Telemedicine-delivered myofunctional therapy remodels upper airway anatomy in obstructive sleep apnea: a prospective controlled study.

STUDY

OBJECTIVES

To evaluate whether telemedicine-delivered myofunctional therapy (MT) produces measurable structural changes in the upper airway (UA) of patients with obstructive sleep apnea (OSA).

METHODS

This prospective, nonrandomized, blinded study included 60 adults with moderate-to-severe OSA, assigned to three groups: moderate OSA + MT (n = 19), severe OSA + MT + CPAP (n = 20), and OSA + CPAP without MT (control, n = 18). MT consisted of daily oropharyngeal exercises for 3 months, monitored through telemedicine. Pre- and postintervention assessments included sleep studies, submental ultrasound (interarterial distance, tongue thickness, and tongue volume), Iowa Oral Performance Instrument (IOPI) scores, and drug-induced sleep endoscopy (DISE; VOTE classification). Ultrasound measurements were performed by a single blinded examiner.

RESULTS

After 3 months, the moderate OSA + MT group showed significant reductions in tongue volume (-8 cm³; P = .002), tongue thickness (-4 mm; P <.001), and interarterial distance (-5 mm; P < .001). In the severe OSA + MT + CPAP group, tongue volume (-12 cm³; P < .001) and interarterial distance (-7 mm; P < .001) decreased, while tongue thickness remained unchanged. No significant changes occurred in controls. Absence of tongue collapse during DISE increased from 15% to 80% in moderate OSA + MT (P = .039) and from 15% to 55% in severe OSA + MT + CPAP (P = .109).

CONCLUSIONS

Telemedicine-based MT promotes measurable UA remodeling. Submental ultrasound provides a practical, noninvasive monitoring tool, supporting MT as a scalable, patient-centered strategy to enhance structural and functional outcomes in OSA management. This prospective study explored whether myofunctional therapy (MT), delivered through a telemedicine platform, could lead to measurable changes in the upper airway of patients with obstructive sleep apnea (OSA). Sixty adults were followed for three months with submental ultrasound and drug-induced sleep endoscopy. Patients with moderate OSA who performed MT showed clear reductions in tongue size and airway width, while no significant changes occurred in CPAP-only controls. These results suggest that telemedicine-based MT can expand upper airway structures, particularly in moderate OSA, and may help guide individualized treatment strategies.

CURRENT KNOWLEDGE/STUDY RATIONALE: Myofunctional therapy has been reported to improve symptoms of OSA, but its structural effects on the upper airway and the role of telemedicine-based delivery remain poorly documented.

STUDY IMPACT: This study provides evidence that MT can induce measurable airway remodeling, especially in moderate OSA. Submental ultrasound proved useful for monitoring these changes, supporting the use of telemedicine MT as a scalable, patient-centered approach to individualized OSA management.