Efficacy of orofacial myofunctional therapy in pediatric obstructive sleep apnea: A systematic review with meta-analysis

Abstract

Introduction: Pediatric obstructive sleep apnea (OSA) is characterized by recurrent episodes of upper airway obstruction during sleep, leading to neurocognitive, behavioral, and cardiovascular consequences. Orofacial myofunctional therapy (OMT) is proposed as a complementary strategy in the management of these patients. Objective: To describe the efficacy of OMT in children with OSA or sleep-disordered breathing. Methods: A systematic review with meta-analysis was conducted, searching the PubMed/MEDLINE, Embase, Cochrane Library (Cochrane Central Register of Controlled Trials), and LILACS/BVS databases. Intervention studies involving pediatric patients undergoing active or passive orofacial myofunctional therapy were included. The outcomes evaluated were the apnea-hypopnea index (AHI), mean oxygen saturation, and morphofunctional parameters. Analyses were performed using Review Manager with a random-effects model. Results: Five studies, totaling 176 children, were included. Meta-analysis of the AHI (n=122) demonstrated a significant reduction following OMT (MD: -2.43 events/hour; 95% CI: -3.33 to -1.54; p<0.00001; I²=53%). Analysis of SaO₂ (n=149) showed an increase in mean oxygen saturation (MD: +0.58%; 95% CI: +0.14 to +1.02; p=0.010; I²=32%). A reduction in mouth breathing and an improvement in respiratory functional patterns were observed. Conclusion: OMT proved capable of reducing the AHI and promoting benefits regarding nocturnal oxygenation and morphofunctional parameters in children with OSA, representing a promising complementary strategy. The quality of the evidence is limited by the small number of studies, small sample sizes, and methodological heterogeneity, requiring caution in the interpretation of the results.