Background OSA pathogenesis is complex and may vary according to ethnicity. The anatomic component predisposing to OSA is the result of the interaction between bony structure and upper airway soft ...tissues and can be assessed using passive critical closing pressure (Pcrit). We hypothesized that Japanese-Brazilians and whites present different predictors of upper airway collapsibility, suggesting different causal pathways to developing OSA in these two groups. Methods Male Japanese-Brazilians (n = 39) and whites (n = 39) matched for age and OSA severity were evaluated by full polysomnography, Pcrit, and upper airway and abdomen CT scans for determination of upper airway anatomy and abdominal fat, respectively. Results Pcrit was similar between the Japanese-Brazilians and the whites (−1.0 ± 3.3 cm H2 O vs −0.4 ± 3.1 cm H2 O, P = .325). The Japanese-Brazilians presented smaller upper airway bony dimensions (cranial base, maxillary, and mandibular lengths), whereas the whites presented larger upper airway soft tissue (tongue length and volume) and a greater imbalance between tongue and mandible (tongue/mandibular volume ratio). The cranial base angle was associated with Pcrit only among the Japanese-Brazilians ( r = −0.535, P < .01). The tongue/mandibular volume ratio was associated with Pcrit only among the whites ( r = 0.460, P < .01). Obesity-related variables (visceral fat, BMI, and neck and waist circumferences) showed a similar correlation with Pcrit in the Japanese-Brazilians and the whites. Conclusions Japanese-Brazilians and whites present different predictors of upper airway collapsibility. Although craniofacial bony restriction influenced Pcrit only in the Japanese-Brazilians, an anatomic imbalance between tongue and mandible volume influenced Pcrit among the whites. These findings may have therapeutic implications regarding how to improve the anatomic predisposition to OSA across ethnicities.
RESUMO A Apneia Obstrutiva do Sono caracteriza-se por episódios recorrentes de colapso parcial ou completo da faringe, seguidos de diminuição da saturação de oxihemoglobina e despertares frequentes. ...É considerada problema de saúde pública com importantes sintomas noturnos e diurnos, impactando qualidade de vida. Seus efeitos associam-se as áreas de competência da Fonoaudiologia. Para estabelecer diagnóstico e métodos de tratamento eficientes, profissionais devem conhecer a patogênese da obstrução da via aérea superior durante o sono. Visando contribuir para a compreensão da fisiopatologia da apneia obstrutiva do sono, elegibilidade de procedimentos terapêuticos individualizados e direcionamento para terapêutica miofuncional orofacial, o presente estudo tem como objetivo descrever e ilustrar os locais e tipos de colapso da via aérea superior durante o sono. Após processos éticos, foram analisados registros originais das sonoendoscopias de uma série de casos com diagnóstico polissonográfico de apneia obstrutiva do sono. As imagens das gravações dos exames foram analisadas por cinco profissionais com expertise na área do sono. Os locais obstrutivos e tipos de colapso foram apresentados conforme classificação vigente. Os vídeos foram divididos em capturas de tela, originando figuras de cada sítio anatômico: sem colapso e com colapso. Os resultados foram apresentados por imagens dos casos, que ilustram cada colapso, predominando colapso velofaríngeo: anteroposterior, lateral ou concêntrico; seguido por colapso orofaríngeo lateral; colapso anteroposterior na hipofaringe e colapso anteroposterior da epiglote. O entendimento dos locais de obstrução e tipos de colapso ilustrados nesse estudo pode ser um preditor de respostas terapêuticas, auxiliando a compreensão das limitações ou direcionando propostas para cada paciente.
