口咽肌训练在成人阻塞性睡眠呼吸暂停综合征中应用研究进展Research progress on the application of orofacial myofunctional therapy in adult obstructive sleep apnea syndrome
王伟吏,李蕾,曹倩倩,秦汉,刘素兰
摘要(Abstract):
阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)是一种常见的睡眠障碍性疾病,以睡眠中上气道反复塌陷导致呼吸暂停和低通气为特征。持续气道正压通气虽是标准疗法,但依从性问题促使人们寻求替代或辅助治疗。口咽肌训练(orofacial myofunctional therapy, OMT)作为一种非侵入性、低成本的辅助手段,可通过增强上气道肌群功能改善OSAHS。本文系统回顾OMT治疗成人OSAHS的研究进展,从理论基础、作用机制、临床疗效、实施方案及影响因素等方面展开综述,并结合当前领域研究存在的局限,对后续研究方向进行展望。
关键词(KeyWords): 阻塞性睡眠呼吸暂停低通气综合征;口咽肌训练;持续气道正压通气;上气道肌群
基金项目(Foundation):
作者(Author): 王伟吏,李蕾,曹倩倩,秦汉,刘素兰
DOI: 10.13201/j.issn.2096-7993.2026.10.014
参考文献(References):
- [1] Tasali E,Pamidi S,Covassin N,et al.Obstructive sleep apnea and cardiometabolic disease:obesity,hypertension,and diabetes[J].Circ Res,2025,137(5):764-787.
- [2] Benjafield AV,Ayas NT,Eastwood PR,et al.Estimation of the global prevalence and burden of obstructive sleep apnoea:a literature-based analysis[J].Lancet Respir Med,2019,7(8):687-698.
- [3] Rahman Z,Nazim A,Mroke P,et al.Long-term management of sleep apnea-hypopnea syndrome:efficacy and challenges of continuous positive airway pressure therapy-a narrative review[J].Med Sci(Basel),2024,13(1):4.
- [4] Liu JM,Zhang XG,Zhao YY,et al.The association between allergic rhinitis and sleep:a systematic review and meta-analysis of observational studies[J].PLoS One,2020,15(2):e0228533.
- [5] Xu Y,Yang RC,Yu M,et al.Efficacy of myofunctional therapy for obstructive sleep apnea:a systematic review and network meta-analysis[J].J Evid Based Dent Pract,2025,25(3):102137.
- [6] Tang RH,Pan JT,Huang Y,et al.Efficacy comparison of aerobic exercise,combined exercise,oropharyngeal exercise and respiratory muscle training for obstructive sleep apnea:a systematic review and network meta-analysis[J].Sleep Med,2024,124:582-590.
- [7] Guimar??es KC,Drager LF,Genta PR,et al.Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome[J].Am J Respir Crit Care Med,2009,179(10):962-966.
- [8] Camacho M,Certal V,Abdullatif J,et al.Myofunctional therapy to treat obstructive sleep apnea:a systematic review and meta-analysis[J].Sleep,2015,38(5):669-675.
- [9] Jordan AS,McSharry DG,Malhotra A.Adult obstructive sleep apnoea[J].Lancet,2014,383(9918):736-747.
- [10] Carrera M,Barbé F,Sauleda J,et al.Patients with obstructive sleep apnea exhibit genioglossus dysfunction that is normalized after treatment with continuous positive airway pressure[J].Am J Respir Crit Care Med,1999,159(6):1960-1966.
- [11] Eckert DJ.Phenotypic approaches to obstructive sleep apnoea-New pathways for targeted therapy[J].Sleep Med Rev,2018,37:45-59.
- [12] Poncin W,Willemsens A,Gely L,et al.Assessment and rehabilitation of tongue motor skills with myofunctional therapy in obstructive sleep apnea:a systematic review and meta-analysis[J].J Clin Sleep Med,2024,20(9):1535-1549.
- [13] Boscato N,Hayakawa H,Iida T,et al.Impact of oral motor task training on corticomotor pathways and diadochokinetic rates in young healthy participants[J].J Oral Rehabil,49(9):924-934.
