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

STUDY

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

methodsThis 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.

resultsAfter 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).

conclusionsTelemedicine-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.