ABSTRACT Obstructive Sleep Apnea is characterized by recurrent episodes of partial or complete collapse of the pharynx, followed by decreased oxyhemoglobin saturation and frequent arousals. It is regarded as a public health issue with important night and day symptoms that impact life quality. Its effects are associated with the areas of competence of Speech and Language Pathologists. To establish efficient diagnosis and treatment methods, professionals must know the pathogenesis of upper airway obstruction during sleep. This study seeks to enlarge the understanding of obstructive sleep apnea pathophysiology, eligibility of individualized therapeutic procedures and guidance for orofacial myofunctional therapy by describing and illustrating the locations and types of upper airway collapse during sleep. We analyzed original records of Drug Induced Sleep Endoscopy exams of a series of cases with polysomnographic diagnosis of obstructive sleep apnea following the proper ethical processes. The images of the exam recordings were analyzed by five professionals with expertise in the sleep area. Obstructive sites and types of collapse were presented according to the current classification. The videos were divided into screenshots, originating figures from each anatomical site: without collapse and collapsed. The results are visualized in the images of the cases showing a predominance of velopharyngeal collapse: anteroposterior, lateral, or concentric; oropharyngeal lateral collapse; tongue anteroposterior collapse and anteroposterior collapse of the epiglottis. Understanding the obstruction sites and types of collapse illustrated in this study may help to predict therapeutic responses and learn the limitations or direct individual proposals patient.
To organize an assessment instrument with questionnaires and myofunctional orofacial/oropharyngeal assessment for OSA patients and correlate it with the upper airway obstructive site detected during ...drug-induced sleep endoscopy (DISE).
29 OSA patients aged 22-65 years with an indication to undergo DISE to evaluate an alternative treatment to PAP and signed the consent form. Patients over 65 years old with maxillofacial deficiency and BMI>30 were excluded. The subjects answered the Pittsburgh, Berlin (snore), and Epworth questionnaires. The myofunctional orofacial/oropharyngeal assessment comprised soft palate, palatine pillars, and uvula (structure and mobility), tonsils (size), mandible (bony bases), hard palate (depth and width), tongue (posture, volume, width, and height), floor of mouth (mylohyoid), tongue suction and sustaining (mobility), "lowering of the back of the tongue" (stimulus), which were scored by three speech-language pathologists with expertise. DISE was scored according to VOTE classification. The statistical analysis (t-test) compared groups without and with obstruction in VOTE with questionnaires and myofunctional orofacial/oropharyngeal assessment.
The following were significantly different: snoring frequency (p=0.03) with VOTE/velopharynx; intensity (p=0.02) and frequency of snoring (p=0.03) with VOTE/lateral wall of oropharynx; suction the tongue and sustain (p=0.02) with VOTE/velopharynx; hard palate depth (p=0.02) and width (p=0.05) with obstruction VOTE/epiglottis; tonsils volume (p=0.05) with VOTE/epiglottis; tongue posture (p=0.00) with obstruction VOTE/epiglottis; floor of the mouth (p=0.02) with VOTE/epiglottis.
Higher snoring frequency and intensity was observed in patients with obstruction at the velopharynx and oropharyngeal lateral wall. Obstruction at the velopharynx was associated with poor tongue ability to suck the tongue against the hard palate. Obstruction at the epiglottis had structural and functional associations, including the oropharyngeal lateral wall, affected by the palatine tonsils size, depth and width of the hard palate, tongue position, and flaccidity of the floor of mouth. Considering that this is a preliminary study, the data should be carefully verified and not generalized.