- [14] Namiki C,Hara K,Tohara H,et al.Tongue-pressure resistance training improves tongue and suprahyoid muscle functions simultaneously[J].Clin Interv Aging,2019,14:601-608.
- [15] Keilholz AN,Pathak I,Smith CL,et al.Tongue exercise ameliorates structural and functional upper airway deficits in a rodent model of hypoglossal motor neuron loss[J].Front Neurol,2024,15:1441529.
- [16] Chen L,Shen YQ,Xiong H,et al.Role of PGC-1α in fiber type conversion in the palatopharyngeus muscle of OSA patients[J].J Clin Lab Anal,2022,36(7):e24551.
- [17] Ieto V,Kayamori F,Montes MI,et al.Effects of oropharyngeal exercises on snoring[J].CHEST,2015,148(3):683-691.
- [18] Cullins MJ,Krekeler BN,Connor NP.Differential impact of tongue exercise on intrinsic lingual muscles[J].Laryngoscope,2018,128(10):2245-2251.
- [19] Boscato N,Hayakawa H,Iida T,et al.Impact of oral motor task training on corticomotor pathways and diadochokinetic rates in young healthy participants[J].J Oral Rehabil,2022,49(9):924-934.
- [20] Krishnamurthy R,Schultz DH,Wang YY,et al.Expiratory musculature targeted resistance training modulates neural connections during swallowing tasks:preliminary fMRI evidence[J].Neural Plast,2025,2025:2075288.
- [21] de Britto AA,Magalh??es KS,da Silva MP,et al.Active expiratory oscillator regulates nasofacial and oral motor activities in rats[J].Exp Physiol,2020,105(2):379-392.
- [22] 姚灵,木拉力别克·黑扎提,杨文博,等.口面肌-膈肌功能训练对老年轻中度阻塞性睡眠呼吸暂停的疗效研究[J].医学信息,2023,36(12):104-108.
- [23] 卢镇章,龙思,钟文倩,等.口面肌功能训练治疗成年人阻塞性睡眠呼吸暂停的疗效及影响因素分析[J].中国耳鼻咽喉头颈外科,2025,32(4):239-243.
- [24] Santos da Silva A,Bianchini EMG,Thuler ER,et al.Upper airway morphofunctional changes during oropharyngeal exercises for sleep-disordered breathing[J].Orthod Craniofacial Res,2026,29(3):469-480.
- [25] 赵雪梅.成人阻塞性睡眠呼吸暂停术后口咽肌训练干预方案的构建及初步应用[D].合肥:安徽医科大学,2025:1-85.
- [26] 王小清,王钰彧,仇金玮,等.口面肌功能训练对鼾声患者鼾声指标及睡眠质量的影响[J].山东大学耳鼻喉眼学报,2025,39(2):101-107.
- [27] Saba ES,Kim H,Huynh P,et al.Orofacial myofunctional therapy for obstructive sleep apnea:a systematic review and meta-analysis[J].Laryngoscope,2024,134(1):480-495.
- [28] 杨霞.口面肌功能训练对成人阻塞性睡眠呼吸暂停低通气综合征患者缺氧的影响[D].重庆:重庆医科大学,2024:1-114.
- [29] 朱洁,祝晋芳,金杨,等.呼吸肌训练应用于阻塞性睡眠呼吸暂停低通气综合征治疗的临床价值探讨[J].中外医疗,2024,43(18):38-41,65.
- [30] 马莉洋,王璐,任盼,等.咽部肌力训练与神经肌肉电刺激联合持续气道正压通气治疗阻塞性睡眠呼吸暂停疗效分析[J].中国耳鼻咽喉头颈外科,2025,32(9):603-606,610.
- [31] Preedeewong C,Chirakalwasan N,Kaboosaya B.Impact of frenectomy on the oral exercise in patients with ankyloglossia and obstructive sleep apnea:double-blind randomized controlled clinical trials[J].Clin Oral Investig,2024,28(10):566.
