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The Somatic Connection  |   July 2012
Oropharyngeal Exercises Improve Sleep Apnea
Article Information
The Somatic Connection   |   July 2012
Oropharyngeal Exercises Improve Sleep Apnea
The Journal of the American Osteopathic Association, July 2012, Vol. 112, 412. doi:10.7556/jaoa.2012.112.7.412
The Journal of the American Osteopathic Association, July 2012, Vol. 112, 412. doi:10.7556/jaoa.2012.112.7.412
Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009;179(10):962-966.  
Obstructive sleep apnea syndrome (OSAS) is an increasingly recognized problem worldwide and has been linked to cardiovascular decompensation if left untreated. Patients with OSAS present with complaints of excessive daytime sleepiness, chronic fatigue, snoring, morning headache, and nocturnal arousals. Poorly controlled hypertension, recurrent exacerbations of congestive heart failure, and nocturnal angina are common cardiovascular manifestations of untreated OSAS.1 These effects are more often associated with severe OSAS, defined by the apneahypopnea index (AHI) as greater than 30 apnic events per hour. Severe OSAS is effectively treated with continuous positive airway pressure (CPAP). However, for moderately affected patients (AHI between 15 and 29.9 events per hour), CPAP may not be necessary. Because a major aspect of OSAS is oropharyngeal muscle hypotonicity, strengthening these muscles may benefit patients with moderate OSAS. Researchers in Brazil studied the effect of speech therapy–derived oropharyngeal exercises on OSAS symptoms in patients with moderate OSAS as diagnosed with a standard sleep study. 
A total of 31 patients with moderate OSAS, predominantly middle-aged overweight or obese men, were randomly selected for the control or experimental group. Both groups performed a daily 30-minute regimen for 3 months. The control group (n=15; 73% men; mean [standard deviation {SD}] age, 47.7 [9.8] years) was assigned sham therapy. The experimental group (n=16; 63% men; mean [SD] age, 51.5 [6.8] years) was assigned a set of oropharyngeal exercises, which consisted of isometric and isotonic exercises involving the tongue, soft palate, and lateral pharyngeal wall, including functions of suction, swallowing, chewing, breathing, and speech. Sham therapy involved a weekly, supervised, 30-minute session of deep nasal breathing while sitting. The participants were also instructed to perform the same procedure at home once a day for 30 minutes, with nasal lavage of 10 mL of saline in each nostril 3 times daily and recommendation of bilateral chewing with meals. Exclusion criteria were body mass index of 40 or greater, craniofacial malformations, regular use of hypnotic medications, hypothyroidism, previous stroke, neuromuscular disease, heart failure, coronary artery disease, or severe obstructive nasal disease. 
Objective measurements included anthropometrics, full polysomnography, and snoring frequency and intensity. Subjective measures included Epworth daytime sleepiness and Pittsburgh sleep quality questionnaires. 
No statistically significant change occurred in the control group across all variables. In contrast, patients assigned to oropharyngeal exercises had a statistically significant decrease (P<.05) in neck circumference, snoring frequency and intensity, daytime sleepiness, and OSAS severity as defined by AHI, as well as an increase in sleep quality score on the Pittsburgh scale. Furthermore, changes in neck circumference correlated inversely with changes in AHI (r=0.59; P<.001). Ten participants (62.5%) in the treatment group shifted from moderate to mild (n=8) or no (n=2) OSAS. 
The results of this pioneer randomized clinical trial led the authors to conclude that oropharyngeal exercises significantly reduced OSAS severity and symptoms. Larger population studies are warranted using this research design.—M.A.S. 
Reference
Reference
Foresman BH, Gwirtz PA, McMahon JP. Cardiovascular disease and obstructive sleep apnea: implications for physicians. J Am Osteopath Assoc. 2000;100(6):360-369. [PubMed]