BACKGROUND Snoring is extremely common in the general population and may indicate OSA. However, snoring is not objectively measured during polysomnography, and no standard treatment is available for ...primary snoring or when snoring is associated with mild forms of OSA. This study determined the effects of oropharyngeal exercises on snoring in minimally symptomatic patients with a primary complaint of snoring and diagnosis of primary snoring or mild to moderate OSA. METHODS Patients were randomized for 3 months of treatment with nasal dilator strips plus respiratory exercises (control) or daily oropharyngeal exercises (therapy). Patients were evaluated at study entry and end by sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index) and full polysomnography with objective measurements of snoring. RESULTS We studied 39 patients (age, 46 ± 13 years; BMI, 28.2 ± 3.1 kg/m2 ; apnea-hypopnea index (AHI), 15.3 ± 9.3 events/h; Epworth Sleepiness Scale, 9.2 ± 4.9; Pittsburgh Sleep Quality Index, 6.4 ± 3.3). Control (n = 20) and therapy (n = 19) groups were similar at study entry. One patient from each group dropped out. Intention-to-treat analysis was used. No significant changes occurred in the control group. In contrast, patients randomized to therapy experienced a significant decrease in the snore index (snores > 36 dB/h), 99.5 (49.6-221.3) vs 48.2 (25.5-219.2); P = .017 and total snore index (total power of snore/h), 60.4 (21.8-220.6) vs 31.0 (10.1-146.5); P = .033. CONCLUSIONS Oropharyngeal exercises are effective in reducing objectively measured snoring and are a possible treatment of a large population suffering from snoring. TRIAL REGISTRY ClinicalTrials.gov ; No.: NCT01636856; URL: www.clinicaltrials.gov
ABSTRACT Recently, the orofacial myofunctional therapy (OMT) has appeared as a possible alternative treatment for obstructive sleep apnea (OSA). Systematic reviews are required to achieve scientific ...evidence, seeking to direct the decision on therapeutic issues. The aim of this study was to systematically review the literature about the OMT proposals in adults with OSA related to symptoms and physiological parameters. Data sources were Lilacs, MEDLINE, Pubmed, Cochrane and Scielo using the descriptors: obstructive sleep apnea; myofunctional therapy; oropharyngeal exercises; breathing exercises; upper airway exercises; speech therapy. Studies published from 2000 to 2017 that evaluated the treatment with isolated OMT in subjects with OSA were included, obligatorily with polysomnographic data, pre and post therapy. Eight studies, out of 124 articles, were eligible according to the criteria adopted. Two systematic reviews, one clinical trial, three randomized clinical trials, and two case reports were included. Six studies showed a decrease in the Apnea and Hypopnea Index (AHI), five studies showed improvement in the minimum SpO2, decrease in the Epworth Sleepiness Scale (ESS) and in snoring. OMT proposals refer to a three-month program changing the parameters related to partial reduction of AHI, ESS index, snoring, and partial increase of SpO2. There are few randomized studies.
RESUMO Recentemente a terapia miofuncional orofacial (TMO) aparece como tratamento alternativo para a apneia obstrutiva do sono (AOS). Revisões sistemáticas são necessárias para apontar evidência científica buscando direcionar sua indicação. O objetivo foi analisar sistematicamente a literatura científica quanto às propostas de TMO em adultos com AOS e sintomas e parâmetros fisiológicos. As buscas ocorreram: Lilacs, MEDLINE, Pubmed, Cochrane e Scielo usando-se os descritores: apneia obstrutiva do sono; terapia miofuncional; exercícios orofaríngeos; exercícios respiratórios; exercícios da via aérea; Fonoaudiologia. Estudos publicados de 2000 a 2017 que avaliaram TMO isolada em sujeitos com AOS foram selecionados. Obrigatoriamente com dados de polissonografia pré e pós terapia. A partir de 124 artigos, oito estudos foram elegíveis de acordo com os critérios adotados. Duas revisões sistemáticas, um ensaio clínico, três ensaios clínicos randomizados e dois estudos de casos foram incluídos. Seis estudos mostraram diminuição do índice de apneia e hipopneia (IAH), cinco estudos mostraram melhora da saturação mínima SpO2, pontuação da escala de sonolência e do ronco. A TMO refere-se à programas de três meses com modificação dos parâmetros referentes à redução parcial do IAH, aumento parcial da saturação mínima SpO2, redução da sonolência diurna e do ronco. Ainda há poucos estudos randomizados.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Upper airway anatomy plays a major role in obstructive sleep apnea (OSA) pathogenesis. An inferiorly displaced hyoid as measured by the mandibular plane to hyoid distance (MPH) has been consistently ...associated with OSA. The hyoid is also a common landmark for pharyngeal length, upper airway volume, and tongue base. Tongue dimensions, pharyngeal length, and obesity are associated with OSA severity, although the link between these anatomical variables and pharyngeal collapsibility is less well known. We hypothesized that obesity as measured by body mass index (BMI), neck and waist circumferences, and variables associated with hyoid position (pharyngeal length, upper airway volume, and tongue dimensions) would be associated with passive pharyngeal critical closing pressure (Pcrit).
