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This is an interesting article from May '09 AM J Resp Crit Care Med with both a control and experimental group, and baseline and follow-up PSG. The exercises are adapted from speech pathology and you feel like you've just worked out at the gym, except it's your upper airway that feels it. You need to be motivated to do this for 20 to 30 minutes a day. Playing the didgeridoo would be much more fun.

Intuitively, this makes a lot of sense. Many of us walk, cycle, go to the gym and we exercise all sorts of muscle groups, but we usually don't exercise the upper airway muscles. We go through many ontogenetic changes and the loss in muscle patency is systemic. Here we have an empirical study that shows a 40% reduction in AHI, decrease in neck circumference, etc., with doing nothing other than oropharyngeal exercises (note: no statistically significant drop in BMI or abdominal circumference). I met one doctor last summer who told me he thought for certain his patient would have OSA, but was fine. Turned out she was the singer in her local church choir. 


Effects of Oropharyngeal Exercises on Patients with Moderate Obstructive Sleep Apnea Syndrome
Kátia C. Guimarães1, Luciano F. Drager1, Pedro R. Genta1, Bianca F. Marcondes1 and Geraldo Lorenzi-Filho1

1 Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil

Correspondence and requests for reprints should be addressed to Geraldo Lorenzi-Filho, M.D., Ph.D., Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas Carvalho de Aguiar, 44, CEP 05403-904, São Paulo, Brazil. E-mail: geraldo.lorenzi@incor.usp.br

Rationale: Upper airway muscle function plays a major role in maintenance of the upper airway patency and contributes to the genesis of obstructive sleep apnea syndrome (OSAS). Preliminary results suggested that oropharyngeal exercises derived from speech therapy may be an effective treatment option for patients with moderate OSAS.

Objectives: To determine the impact of oropharyngeal exercises in patients with moderate OSAS.

Methods: Thirty-one patients with moderate OSAS were randomized to 3 months of daily (~30 min) sham therapy (n = 15, control) or a set of oropharyngeal exercises (n = 16), consisting of exercises involving the tongue, soft palate, and lateral pharyngeal wall.

Measurements and Main Results: Anthropometric measurements, snoring frequency (range 0–4), intensity (1–3), Epworth daytime sleepiness (0–24) and Pittsburgh sleep quality (0–21) questionnaires, and full polysomnography were performed at baseline and at study conclusion. Body mass index and abdominal circumference of the entire group were 30.3 ± 3.4 kg/m2 and 101.4 ± 9.0 cm, respectively, and did not change significantly over the study period. No significant change occurred in the control group in all variables. In contrast, patients randomized to oropharyngeal exercises had a significant decrease (P < 0.05) in neck circumference (39.6 ± 3.6 vs. 38.5 ± 4.0 cm), snoring frequency (4 [4–4] vs. 3 [1.5–3.5]), snoring intensity (3 [3–4] vs. 1 [1–2]), daytime sleepiness (14 ± 5 vs. 8 ± 6), sleep quality score (10.2 ± 3.7 vs. 6.9 ± 2.5), and OSAS severity (apnea-hypopnea index, 22.4 ± 4.8 vs. 13.7 ± 8.5 events/h). Changes in neck circumference correlated inversely with changes in apnea-hypopnea index (r = 0.59; P < 0.001).

Conclusions: Oropharyngeal exercises significantly reduce OSAS severity and symptoms and represent a promising treatment for moderate OSAS.

Clinical trial registered with www.clinicaltrials.gov (NCT 00660777).

Key Words: obstructive sleep apnea • treatment • oropharyngeal exercises[/b]