CoDAS
https://codas.org.br/article/doi/10.1590/2317-1782/e20250161en
CoDAS
Original Article

Exploratory study on the effect of orofacial myofunctional therapy on habitual tongue resting position in people with obstructive sleep apnea

Natália de Castro e Silva Martins; Luciana Moraes Studart-Pereira; Hilton Justino da Silva

http://dx.doi.org/10.1590/2317-1782/e20250161en CoDAS, vol.38, n3, e20250161, 2026
PDF
PDF
SciELO
Downloads: 0
Views: 12

Abstract

ABSTRACT: Purpose: To analyze the effect of OMT on the habitual tongue resting position and the results in people with OSA.

Methods: This exploratory study comprising 18 individuals. The study considered eligible individuals of both sexes with a medical diagnosis of OSA (polysomnography) and orofacial myofunctional disorder. Exclusion criteria were those with a history of surgery for OSA or head/neck surgery, cancer in the region, previous oral motor speech-language therapy, psychiatric or neurological disorders that impair communication, oropharyngeal dysphagia, or neuromuscular diseases. They were submitted to speech-language-hearing assessment, sleep questionnaires (Pittsburgh and Epworth), anthropometric measurement, photo/film recordings, and tongue ultrasound examination. Individuals with an indication for OMT had 12 individual weekly sessions and were subsequently reassessed.

Results: Changes were observed in mean tongue distances of the tongue regions pre- and post-OMT. The anterior region (RA) increased from 3.21 mm to 3.38 mm; the middle region (MR) increased from 3.14 mm to 3.25, and the posterior region (RP) decreased from 2.65 to 2.57. The analysis of delta percentage differences between tongue regions pre- and post-OMT shows that the mean percentage ± SD of AR increased by 3.5±6.1, and that of PR decreased by -3.8±4.8. The deltas of AR and PR were significantly different.

Conclusion: OMT changes the distances between the base of the tongue and the contour surface of its three regions, increasing AR and decreasing PR, which generated subjective improvements in the sleep quality of patients with OSA, reflected in lower Pittsburgh and Epworth scores.

Keywords

Speech, Language and Hearing Sciences, Myofunctional Therapy, Sleep Apnea, Obstructive, Tongue, Ultrasonography

References

1 Ryu SY, Kim KS, Han MA. Factors associated with sleep duration in Korean adults: results of a 2008 community health survey in Gwangju metropolitan city. J Korean Med Sci. 2011;26(9):1124-31. https://doi.org/10.3346/jkms.2011.26.9.1124. PMid:21935265.

2 Castro LS, Poyares D, Leger D, Bittencourt L, Tufik S. Objective prevalence of insomnia in the São Paulo, Brazil epidemiologic sleep study. Ann Neurol. 2013;74(4):537-46. https://doi.org/10.1002/ana.23945. PMid:23720241.

3 Liu Y, Croft JB, Wheaton AG, Perry GS, Chapman DP, Strine TW, et al. Association between perceived insufficient sleep, frequent mental distress, obesity and chronic diseases among US adults, 2009 behavioral risk factor surveillance system. BMC Public Health. 2013;13:84. https://doi.org/10.1186/1471-2458-13-84. PMid:23360346.

4 de Moura WL, de Moura CS, Silva TSO, Sipaúba GMO, de Moura MSL, Martins GAS. Prevalência do risco da Síndrome da Apneia Obstrutiva do Sono na população adulta de uma capital brasileira. Rev Fac Odontol (Univ Passo Fundo). 2017;22(3):303-8. https://doi.org/10.5335/rfo.v22i3.7390.

5 Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al. Estimativa da prevalência global e carga da apneia obstrutiva do sono: uma análise baseada na literatura. Lancet Respir Med. 2019;7(8):687-98. https://doi.org/10.1016/S2213-2600(19)30198-5. PMid:31300334.

6 Brasil. Câmara dos Deputados. Projeto de Lei nº 496, de 2024. Institui a Política Nacional de Atenção aos Distúrbios do Sono no âmbito do Sistema Único de Saúde – SUS. Diário Oficial da União; Brasília; 2024.

7 Teixeira CAD, Moura JED, Regalado TFS, de Souza DMT, de Souza JF, de Azevedo AC, et al. Principais distúrbios do sono na população idosa: uma revisão de literatura. Braz J Health Rev. 2020;3(2):2702-9. https://doi.org/10.34119/bjhrv3n2-116.

8 Drager LF, Lorenzi-Filho G, Cintra FD, Pedrosa RP, Bittencourt LRA, Poyares D, et al. 1º Posicionamento Brasileiro sobre o Impacto dos Distúrbios de Sono nas Doenças Cardiovasculares da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol. 2018;111(2):290-34. https://doi.org/10.5935/abc.20180154. PMid:30335871.

9 Perceval AH, Meucci RD. Prevalência de alto risco para a síndrome da apneia obstrutiva do sono na população idosa residente na área rural de Rio Grande-RS. Cad Saude Colet. 2020;28(2):241-50. https://doi.org/10.1590/1414-462x202028020189.

10 Duarte RLM, Togeiro SMGP, Palombini LO, Rizzatti FPG, Fagondes SC, Magalhães-da-Silveira FJ, et al. Brazilian thoracic association consensus on sleep-disordered breathing. J Bras Pneumol. 2022;48(4):e20220106. https://doi.org/10.36416/1806-3756/e20220106. PMid:35830079.

