Exploration of Medicine

Table 1. Main characteristics of randomized controlled trials (RCTs) included in the systematic review, reporting study design, sample size, intervention type, inclusion criteria, demographics, follow-up time, and evaluated outcomes.

Study	Country/Disctrict, design, sample size	Intervention	Inclusion criteria	Sex and age	Time	Outcomes
Villa et al. (2015) [11]	Italy, single-blinded RCT, n: 27	OE + nasal washing, n: 14 Controls (nasal washing), n: 13	Children with AHI > 5 events/h Children with residual OSAS AHI > 1 event/h after AT persistence of respiratory symptoms	4.82 ± 1.36 years 24 males 3 females	2 months of treatment	AHI, oxygen saturation, SCR, IOPI measurements
Diaferia et al. (2013) [18]	Brazil, RCT, n.d.	MFT + CPAP vs. sham	OSAS patients (criteria not detailed)	n.d.	3 months	AHI, snoring, oxygen saturation
Diaféria et al. (2017) [19]	Brazil, RCT, n.d.	MFT + CPAP vs. sham	OSAS patients (criteria not detailed)	n.d.	3 months	AHI, PSG, functional outcomes
Erturk et al. (2020) [20]	Turkey, non-blinded RCT, n: 41	IMT, n:15 OE, n: 14 Control, n: 12	Patients with mild, moderate, or severe OSAS, were not using CPAP	Patients aged 19 to 75 years	3 months of treatment	AHI, PSG, MIP and MEP values, inspiratory muscle work and expiratory muscle work outcomes
Guimarães et al. (2009) [21]	Brazil, single-blinded RCT, n: 31	OE, n: 16 Controls (deep breathing), n: 15	Patients between 25 and 65 years of age with a recent diagnosis of moderate OSAS	Intervention group: 51.5 ± 6.8 years Controls: 47.7 ± 9.8 years 21 males 10 females	3 months of treatment	AHI, PSG, snoring outcomes Epworth daytime sleepiness scale, and Pittsburgh sleep quality index questionnaires
Villa et al. (2017) [22]	Italy, single-blinded RCT, n.d.	OE vs. nasal washing	Children with OSAS	n.d.	2 months	AHI, sleep quality
Ieto et al. (2015) [23]	Brazil, RCT, n.d.	OE + nasal washing vs. control	Adults with primary snoring or mild OSAS	n.d.	3 months	Snoring intensity, AHI
Kim et al. (2020) [24]	Korea, RCT, n.d.	MFT vs. no treatment	Adults with OSAS	n.d.	12 weeks	AHI, sleep parameters
Lin et al. (2020) [25]	Taiwan, China, RCT, n.d.	Nasal washing + MFT + endurance training vs. control	Adults with OSAS	n.d.	12 weeks	AHI, oxygen saturation, functional outcomes

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n.d.: no data. AHI: apnea-hypopnea index; AT: adenotonsillectomy; CPAP: continuous positive airway pressure; IMT: inspiratory muscle training; IOPI: Iowa Oral Performance Instrument; MEP: maximal expiratory pressure; MFT: myofunctional therapy; MIP: maximal inspiratory pressure; OE: oropharyngeal exercises; OSAS: obstructive sleep apnea syndrome; PSG: polysomnography; SCR: sleep clinical record.

Declarations

Author contributions

SS: Resources, Data curation, Formal analysis, Software. CV: Resources, Data curation, Formal analysis, Software. MP: Conceptualization, Formal analysis, Data curation. SES: Investigation, Visualization. FI: Formal analysis, Supervision. LF: Validation, Formal analysis, Writing—review & editing. ADI: Methodology, Investigation. AP: Software, Formal analysis. GI: Methodology, Software. GD: Conceptualization, Formal analysis. AMI: Validation, Investigation. All authors read and approved the submitted version.

Conflicts of interest

Gaetano Isola, who is the Associate Editor of Exploration of Medicine, had no involvement in the decision-making or the review process of this manuscript. The other authors declare no conflicts of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publication

Not applicable.

