Efficacy of myofunctional therapy for obstructive sleep apnea: A systematic review and network meta-analysis

Myofunctional therapy (MT) has emerged as an adjunct treatment for obstructive sleep apnea (OSA). This systematic review and network meta-analysis of randomized controlled trials (RCTs) aims to evaluate the efficacy of MT in treating adult and pediatric OSA.

Four electronic databases were searched until April 30, 2024. Meta-analysis, subgroup, and network meta-analysis using multivariate random effects were performed to estimate pooled differences, focusing on objective and subjective indicators.

A total of 15 RCTs involving 473 adults and 139 children were eligible, with 10 adult studies (n = 380) included in the network meta-analysis. Compared to the controls, MT yielded an improved decrease in Epworth sleepiness scale (ESS) of -3.54 (95%CI -5.96 to -1.13, P = .004) and Pittsburgh sleep quality index (PSQI) of -2.24 (95%CI -3.46 to -1.01, P = .0003), though no statistically significant change in apnea-hypopnea index (AHI) (-8.73/h, 95%CI -21.19 to 3.74/h, P = 0.17). Improvements in arousal index and snoring intensity were also noted in adults. Combining MT with continuous positive airway pressure (CPAP) could lead to a pronounced reduction in AHI but did not significantly increase CPAP efficacy. Limited evidence suggests MT may benefit AHI and average SpO2 in pediatric OSA, with high compliance being essential.

The network meta-analysis supports MT as a promising adjunct for improving subjective indicators in adults and suggests that when daily training exceeds 30 minutes, MT can significantly improve AHI. Additionally, MTSP and MT combined with myofascial release may offer further benefits in subjective outcomes.