11 Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of adult obstructive sleep apnea with positive airway pressure: an american academy of sleep medicine clinical practice guideline. J Clin Sleep Med. 2019;15(2):335-43. https://doi.org/10.5664/jcsm.7640. PMid:30736887.

12 Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009;179(10):962-6. https://doi.org/10.1164/rccm.200806-981OC. PMid:19234106.

13 Studart-Pereira LM. Fonoterapia na apneia obstrutiva do sono em adultos. In: Picinato-Pirola M, Genaro KF, Berretin-Felix G, Marchesan IQ, Silva HJ, Valera FCP. Terapia em Motricidade Orofacial: como eu faço. São José dos Campos, SP: Pulso Editorial. 2019. p. 86-100.

14 Koka V, De Vito A, Roisman G, Petitjean M, Filograna Pignatelli GR, Padovani D, et al. Orofacial Myofunctional Therapy in Obstructive Sleep Apnea Syndrome: a pathophysiological perspective. Medicina (Kaunas). 2021;57(4):323. https://doi.org/10.3390/medicina57040323. PMid:33915707.

15 Berti LC, Bragato SGR, Silva LM, Marino VCC. Aplicabilidade da ultrassonografia de língua na motricidade orofacial. In: Silva HJ, Genaro KF, Berretin-Felix G, Marchesan IQ, Valera FCP, Motta AR. Tratado de motricidade orofacial. São Paulo: Pulso Editorial; 2019. p. 395-406.

16 Weng CK, Chen JW, Lee PY, Huang CC. Implementation of a wearable ultrasound device for the overnight monitoring of tongue base deformation during obstructive sleep apnea events. Ultrasound Med Biol. 2017;43(8):1639-50. https://doi.org/10.1016/j.ultrasmedbio.2017.04.004. PMid:28522150.

17 Hofauer B, Strohl K, Knopf A, Bas M, Wirth M, Stock K, et al. Sonographic evaluation of tongue motions during upper airway stimulation for obstructive sleep apnea: a pilot study. Sleep Breath. 2017;21(1):101-7. https://doi.org/10.1007/s11325-016-1383-3. PMid:27411337.

18 Folha GA, Valera FCP, Felício CM. Validity and reliability of a protocol of orofacial myofunctional evaluation for patients with obstructive sleep apnea. Eur J Oral Sci. 2015;123(3):165-72. https://doi.org/10.1111/eos.12180. PMid:25780946.

19 Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. https://doi.org/10.1016/0165-1781(89)90047-4. PMid:2748771.

20 Murray JW. A new method for measuring daytime sleepiness: the epworth sleepiness scale. Sleep. 1991;14(6):540-5. https://doi.org/10.1093/sleep/14.6.540. PMid:1798888.

21 Friedman M, Hamilton C, Samuelson CG, Lundgren ME, Pott T. Diagnostic value of the Friedman tongue position and Mallampati classification for obstructive sleep apnea: a meta-analysis. Otolaryngol Head Neck Surg. 2013;148(4):540-7. https://doi.org/10.1177/0194599812473413. PMid:23322629.

22 Medeiros CM, Nakashima E, Feijó E, Bonnet F, Silva LS, Gandra LL. Preditores de síndrome da apneia obstrutiva do sono em caminhoneiros. Saúde, Ética & Justiça. 2016;21(1):28-37. https://doi.org/10.11606/issn.2317-2770.v21i1p28-37.

23 Ieto V, Kayamori F, Montes MI, Hirata RP, Gregório MG, Alencar AM, et al. Effects of oropharyngeal exercises on snoring: a randomized trial. Chest. 2015;148(3):683-91. https://doi.org/10.1378/chest.14-2953. PMid:25950418.

24 Felício CM, Dias FVS, Trawitzki LVV. Obstructive sleep apnea: focus on myofunctional therapy. Nat Sci Sleep. 2018;10:271-86. https://doi.org/10.2147/NSS.S141132. PMid:30233265.

25 Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, et al. myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep. 2015;38(5):669-75. https://doi.org/10.5665/sleep.4652. PMid:25348130.

26 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;21(4):1025-32. https://doi.org/10.1007/s11325-017-1489-2. PMid:28315149.

27 Neelapu BC, Kharbanda OP, Sardana HK, Balachandran R, Sardana V, Kapoor P, et al. Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: a systematic review and meta-analysis of cephalometric studies. Sleep Med Rev. 2017;31:79-90. https://doi.org/10.1016/j.smrv.2016.01.007. PMid:27039222.

28 Wang H, Yang B, Zeng X, Zhang S, Jiang Y, Wang L, et al. Association Between the Weight-Adjusted Waist Index and OSA Risk: Insights from the NHANES 2017-2020 and Mendelian Randomization Analyses. Nat Sci Sleep. 2024;16:1779-95. https://doi.org/10.2147/NSS.S489433. PMid:39583933.

29 Miranda VSG, Buffon G, Vidor DCGM. Orofacial myofunctional profile of patients with sleep disorders: relationship with result of polysomnography. CoDAS. 2019;31(3):1-6. PMid:31066751.

30 Chen JW, Chang CH, Wang SJ, Chang YT, Huang CC. Submental ultrasound measurement of dynamic tongue base thickness in patients with obstructive sleep apnea. Ultrasound Med Biol. 2014;40(11):2590-8. https://doi.org/10.1016/j.ultrasmedbio.2014.06.019. PMid:25220277.
 

Submitted date:
05/12/2025

Accepted date:
09/15/2025

69e6b35fa953951bfe4388a7 codas Articles
2317-1782 (Electronic)
CoDAS ©2026 All rights reserved.

CoDAS

Share this page
Page Sections