Cross-sectional.
Academic hospital.
34 Japanese-Brazilian males age 21 to 70 y.
N/A.
We performed computed tomography scans of the upper airway, overnight polysomnography, and Pcrit measurements in all subjects. On average, subjects were overweight (BMI = 28 ± 4 kg/m(2)) and OSA was moderately severe (apnea-hypopnea index = 29 13-51, range 1-90 events/h). Factor analysis identified two factors among the studied variables: obesity (extracted from BMI, neck and waist circumferences) and hyoid position (MPH, pharyngeal length, tongue length, tongue volume, and upper airway volume). Both obesity and hyoid position correlated with Pcrit (r = 0.470 and 0.630, respectively) (P < 0.01). In addition, tongue volume, tongue length, pharyngeal length, and MPH correlated with waist and neck circumferences (P < 0.05).
Pharyngeal critical closing pressure is associated with obesity and hyoid position. Tongue dimensions, pharyngeal length, and the mandibular plane to hyoid distance are associated with obesity variables. These findings provide novel insight into the potential factors mediating upper airway collapse in obstructive sleep apnea.
Snoring is extremely common in the general population and may indicate OSA. However, snoring is not objectively measured during polysomnography, and no standard treatment is available for primary ...snoring or when snoring is associated with mild forms of OSA. This study determined the effects of oropharyngeal exercises on snoring in minimally symptomatic patients with a primary complaint of snoring and diagnosis of primary snoring or mild to moderate OSA.
Patients were randomized for 3 months of treatment with nasal dilator strips plus respiratory exercises (control) or daily oropharyngeal exercises (therapy). Patients were evaluated at study entry and end by sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index) and full polysomnography with objective measurements of snoring.
We studied 39 patients (age, 46 ± 13 years; BMI, 28.2 ± 3.1 kg/m2; apnea-hypopnea index (AHI), 15.3 ± 9.3 events/h; Epworth Sleepiness Scale, 9.2 ± 4.9; Pittsburgh Sleep Quality Index, 6.4 ± 3.3). Control (n = 20) and therapy (n = 19) groups were similar at study entry. One patient from each group dropped out. Intention-to-treat analysis was used. No significant changes occurred in the control group. In contrast, patients randomized to therapy experienced a significant decrease in the snore index (snores > 36 dB/h), 99.5 (49.6-221.3) vs 48.2 (25.5-219.2); P = .017 and total snore index (total power of snore/h), 60.4 (21.8-220.6) vs 31.0 (10.1-146.5); P = .033.
Oropharyngeal exercises are effective in reducing objectively measured snoring and are a possible treatment of a large population suffering from snoring.
ClinicalTrials.gov; No.: NCT01636856; URL: www.clinicaltrials.gov.
There is a growing interest to develop a simple method to characterize the mechanisms leading to upper airway collapse in order to guide treatment options in patients with obstructive sleep apnea ...(OSA). Critical closing pressure (Pcrit) during sleep is able to predict the anatomical component of OSA. However, Pcrit is a laborious method that is only used for research purposes. The application of negative expiratory pressure (NEP) is a simple method to assess upper airway collapsibility that can be easily performed during wakefulness. We hypothesized that NEP will be, similarly to Pcrit, associated with upper airway anatomy assessed by computed tomography (CT) scan.
Patients under investigation for OSA underwent polysomnography, CT of the upper airway, NEP while awake, and Pcrit during sleep. NEP was performed with -5 cm H
O in supine position using a nasal mask. Pcrit was measured during sleep induced by low doses of midazolam.
