Myofunctional Therapy in Adults and Children With Obstructive Sleep Apnea: An Overview and Re-Analysis of Systematic Reviews.

Abstract

This overview with re-analysis of systematic reviews (SRs) aims to assess the effectiveness of orofacial myofunctional therapy (MT) for Obstructive Sleep Apnea (OSA) patients. We searched PubMed, Embase, and the Cochrane Library up to July 2024. SRs with meta-analyses on OSA in adults or children who underwent MT intervention compared to any control were included. Primary outcomes were severity of sleep apnea, oxygen saturation, sleep efficiency, and daytime sleepiness, while secondary outcomes included snoring intensity, frequency, and sleep quality. We included nine SRs, encompassing 21 unique primary studies (13 RCTs, 8 pre-post studies; n = 716 participants). The methodological quality of the SRs was generally critically low (5/9 SRs). After re-analyzing outcome data (primary studies overlap: 13.44%), MT seems to be more effective than control in reducing severity of sleep apnea (MD -9.54; CIs 95% -14.04, -5.04), daytime sleepiness (MD -3.62; CIs 95% -6.61, -0.63), sleep quality (MD -2.23; CIs 95% -2.93, -1.53), and in improving minimum oxygen saturation (MD 3.19; CIs 95% 1.47, 4.91) in adults. No differences were found in mean oxygen saturation and sleep efficiency. Meta-analyses comparing pre-MT to post-MT showed improvements post-MT. Sparse evidence was found for other outcomes and for children. MT may improve multiple clinical outcomes in OSA. Results should be interpreted cautiously, as most primary studies are at high risk of bias. More research is needed on the pediatric population.