Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Nov 9;8(11):e23123.
doi: 10.2196/23123.

Myofunctional Therapy App for Severe Apnea-Hypopnea Sleep Obstructive Syndrome: Pilot Randomized Controlled Trial

Carlos O'Connor-Reina #  1   2 , Jose Maria Ignacio Garcia #  3   4 , Elisa Rodriguez Ruiz #  3 , Maria Del Carmen Morillo Dominguez #  3 , Victoria Ignacio Barrios #  3   4 , Peter Baptista Jardin #  5 , Juan Carlos Casado Morente #  1   2 , Maria Teresa Garcia Iriarte #  6 , Guillermo Plaza #  7   8
Affiliations
Randomized Controlled Trial

Myofunctional Therapy App for Severe Apnea-Hypopnea Sleep Obstructive Syndrome: Pilot Randomized Controlled Trial

Carlos O'Connor-Reina et al. JMIR Mhealth Uhealth. .

Abstract

Background: Myofunctional therapy has demonstrated efficacy in treating sleep-disordered breathing. We assessed the clinical use of a new mobile health (mHealth) app that uses a smartphone to teach patients with severe obstructive sleep apnea-hypopnea syndrome (OSAHS) to perform oropharyngeal exercises.

Objective: We conducted a pilot randomized trial to evaluate the effects of the app in patients with severe OSAHS.

Methods: Forty patients with severe OSAHS (apnea-hypoxia index [AHI]>30) were enrolled prospectively and randomized into an intervention group that used the app for 90 sessions or a control group. Anthropometric measures, Epworth Sleepiness Scale (0-24), Pittsburgh Sleep Quality Index (0-21), Iowa Oral Performance Instrument (IOPI) scores, and oxygen desaturation index were measured before and after the intervention.

Results: After the intervention, 28 patients remained. No significant changes were observed in the control group; however, the intervention group showed significant improvements in most metrics. AHI decreased by 53.4% from 44.7 (range 33.8-55.6) to 20.88 (14.02-27.7) events/hour (P<.001). The oxygen desaturation index decreased by 46.5% from 36.31 (27.19-43.43) to 19.4 (12.9-25.98) events/hour (P=.003). The IOPI maximum tongue score increased from 39.83 (35.32-45.2) to 59.06 (54.74-64.00) kPa (P<.001), and the IOPI maximum lip score increased from 27.89 (24.16-32.47) to 44.11 (39.5-48.8) kPa (P<.001). The AHI correlated significantly with IOPI tongue and lip improvements (Pearson correlation coefficient -0.56 and -0.46, respectively; both P<.001). The Epworth Sleepiness Scale score decreased from 10.33 (8.71-12.24) to 5.37 (3.45-7.28) in the app group (P<.001), but the Pittsburgh Sleep Quality Index did not change significantly.

Conclusions: Orofacial exercises performed using an mHealth app reduced OSAHS severity and symptoms, and represent a promising treatment for OSAHS.

Trial registration: Spanish Registry of Clinical Studies AWGAPN-2019-01, ClinicalTrials.gov NCT04438785; https://clinicaltrials.gov/ct2/show/NCT04438785.

Keywords: apnea; app; efficacy; mHealth; myofunctional therapy; oropharyngeal exercises; randomized trial; sleep; sleep apnea; smartphone app; therapy.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: CR is the creator of, and has financial interest in, the AirwayGym app. All other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Screenshot of a gif showing an exercise.
Figure 2
Figure 2
Screenshot of a patient’s progress in following the exercises for 1 year.
Figure 3
Figure 3
CONSORT flowchart for pilot randomized trials for recruitment of participants in this study. AGG: AirwayGym group; CG: control group.
Figure 4
Figure 4
Apnea–hypopnea index (AHI) before (baseline) and after 3 months in patients with severe obstructive sleep apnea. Intragroup comparison from before to after the study was performed using the Wilcoxon test owing to the skewed data distribution. CG: control group; AGG: AirwayGym group.
Figure 5
Figure 5
Iowa Oral Performance Instrument (IOPI) tongue strength (kPa) at baseline and after 3 months in patients with severe obstructive sleep apnea. The intragroup comparison is shown from before to after the study. AGG: AirwayGym group; CG: control group.
Figure 6
Figure 6
Iowa Oral Performance Instrument (IOPI) lip strength (kPa) at baseline and after 3 months in patients with severe obstructive sleep apnea. The intragroup comparison is shown from before to after the study. AGG: AirwayGym group; CG: control group.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Mendes FA, Marone SAM, Duarte BB, Arenas ACP. Epidemiologic profile of patients with snoring and obstructive sleep apnea in a university hospital. Int Arch Otorhinolaryngol. 2014 Apr;18(2):142–145. doi: 10.1055/s-0033-1359309. http://www.thieme-connect.com/DOI/DOI?10.1055/s-0033-1359309 - DOI - PMC - PubMed
    1. Bakker JP, Wang R, Weng J, Aloia MS, Toth C, Morrical MG, Gleason KJ, Rueschman M, Dorsey C, Patel SR, Ware JH, Mittleman MA, Redline S. Motivational Enhancement for Increasing Adherence to CPAP: A Randomized Controlled Trial. Chest. 2016 Aug;150(2):337–345. doi: 10.1016/j.chest.2016.03.019. http://europepmc.org/abstract/MED/27018174 - DOI - PMC - PubMed
    1. Hanning CD. Laryngeal and velopharyngeal sensory impairment in obstructive sleep apnea. Sleep. 2005 Oct;28(10):1335. doi: 10.1093/sleep/28.10.1335. - DOI - PubMed
    1. Guilleminault C, Huang Y, Quo S. Apraxia in children and adults with obstructive sleep apnea syndrome. Sleep. 2019 Dec 24;42(12):zsz168. doi: 10.1093/sleep/zsz168. - DOI - PubMed
    1. Villa MP, Evangelisti M, Martella S, Barreto M, Del Pozzo M. Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep Breath. 2017 Dec;21(4):1025–1032. doi: 10.1007/s11325-017-1489-2. - DOI - PubMed

Publication types

Associated data