Myofunctional training with negative airway pressure for obstructive sleep apnea: a prospective non-randomized cohort feasibility study

Abstract

Background: Orofacial myofunctional therapy (OMT), for obstructive sleep apnea (OSA) is emerging with recognition of specific phenotypes. Since many OSA sufferers are already familiar with positive airway pressure machines, we designed an OMT protocol involving the modification of such a machine to deliver negative airway pressure.  We hypothesized that a three-month trial of using this protocol while awake would reduce the signs and symptoms of OSA. Methods: Fifteen adults with OSA enrolled for 30-minute sessions/three days a week for a three-month trial of “upper airway muscle physical therapy” while awake. Overnight sleep studies were performed before and after the intervention to determine each subject’s apnea hypopnea index (AHI), the primary outcome measure. Negative airway pressure application was determined by estimation of each subject’s one-repetition maximum (an exercise physiology measure of strength capacity). Exercise sessions consisted of subjects breathing against this pressure for a series of repetitions, and sets. Results: While the mean post study AHI was slightly improved (-4.3 ± 12.0 [ -10.9, 2.3], mean ± standard deviation, 95% confidence interval), it was not statistically significant.  The results were similar when the AHI was divided by the sleep state (REM vs. non-REM).  The nadir saturation was also essentially unchanged. The eight subjects with mild or moderate OSA (AHI < 30) showed similar results. Conclusions: Though there was no significant reduction in AHI in this small cohort, the methods elucidate a new daytime use for a machine with which many OSA sufferers are familiar. Trial registration: ClinicalTrials.gov NCT02109731 (registered on April 10th 2015)