Daily oropharyngeal exercises yield results, but mechanism is unclear..

Daily oropharyngeal exercises reduced snoring levels compared with nasal dilator strips plus respiratory exercises, researchers reported.

Three months of oropharyngeal exercises reduced both the frequency and power of snoring, wrote Vanessa Ieto, PhD, of the Heart Institute at the University of Sao Paulo Medical School in Brazil, and colleagues in CHEST.

There are no standard treatments for snoring unless patients have severe sleep apnea, Geraldo Lorenzi-Filho, MD, PhD, a pulmonologist at the Heart Institute, told MedPage Today in an email. “Science had devoted little attention to treatments of snoring,” he said.

The principle of exercising while awake to influence muscle behavior while asleep is a good one, but the mechanism is neither known nor intuitive, Kingman Strohl, MD, a pulmonary/critical care and sleep medicine specialist at University Hospitals Case Medical Center in Cleveland, told MedPage Today.

Previous studies have shown that training the upper airways either by an exercise regimen or by playing the didgeridoo (a wind instrument) can reduce moderate OSA and snoring, the authors wrote.

“You can change how your muscles work if you are training muscles that open the airway more than you’re training muscles that close the airway, or you’re de-training muscles that close the airway while keeping muscles that open the airway more active,” Strohl said. “But these are speculation.”

More research is needed to define exactly which muscles are being activated during such exercises and which muscles are involved in snoring and sleep apnea, he added.

The exercises were developed by speech therapists in Brazil over the last 15 years, Lorenzi-Filho said. “[They] are directed to the muscles that are involved directly and indirectly with snoring and sleep apnea, and include the tongue and the palate.”

Exercises involved the tongue, soft palate, and hard palate. They included elevation of the soft palate and uvula for several seconds, pushing the tip of the tongue against the hard palate while sliding the tongue backward, sucking the tongue upward against the hard palate, and pushing the back of the tongue against the floor of the mouth.

Authors acknowledged the limitation that the exercises were derived from those targeting speech or swallowing activity rather than snoring itself.

Patients in the control group used nasal dilators while sleeping, performed nasal lavage with saline solution three times daily, and did deep breathing exercises through the nose.

Those in the therapy group did nasal lavage three times daily followed by 8 minutes of oropharyngeal exercises.

More than three-quarters of patients in both groups adhered to the exercises for 3 months (mean 85 ± 8%).

Adherence may also be a limitation in a real-world setting without regular coaching, Strohl said. “Unless there is an immediate response perceived by the individual, it’s hard to maintain,” he said.

Author Lorenzi-Filho agreed. “[The exercises] are not long, but most people do not have the determination to do it,” he said. “However, this is a little bit like doing exercises — it may be be difficult to start, but once you get used to it and see results, it is feasible.”

The study excluded patients with a body mass index ≥ 40 kg/m², those who were smokers, had a history of alcohol abuse, lacked teeth, had severe nasal obstruction, had hypertrophic tonsils, had craniofacial malformation, used hypnotic medications regularly, or had severe comorbidities.

Before randomization, all patients underwent polysomnography and a snore recording to diagnose OSA and establish objective measurements for snoring.

Patients were primarily “middle aged and overweight patients who were disturbed by snoring, were on average not sleepy, and did not present severe OSA,” the authors wrote.

Outcomes were expressed as Snore Index (total number of snores/total sleep time) and Total Snore Index (sound intensity power generated by all snoring episodes/total sleep time).

Questionnaires were also completed by both the participants and the bed partner to evaluate snoring levels, daytime sleepiness, and quality of sleep.

Those in the therapy group had a reduction in snoring frequency by 36% and total power by 59%. There was also a decrease in the perception of snoring by the bed partner.

Patients in the therapy group had a “small but significant decrease” in neck circumference as well.

In a subgroup analysis of patients with moderate OSA, the Apnea-Hypopnea Index decreased significantly in the therapy group: 25.4 (22.1-28.7) versus 18.1 (15.4-24.1) events/hour, P=0.017).