Twenty-eight male subjects were studied (age 45 ± 13 y, body mass index 29.4 ± 4.9 kg/m
, apnea-hypopnea index (AHI) 30 ± 26, range 2 to 86 events/h). NEP and Pcrit were similarly associated with tongue area (r = 0.646 and r = 0.585), tongue volume (r = 0.565 and r = 0.613) and pharyngeal length (r = 0.580 and r = 0.611), respectively (p < 0.05 for all comparisons). NEP and Pcrit were also significantly correlated with AHI (r = 0.490 and r = 0.531). NEP and Pcrit were significantly higher in patients with severe OSA than the remaining population.
NEP is a simple and promising method that is associated with the anatomical component of upper airway collapsibility. NEP may be valuable to select patients for noncontinuous positive airway pressure alternative therapies for OSA.
Obstructive Sleep Apnea is characterized by recurrent episodes of partial or complete collapse of the pharynx, followed by decreased oxyhemoglobin saturation and frequent arousals. It is regarded as ...a public health issue with important night and day symptoms that impact life quality. Its effects are associated with the areas of competence of Speech and Language Pathologists. To establish efficient diagnosis and treatment methods, professionals must know the pathogenesis of upper airway obstruction during sleep. This study seeks to enlarge the understanding of obstructive sleep apnea pathophysiology, eligibility of individualized therapeutic procedures and guidance for orofacial myofunctional therapy by describing and illustrating the locations and types of upper airway collapse during sleep. We analyzed original records of Drug Induced Sleep Endoscopy exams of a series of cases with polysomnographic diagnosis of obstructive sleep apnea following the proper ethical processes. The images of the exam recordings were analyzed by five professionals with expertise in the sleep area. Obstructive sites and types of collapse were presented according to the current classification. The videos were divided into screenshots, originating figures from each anatomical site: without collapse and collapsed. The results are visualized in the images of the cases showing a predominance of velopharyngeal collapse: anteroposterior, lateral, or concentric; oropharyngeal lateral collapse; tongue anteroposterior collapse and anteroposterior collapse of the epiglottis. Understanding the obstruction sites and types of collapse illustrated in this study may help to predict therapeutic responses and learn the limitations or direct individual proposals patient.
INTRODUÇÃO: A apneia obstrutiva do sono (AOS) é um problema de saúde pública, com grande prevalência e graves consequências. O tratamento considerado padrão-ouro para AOS grave é a aplicação do ...aparelho de pressão positiva aérea contínua (CPAP) durante o sono. Porém a adesão ao CPAP é baixa, em especial nos pacientes com ronco primário e AOS leve. Estudo prévio do nosso laboratório demonstrou que a terapia miofuncional orofacial (TMO) é efetiva em pacientes com AOS moderada (Guimaraes et. al, AJRCCM 2009:(179);962-966). No entanto, no trabalho inicial o número de pacientes foi relativamente pequeno (n=31), avaliou-se apenas pacientes com AOS moderada. Adicionalmente, a quantidade de exercícios orofaríngeos realizados foi relativamente grande (n=10) dificultando a adesão ao tratamento e os potenciais mecanismos de ação da terapia não foram elucidados. OBJETIVO: O objetivo primário do trabalho é avaliar a efetividade na redução da gravidade da AOS de um programa com um número reduzido de exercícios de TMO (6 exercícios) em pacientes com ronco primário, AOS leve, moderada e grave. Os objetivos secundários foram avaliar o impacto da TMO no índice de apneia hipopneia (IAH) em pacientes estratificados pelo IAH basal, a anatomia da via aérea superior (VAS) por meio da ressonância magnética (RM), a fisiologia da VAS por meio da força e fadiga da língua e a pressão