line treatment, Continuous Positive Airway Pressure (CPAP), is limited by poor long-term patient adherence, with compliance rates often below 20%. For patients who are intolerant to CPAP, surgical options are available, but their long-term success rates are modest, averaging around 30%. This study is based on the rationale that surgery primarily addresses static anatomical obstructions, while a key functional deficit-poor neuromuscular tone of the upper airway dilator muscles-remains uncorrected by surgery alone. Myofunctional therapy (MFT) is a structured exercise program designed to strengthen oropharyngeal muscles (e.g., tongue, soft palate), improve neuromuscular control, and enhance airway stability during sleep. This study was designed to evaluate the synergistic effect of combining surgery with postoperative MFT. The hypothesis is that a dual approach, where surgery provides anatomical relief and MFT enhances dynamic airway stability, will lead to superior treatment outcomes compared to surgery alone.
Interventions
PROCEDUREmyofunctional therapy
A 12-week structured program of oropharyngeal exercises that commenced three weeks after surgery. The program consisted of initial face-to-face instruction, twice-daily home practice (15 minutes each) guided by videos, and biweekly supervision. Exercises included tongue elevation and protrusion drills, soft palate elevation, and pharyngeal wall contractions to enhance neuromuscular control of the upper airway.
Sponsors
Taipei Medical University
National Yang Ming Chiao Tung University Hospital
National Tsing Hua University,Taiwan
Taipei Medical University Shuang Ho Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
None (Open Label)
Intervention model description
Enrolled patients were divided into two parallel groups based on personal willingness after discussion: Group A (OP+MFT) or Group B (OP-only)
Eligibility
Sex/Gender
ALL
Age
20 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age 20-65 years * Moderate-to-severe Obstructive Sleep Apnea (AHI ≥ 15 events/hour) confirmed by PSG * Friedman palate position grade I-II and tonsil size grade III-IV * Patients who refuse or are unable to tolerate CPAP
Exclusion criteria
* \- Central or mixed sleep apnea * BMI \> 27 kg/m² * Severe cardiopulmonary disease or psychiatric illness * Pregnancy or cancer * Significant weight gain during the follow-up period
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Apnea-Hypopnea Index | Baseline, 3 months post-surgery, and 12 months post-surgery | Change in AHI from baseline, measured by polysomnography in events per hour. Treatment success is defined as a reduction of ≥50% from baseline AHI and a final AHI of \<20 events/hour. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Lowest Oxygen Saturation (LSaO₂) | Baseline, 3 months post-surgery, and 12 months post-surgery | Change in the lowest oxygen saturation (LSaO₂) during sleep, measured by polysomnography as a percentage |
| Change in Snore Index | Baseline, 3 months post-surgery, and 12 months post-surgery | Change in the snore index, measured by polysomnography as the percentage of total sleep time with snoring events |
Countries
Taiwan
Outcome results
None listed