A new network meta-analysis of 15 randomized controlled trials investigates the efficacy of myofunctional therapy (MT)—targeted exercises for the tongue and upper airway muscles—for treating obstructive sleep apnea (OSA)^[1]. The results present a nuanced picture: while MT provides significant subjective improvements in sleep quality and daytime sleepiness, its effect on the primary objective measure of OSA severity, the Apnea-Hypopnea Index (AHI), appears to be dependent on the daily duration of the exercises.

Key Findings

This network meta-analysis, which included 473 adults and 139 children, provides a robust summary of the current evidence on myofunctional therapy for OSA.

• Significant Subjective Improvement: In adults, MT led to a clinically meaningful reduction in daytime sleepiness, improving the Epworth Sleepiness Scale (ESS) by -3.54 points (P = .004). It also improved overall sleep quality, reducing the Pittsburgh Sleep Quality Index (PSQI) by -2.24 points (P = .0003).
• No Overall Effect on AHI: When all studies were pooled, MT did not produce a statistically significant reduction in the Apnea-Hypopnea Index (AHI), the core diagnostic metric for OSA (-8.73 events/hour, P = 0.17).
• Dose-Dependent AHI Reduction: A critical subgroup analysis revealed that daily training sessions exceeding 30 minutes were associated with a significant improvement in AHI. This suggests that the intensity and duration of therapy are key determinants of its objective success.

The Longevity Context

Obstructive sleep apnea is far more than a snoring nuisance; it is a significant risk factor for major age-related diseases. The recurrent episodes of hypoxia (low oxygen) and sleep fragmentation in OSA drive systemic inflammation, oxidative stress, and sympathetic nervous system overactivation, contributing directly to cardiovascular diseases like hypertension, stroke, and heart failure, as well as metabolic dysfunction and cognitive decline^[2]. The Apnea-Hypopnea Index (AHI) is the primary biomarker used to quantify the severity of these events, representing the number of breathing cessations or reductions per hour of sleep^[3].

Myofunctional therapy targets the root cause of OSA in many individuals: poor muscle tone in the upper airway. By strengthening the tongue, soft palate, and pharyngeal muscles, MT aims to prevent the airway from collapsing during sleep. This analysis, building on earlier work^[4], suggests that while MT consistently improves the symptoms of OSA (like feeling tired), achieving a physiologically significant impact on airway collapsibility (measured by AHI) requires a dedicated and consistent time commitment. The finding that >30 minutes of daily practice can move the needle on AHI is a crucial insight for anyone implementing this therapy.

Actionable Protocol

For individuals with mild to moderate OSA, particularly as an adjunct to other therapies or for those intolerant to CPAP, consider a structured myofunctional therapy program.

1. Consult a Professional: Seek guidance from a qualified myofunctional therapist, often a speech-language pathologist or a specially trained dentist or orthodontist, to learn the correct exercises.
2. Commit to the Duration: To target objective improvements in AHI, protocol adherence is key. Plan for a minimum of 30-45 minutes of daily exercise as suggested by the subgroup analysis.
3. Monitor and Track: Combine the intervention with objective tracking. Use home sleep studies or data from wearable devices to monitor for changes in snoring, oxygen saturation, and respiratory events alongside subjective tracking of sleep quality and daytime energy levels.