Protocol
Myofunctional therapy (mouth and throat exercises) for obstructive sleep apnea
(Cochrane Database Syst Rev, 2020; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 33141943) pooled randomized trials against sham A fake version of a procedure or device used as the comparison, so participants cannot tell which one they received. exercises: Epworth sleepiness 4.5 points lower (two studies, moderate certainty) and the apnea-hypopnea index 13.2 events an hour lower (low certainty), over two to four months.
At a glance
This therapy is a set of daily exercises for the tongue, mouth and throat. People do them for about half an hour a day. In small studies of two to four months, adults with sleep apnea felt less sleepy in the day. They also had fewer breathing stops at night than people doing fake exercises. Children did not gain, mostly because few kept up the exercises.
Rueda et al. (Cochrane Database Syst Rev, 2020; PMID 33141943) pooled randomized trials against sham exercises: Epworth sleepiness 4.5 points lower (two studies, moderate certainty) and the apnea-hypopnea index 13.2 events an hour lower (low certainty), over two to four months. Capped at B because the outcomes are a questionnaire and a breathing count.
Why this letter
Why this gradeThe reasoning, and what the grade does not cover.
Grade B on daytime sleepiness and the apnea-hypopnea index in adults with sleep apnea: the Cochrane review found sleepiness and breathing counts improved against sham exercises (Rueda et al., 2020; PMID 33141943), and a second meta-analysis A study that pools the numbers from several trials into one combined estimate. of seven trials agreed (Saba et al., 2024; PMID 37606313).
WHY NOT Athe outcomes are a questionnaire scored by the participants, often without blinded assessors, and a breathing count.
WHAT THIS GRADE DOES NOT COVERchildren, in whom the pooled trial showed no benefit; any period longer than four months; and accidents, cardiovascular disease or death, which no included trial measured.
A grade describes the human evidence for a named use. It is not advice, and it is not a judgment on any individual prescription. How the letters are decided →
Evidence notes: meta-analysis, randomized trial
Endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score. graded: Daytime sleepiness and apnea-hypopnea index after two to four months of daily mouth and throat exercises (self_report)
Last reviewed: October 2026
The trial that would change this grade.
Positive trials of this shape from independent research groups would move this entry to A.
Why the current trials fall short
The trials so far are small and short, and most of their sleepiness scores were self-rated without blinded assessors.
Dose, form and timing
Apnea-hypopnea index on a home sleep study before and after 3 months of daily exercises, and the Epworth Sleepiness Scale.
As studiedDose, form, population and duration for every use.
A grade describes the intervention that was tested. Where the product on the shelf differs from it, this says so.
Grade history
How this letter has changedLatest: No. 374 · October 2026 · First graded.
Daily mouth and throat exercises now have a record. Against sham exercises they lowered daytime sleepiness and breathing pauses over two to four months (Rueda et al., Cochrane Database Syst Rev, 2020; PMID 33141943; Saba et al., Laryngoscope, 2024; PMID 37606313). Self-rated sleepiness and a breathing count cap the letter at B.PMID 33141943 PMID 37606313
Every change to a letter on this site is dated and published. The full evidence log →
Sources
- Citations
- Every paper cited on this page is matched to its PubMed record on every build.
- Retractions
- None of these papers is retracted or under a journal expression of concern. PubMed is checked again on every build.
- Read against the papers
- October 2026. By a language model (AI-assisted reading), not yet reviewed by a clinician.
- Outside review
- Not yet done. No reviewer outside EBL has checked this record.
What each of these checks can and cannot show: evidence integrity.
The evidence, in fullFive papers, each linked to its PubMed record.
Rueda et al. (Cochrane Database Syst Rev, 2020; PMID 33141943): nine randomized trials, 347 participants, two to four months; no trial assessed accidents, cardiovascular disease or mortality, and none reported adverse events. Guimaraes et al. (Am J Respir Crit Care Med, 2009; PMID 19234106): 31 patients with moderate sleep apnea, 3 months of daily exercises against sham; apnea-hypopnea index 22.4 to 13.7, Epworth 14 to 8. Saba et al. (Laryngoscope, 2024; PMID 37606313): seven randomized trials, 310 patients; in adults, apnea-hypopnea index 10.2 lower and Epworth 5.7 lower than sham or no therapy; children did poorly because few kept up the exercises. Camacho et al. (Sleep, 2015; PMID 25348130): before-and-after pooling, shown as context. Puhan et al. (BMJ, 2006; PMID 16377643): didgeridoo playing, a related form of airway muscle training, against a waiting list in 25 adults; Epworth 3.0 lower and apnea-hypopnea index 6.2 lower.
How EBL searched for the trials (1 search)
The search that was run, what it returned, and what was left out and why, so the absence of evidence can be checked as well as its presence.
(myofunctional therapy[tiab] OR oropharyngeal exercise*[tiab]) AND sleep apnea AND (randomized controlled trial[pt] OR meta-analysis[pt])Disclosure
Educational use only · Not medical advice · EBL grades published human evidence and does not recommend treatment. Stopping a prescription is a decision for your physician.
Evidence Based Longevity, Inc. is owner-operated and edited by Arnold Sandlow, D.C., a California-licensed chiropractor. Evidence Based Longevity publishes in English only · Machine translations are not produced or reviewed by EBL for accuracy
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