- [32] 胡凤英,马祥,单卿卿,等.口咽部肌训练联合肺康复在IPF-OSA患者中的临床应用效果[J].重庆医学,2024,53(7):1041-1044,1049.
- [33] Huang ZF,Huang DL,Liu F,et al.Modified oropharyngeal muscle training and scientific vocalization are effective in treating mild-to-moderate obstructive sleep apnea hypoventilation syndrome in adults[J].Acta Oto Laryngol,2023,143(11-12):989-995.
- [34] 赵雪梅,王海凤,史凤凤,等.成人阻塞性睡眠呼吸暂停患者口咽肌训练的最佳证据总结[J].护士进修杂志,2025,40(8):875-881.
- [35] 周颖倩,顼晋昆,曹鑫,等.药物诱导睡眠下不同颏舌肌负压反射模式的阻塞性睡眠呼吸暂停患者上气道塌陷特点比较和影响因素分析[J].临床耳鼻咽喉头颈外科杂志,2026,40(1):15-21.
- [36] Biben V,Dewi F,Ratunanda SS,et al.Myofunctional therapy and its effects on retropalatal narrowing and snoring:a preliminary analysis of rehabilitative approaches[J].Int J Med Sci,2025,22(13):3371-3379.
- [37] Diaferia G,Badke L,Santos-Silva R,et al.Effect of speech therapy as adjunct treatment to continuous positive airway pressure on the quality of life of patients with obstructive sleep apnea[J].Sleep Med,2013,14(7):628-635.
- [38] Verma RK,Johnson J JR,Goyal M,et al.Oropharyngeal exercises in the treatment of obstructive sleep apnoea:our experience[J].Sleep Breath,2016,20(4):1193-1201.
- [39] Suzuki H,Yoshimiura M,Iwata Y,et al.Lip muscle training improves obstructive sleep apnea and objective sleep:a case report[J].Sleep Sci,2017,10(3):128-131.
- [40] 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[J].Sleep Breath,2025,29(2):163.
- [41] Puhan MA,Suarez A,Cascio CL,et al.Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome:randomised controlled trial[J].BMJ,2006,332(7536):266-270.
- [42] McKeown P,O’Connor-Reina C,Plaza G.Breathing re-education and phenotypes of sleep apnea:a review[J].J Clin Med,2021,10(3):471.
- [43] Valbuza JS,de Oliveira MM,Conti CF,et al.Methodsfor increasing upper airway muscle tonus in treating obstructive sleep apnea:systematic review[J].Sleep Breath,2010,14(4):299-305.
- [44] Li WY,Jin HY,Zou Y,et al.The different effect of tongue motor task training(TTT)and strength training(ST)on the modulation of genioglossus corticomotor excitability and upper airway stability in rats[J].Sleep,2022,45(10):zsac170.
- [45] Ren YQ,Ding N,Mao M,et al.A WeChat mini-program-based intervention for orofacial myofunctional therapy in adults with obstructive sleep apnea-hypopnea syndrome:a randomized controlled trial protocol[J].Trials,2025,26(1):546.
- [46] Rueda JR,Mugueta-Aguinaga I,Vilaró J,et al.Myofunctional therapy(oropharyngeal exercises)for obstructive sleep apnoea[J].Cochrane Database Syst Rev,2020,11(11):CD013449.
- [47] Poncin W,Correvon N,Tam J,et al.The effect of tongue elevation muscle training in patients with obstructive sleep apnea:a randomised controlled trial[J].J Oral Rehabil,2022,49(11):1049-1059.
- [48] Marzouqah R,Dharmakulaseelan L,Colelli DR,et al.Strengthening oropharyngeal muscles as an approach to treat post-stroke obstructive sleep apnea:a feasibility randomised controlled trial[J].J Sleep Res,2024,33(4):e14086.
- [49] Ong JH,Liu CY,Chooi MH,et al.Effectiveness of supervised multilevel oropharyngeal rehabilitation via videoconference on tongue function and apnea severity in obstructive sleep apnea:Quasi-experimental study[J].Rehabilitación,2026,60(1):100963.