crítica de fechamento (Pcrit). METODOLOGIA: Foram incluídos pacientes de ambos os sexos, com idade entre 20 e 65 anos, recentemente diagnosticados com ronco primário, AOS leve, moderada ou pacientes com AOS grave que se recusaram a utilizar o CPAP. Foram excluídos pacientes com índice de massa corpórea (IMC) >= 35 kg/m2, malformações craniofaciais, desdentados, uso regular de medicação hipnótica, doença obstrutiva nasal grave, pacientes já submetidos a outros tipos de tratamentos e pacientes com indisponibilidade de comparecimento semanal durante o estudo. Os pacientes foram avaliados no início e final do estudo por questionário de sonolência (Epworth, variando de 0 a 24 pontos), qualidade de sono (Pittsburgh, variando de 0 a 21 pontos), avaliação fonoaudiológica específica para AOS (variando de 0 a 20 pontos), RM da via aérea superior, força e fadiga de língua, Pcrit e polissonografia. Os pacientes foram sorteados para 3 meses de TMO (6 exercícios) ou controle (dilatador nasal durante o sono e exercícios respiratórios inespecíficos). Todos os pacientes foram acompanhados semanalmente por uma fonoaudióloga e orientados a realizar os exercícios três vezes por dia. Foi realizada ANOVA de dois caminhos para medidas repetidas para avaliar a eficácia dos tratamentos nos diferentes desfechos. Secundariamente também avaliamos o efeito dos tratamentos por meio do teste t pareado. RESULTADOS: Inicialmente 251 pacientes foram avaliados, e após avaliação dos critérios de inclusão e exclusão, 60 pacientes entraram no estudo, sendo que 30 foram randomizados para TMO e 30 para o grupo Controle. Os dois grupos foram semelhantes para todos os parâmetros na entrada. Finalizaram o estudo 58 pacientes (58,6% do sexo masculino, média de idade 45,9 ± 12,2 anos, IMC 28,8 ± 4,3 kg/m2, IAH=18,4 ± 12,6 eventos/h e saturação mínima de oxigênio 84,6 ± 6,4%). O grupo Controle não teve modificações em nenhuma das variáveis ao longo do estudo. O grupo TMO não modificou o IMC e não apresentou mudança significativa nos questionários Epworth e Pittsburgh. Em relação ao início do estudo, o grupo TMO apresentou uma redução significativa na circunferência cervical (38,8±3,3 vs 38,4±4 cm), índice de despertar (21,3±10,9 vs 16,9±7,9 despertares/h), IAH (19,5 ± 14,2 vs 15 ± 10,2 eventos/h) e avaliação fonoaudiológica específica para AOS (9,3 ± 2,9 vs 3,6 ± 2,4). O efeito da TMO sobre o IAH foi significativo somente nos pacientes que apresentavam na entrada AOS moderada (23,8 ± 5,2 vs 17,7 ± 5,2) e grave (43,9 ± 19,5 vs 24,7 ± 21,4). Não foram observadas modificações significativas quando avaliado por meio do teste de ANOVA de duas vias para medidas repetidas na RM da via aérea superior em 24 pacientes (10 Controle e 14 TMO) e fisiologia avaliados por força e fadiga de língua em 38 pacientes (19 Controle e 19 TMO) e Pcrit em 17 pacientes (7 Controle e 10 TMO). No entanto, observamos uma redução significativa (teste t pareado) com diminuição do volume da língua (p=0.031), quantidade de gordura da língua (p=0.008) e aumento significativo da força da língua (p=0,046) no grupo TMO. CONCLUSÃO: Um programa reduzido de TMO é efetivo e capaz de reduzir a gravidade da apneia do sono em pacientes com AOS moderada e grave. A tendência ao aumento da força de língua e redução da gordura de língua podem auxiliar a explicar os efeitos benéficos da TMO em pacientes com AOS
