Upper Airway Morphofunctional Changes During Oropharyngeal Exercises for Sleep-Disordered Breathing.

Abstract

Background: Orofacial myofunctional therapy (OMT) has emerged as an alternative and adjunct for the treatment of sleep-disordered breathing (SDB) in adults and children. While OMT efficacy has been demonstrated, the morphofunctional mechanisms triggered by each exercise remain poorly elucidated. This study aimed to characterise morphofunctional upper airway (UA) changes associated with established oropharyngeal exercises utilised to treat SDB by nasofibrolaryngoscopy (NFL).

Methods: Thirteen OMT exercises were selected and analysed based on the relevant literature. Respecting inclusion and exclusion criteria, 15 healthy adult subjects of both sexes performed all the exercises, resulting in 390 video recordings of changes in UA dynamics through NFL, from the nasopharyngeal and oropharyngeal view. The video analyses were performed by three blinded ENT doctors using a specific instrument that included structural verification, movement type and intensity classification. Statistical analyses included the Fleiss Kappa Agreement Coefficient and the Friedman Test for comparison between exercises.

Results: This original study used a methodology that allowed for the description and identification of which exercises produce greater mobility, stiffness and modification in the regions of the soft palate, pharyngeal/hypopharyngeal wall, retrolingual region and epiglottis. The 13 exercises analysed provided insights into their action mechanisms in the UA. The exercises that induce the most significant changes, for each pharyngeal region, were identified.

Conclusion: The analyses of the morphofunctional changes described in this study contribute to the understanding of how exercises used in OMT act, aiding in the selection of the most effective clinical approaches.