Availability of data and materials

This study does not involve original data; all data analyzed are publicly available and have been appropriately cited.

Funding

This research received no external funding.

Copyright

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Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

References

Fisher J, Berman R, Buse K, Doll B, Glick M, Metzl J, et al. Achieving Oral Health for All through Public Health Approaches, Interprofessional, and Transdisciplinary Education. NAM Perspect. 2023;2023:10.31478/202302b. [DOI] [PubMed] [PMC]

Mohammadieh AM, Chan A, Cistulli PA. Sleep-disordered breathing - clinical spectrum. Aust Dent J. 2024;69:S45–52. [DOI] [PubMed] [PMC]

Abbasi A, Gupta SS, Sabharwal N, Meghrajani V, Sharma S, Kamholz S, et al. A comprehensive review of obstructive sleep apnea. Sleep Sci. 2021;14:142–54. [DOI] [PubMed] [PMC]

Lévy P, Kohler M, McNicholas WT, Barbé F, McEvoy RD, Somers VK, et al. Obstructive sleep apnoea syndrome. Nat Rev Dis Primers. 2015;1:15015. [DOI]

Riley RW, Powell NB, Guilleminault C. Maxillofacial surgery and nasal CPAP. A comparison of treatment for obstructive sleep apnea syndrome. Chest. 1990;98:1421–5. [DOI] [PubMed]

Saccomanno S, Antonini G, D’Alatri L, D’Angeloantonio M, Fiorita A, Deli R. Case report of patients treated with an orthodontic and myofunctional protocol. Eur J Paediatr Dent. 2014;15:184–6. [PubMed]

Aubertin G, Schröder C, Sevin F, Clouteau F, Lamblin MD, Vecchierini MF. Obstructive sleep apnea-hypopnea syndrome in children: Clinical diagnosis. Arch Pediatr. 2017;24:S7–15. [DOI] [PubMed]

Sakai RH, de Assumpção MS, Ribeiro JD, Sakano E. Impact of rapid maxillary expansion on mouth-breathing children and adolescents: A systematic review. J Clin Exp Dent. 2021;13:e1258–70. [DOI] [PubMed] [PMC]

Platon AL, Stelea CG, Boișteanu O, Patrascanu E, Zetu IN, Roșu SN, et al. An Update on Obstructive Sleep Apnea Syndrome-A Literature Review. Medicina (Kaunas). 2023;59:1459. [DOI] [PubMed] [PMC]

10.

Sutherland K, Vanderveken OM, Tsuda H, Marklund M, Gagnadoux F, Kushida CA, et al. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med. 2014;10:215–27. [DOI] [PubMed] [PMC]

11.

Villa MP, Brasili L, Ferretti A, Vitelli O, Rabasco J, Mazzotta AR, et al. Oropharyngeal exercises to reduce symptoms of OSA after AT. Sleep Breath. 2015;19:281–9. [DOI] [PubMed]

12.

Xu X, He Y, Lv M, Ji J, Chen B, Liu Z, et al. Severity and phenotype of sleep-disordered breathing in Prader-Willi syndrome compared to obstructive sleep apnea syndrome in children. Respir Med. 2026;253:108694. [DOI] [PubMed]

13.

Huang YS, Hsu SC, Guilleminault C, Chuang LC. Myofunctional Therapy: Role in Pediatric OSA. Sleep Med Clin. 2019;14:135–42. [DOI] [PubMed]

14.

Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7:687–98. [DOI] [PubMed] [PMC]

15.

Wickwire EM. Value-based sleep and breathing: health economic aspects of obstructive sleep apnea. Fac Rev. 2021;10:40. [DOI] [PubMed] [PMC]

16.

Faria A, Allen AH, Fox N, Ayas N, Laher I. The public health burden of obstructive sleep apnea. Sleep Sci. 2021;14:257–65. [DOI] [PubMed] [PMC]

17.