INTRODUCTION: Obstructive sleep apnea (OSA) is a public health problem, with high prevalence and severe consequences. The gold standard treatment for severe OSA is the application of continuous positive airway pressure (CPAP) during sleep. However, adherence to CPAP is low, especially in patients with primary snore and mild OSA. A previous study from our laboratory demonstrated that oropharyngeal exercises are effective in patients with moderate OSA (Guimaraes et. al, AJRCCM 2009:(179);962-966). Nonetheless, in this first study the number of patients included in the randomized trial was relatively small (n=31) and evaluated only patients with moderate OSA. Moreover, the number of oropharyngeal exercises the patients had to do 3 times a day was large (n=10) and raised doubt about the compliance to treatment, and the mechanism by which the therapy was effective was not elucidated. OBJECTIVE: The primary objective was to evaluate the effectiveness to reduce OSA severity of a short program of oropharyngeal exercises (6 exercises) in patients with primary snore, mild, moderate and severe OSA. The secondary objective was to evaluate the impact of reduced oropharyngeal exercises program on apnea hypopnea index (AHI) in patients stratified by baseline AHI, the anatomy of upper airway by magnetic resonance (MR), strength and fatigue of the tongue and critical closing pressure (Pcrit). METHODOLOGY: Patients of both sexes, with age between 20 and 65 years old, recently diagnosed with primary snore, mild, moderate or severe OSA who refused to use CPAP were included. Patients with body mass index (BMI) >= 35kg/m2, craniofacial deformities, edentulous, regular use of hypnotic medication, severe nasal obstruction, patients undergoing other treatments for OSA and patients with unavailability to comply with the protocol were excluded. The patients were evaluated at the beginning and end of the study by questionnaire of daytime sleepiness (Epworth, ranging from 0 to 24 points), quality of sleep (Pittsburgh, ranging from 0 to 21 points), oral myofunctional evaluation for OSA (ranging from 0 to 20 points), MR of the upper airway, tongue strength and fatigue, critical closing pressure (Pcrit) and polysomnography. The patients were randomized to 3 months of oropharyngeal exercises (6 exercises) or Control (use of nasal dilator strip and respiratory non specific respiratory exercises). All patients were instructed to perform the exercises 3 times a day and evaluated by a speech pathologist once a week. The primary endpoints were evaluated primarily by two-way repeated-measures ANOVA. A paired t test was also used as a secondary evaluation. RESULTS: A total of 251 patients were evaluated and 60 patients were randomized. The 2 groups (n=30) were similar at study entry for all the parameters and 58 patients completed the study (58.6% males, age: 45.9±12.2 years, BMI: 28.8±4.3 kg/m2, AHI=18.4±12.6 events/h and minimum saturation84.9±6.4%). All variables remained unchanged in the Control group. There were no changes in Epworth and Pittsburgh questionnaires as well as BMI in patients randomized to oropharyngeal exercises. As compared to study entry, there was a significantly reduction on neck circumference (38.8 ± 3.3 vs 38.4±4.4cm), arousals index (21.3 ± 10.9 vs 16.9 ± 7.9 arousals/h), AHI (19.5 ± 14.2 vs 15 ± 10.2 events/h), oral myofunctional evaluation for OSA (9.3 ± 2.9 vs 3.6 ± 2.4) in the patients randomized for oropharyngeal exercises. Oropharyngeal exercises only reduced AHI significantly among patients with moderate OSA (23.8 ± 5.2 vs 17.7 ± 5.2) and severe OSA (43.9 ± 19.5 vs 24.7 ± 21.4) at study entry. No significantly changes as evaluated by two-way repeated-measures ANOVA were observed on upper airway MR anatomy (10 Control and 14 oropharyngeal exercises), tongue force and fatigue (19 Control and 19 oropharyngeal exercises) and Pcrit (7 Control and 10 oropharyngeal exercises). As compared to study entry there was a significant reduction as evaluated by paired T test on tongue volume (p=0.031), tongue fat (p=0.008) and a significant increase of tongue strength (p=0.046) of patients randomized to oropharyngeal exercises. CONCLUSION: A short program of oropharyngeal exercises is effective to reduce OSA severity in patients with moderate and severe OSA. The trend to increase tongue strength and reduce tongue fat may explain the beneficial effects of oropharyngeal exercises
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