A Comparison of Three Different Forms of Oral Myofunctional Training (OMT) as Methods for Reducing Snoring and Mild to Moderate Sleep Apnea

Introduction/Background

Snoring and obstructive sleep apnea (OSA) are common among the adult population; a mean of 22% and 17% of the women are affected. Obstructive sleep apnea is related to several negative health effects, such as sleepiness, hypertension, cardiovascular disease, and cognitive impairment. Continuous positive airway pressure (CPAP), oral appliances (OA), as well as oropharyngeal surgery in selected cases are available as a treatment for OSA. The same methods can be used for reducing snoring, but the cost for the devices is high, and the compliance tends to be low, although snoring affects the individual as well as the bed partner. Snoring produces vibrations in the upper airway, and over time, it can affect both the motor and sensory function of the tissue in the upper airway. The deterioration process is unknown, but previously published data shows a correlation between the level of snoring/OSA and altered sensory and motor function. This is probably due to the adverse effects of the vibrations and stretching of the nerves and muscles in the airway during snoring and apneas. Our and other research groups have presented similar results and hypothesize that the deterioration may explain why the airway slowly tends to collapse more frequently. This may also explain why more than half of the habitual snorers show deviant swallowing function and thereby have a higher risk of aspiration. It is unknown if this degenerative process of the upper airway is possible to slow down, stop or perhaps even be reversed and thereby improve the sensory and motor function by treatment that decrease or determine snoring and OSA. However, recent data give promising indications that myofunctional training of the upper airway can decrease levels and intensity of snoring and reduce the apnea-hypopnea index (AHI).

Oral screen training can affect brain plasticity and have a strengthening effect on oral and pharyngeal muscles. Oral screen training is used to improve oral and pharyngeal muscle function and has been reported to improve swallowing function in patients suffering from dysphagia including aspiration after stroke. Further, it has been reported to be efficient for the treatment of dysphagia caused by other conditions.

Daily neuromuscular electrical training (NMES) by an oral device eXciteosa® has shown promising results in patients with primary snoring and mild sleep apnea, reducing objective and subjective snoring. Orofacial training guided by an occupational therapist (group training) has also shown positive results in adhering to the training program and affecting the AHI, reducing it in persons aged 60 and younger.

The aim of the present study is, therefore, to assess 1) the impact of three different training methods to reduce AHI among adults with mild to moderate sleep apnea and 2) if the oral screen training can lower the level and intensity of snoring, change levels of sleepiness, quality of life and strength of the tongue muscle.