PRISMA flow diagram [Internet]. PRISMA Executive; c2024–2026 [cited 2026 Mar 1]. Available from: https://www.prisma-statement.org/prisma-2020-flow-diagram

18.

Diaferia G, Badke L, Santos-Silva R, Bommarito S, Tufik S, Bittencourt L. Effect of speech therapy as adjunct treatment to continuous positive airway pressure on the quality of life of patients with obstructive sleep apnea. Sleep Med. 2013;14:628–35. [DOI] [PubMed]

19.

Diaféria G, Santos-Silva R, Truksinas E, Haddad FLM, Santos R, Bommarito S, et al. Myofunctional therapy improves adherence to continuous positive airway pressure treatment. Sleep Breath. 2017;21:387–95. [DOI] [PubMed]

20.

Erturk N, Calik-Kutukcu E, Arikan H, Savci S, Inal-Ince D, Caliskan H, et al. The effectiveness of oropharyngeal exercises compared to inspiratory muscle training in obstructive sleep apnea: A randomized controlled trial. Heart Lung. 2020;49:940–8. [DOI] [PubMed]

21.

Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009;179:962–6. [DOI] [PubMed]

22.

Villa MP, Evangelisti M, Martella S, Barreto M, Del Pozzo M. Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep Breath. 2017;21:1025–32. [DOI] [PubMed]

23.

Ieto V, Kayamori F, Montes MI, Hirata RP, Gregório MG, Alencar AM, et al. Effects of Oropharyngeal Exercises on Snoring: A Randomized Trial. Chest. 2015;148:683–91. [DOI] [PubMed]

24.

Kim J, Oh EG, Choi M, Choi SJ, Joo EY, Lee H, et al. Development and Evaluation of Myofunctional Therapy Support Program (MTSP) Based on Self-Efficacy Theory for Patients with Obstructive Sleep Apnea. Sleep Breath. 2020;24:1051–8. [DOI]

25.

Lin HY, Chang CJ, Chiang CC, Su PL, Lin CY, Hung CH. Effects of a comprehensive physical therapy on moderate and severe obstructive sleep apnea- a preliminary randomized controlled trial. J Formos Med Assoc. 2020;119:1781–90. [DOI] [PubMed]

26.

Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18:2119–26. [DOI] [PubMed]

27.

Chuang LC, Hwang YJ, Lian YC, Hervy-Auboiron M, Pirelli P, Huang YS, et al. Changes in craniofacial and airway morphology as well as quality of life after passive myofunctional therapy in children with obstructive sleep apnea: a comparative cohort study. Sleep Breath. 2019;23:1359–69. [DOI] [PubMed]

28.

Auladell A, De La Iglesia F, Quevedo O, Walter A, Puigdollers A. The efficiency of molar distalization using clear aligners and mini-implants: Two clinical cases. Int Orthod. 2022;20:100604. [DOI] [PubMed]

29.

Bondemark L. A Comparative Analysis of Distal Maxillary Molar Movement Produced by a New Lingual Intra-Arch Ni-Ti Coil Appliance and a Magnetic Appliance. Eur J Orthod. 2000;22:683–95. [DOI]

30.

Bondemark L, Kurol J. Class II correction with magnets and superelastic coils followed by straight-wire mechanotherapy. Occlusal changes during and after dental therapy. J Orofac Orthop. 1998;59:127–38. [DOI] [PubMed]

31.

Chang JL, Goldberg AN, Alt JA, Mohammed A, Ashbrook L, Auckley D, et al. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol. 2023;13:1061–82. [DOI] [PubMed] [PMC]

32.

Prakassajjatham M, Opascharoenkij R, Rojanamungkalporn M. The effect of orofacial myofunctional therapy on biometrics and compliance of positive airway pressure therapy in patients with obstructive sleep apnea. Sleep Breath. 2025;29:163. [DOI] [PubMed]

33.

Ahmad M, Makati D, Akbar S. Review of and Updates on Hypertension in Obstructive Sleep Apnea. Int J Hypertens. 2017;2017:1848375. [DOI] [PubMed] [PMC]