Patients With Obstructive Sleep Apnea May Have Sleep Improvement After Oropharyngeal-Based Therapies

A study showed that a 4 week intervention of oropharyngeal stimulation and tongue PNF improved cognition, Hba1c and quality of sleep in patients with OSA.

Researchers from the KAHER Institute of Physiotherapy in India found a 4-week oropharyngeal stimulation or tongue proprioceptive neuromuscular facilitation (PNF) therapy improved cognition and sleep among patients with obstructive sleep apnea (OSA). These results were published in the Journal of Sleep Disorders and Therapy.

Patients (N=30) with OSA were recruited for this clinical study. Patients were randomized to receive 20 minutes of oropharyngeal stimulation between 30-100 Hz or tongue PNF exercise for 4 weeks. Patients were assessed by Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Mindful Awareness Scale (MAAS), Addenbrooke Cognitive Examination-III (ACE-III), Trail Making Test A and B (TMT), Digit Span Test (DST).Blood glucose levels were also tested.

The participants were 66.67% men with average ages of 49.53±8.98 years and 48.93±8.84 years and body mass indexes of 27.20±2.57 kg/m2 and 26.33±2.74 kg/m2 for the oropharyngeal and PNF groups, respectively. At baseline, the oropharyngeal and PNF cohorts had significantly different ACE-III scores (t, 2.1185; P =.0431).

Among the oropharyngeal stimulation group, significant differences between the pre- and post-test were observed for ESS (mean difference, 9.73; t, 6.1918; P =.0001), PSQI (mean difference, 11.93; t, 6.5225; P =.0001), MAAS (mean difference, 10.2; t, 2.4227; P =.0296), TMT-A (mean difference, 0.86; t, 5.2256; P =.0001), TMT-B (mean difference, 1.71; t, 6.9848; P =.0001), DST (mean difference, 0.81; t, 5.0286; P =.0002), and glycated hemoglobin (mean difference, 1.55; t, 4.9219; P =.0002).

Among the tongue PNF group, significant differences between the pre- and post-test were observed for ESS (mean difference, 9.87; t, 9.8262; P =.0001), PSQI (mean difference, 11.87; t, 5.5052; P =.0001), ACE-III (mean difference, -12.93; t, 3.0289; P =.0090), TMT-A (mean difference, 0.96; t, 5.4883; P =.0001), TMT-B (mean difference, 2.04; t, 4.4448; P =.0006), and glycated hemoglobin (mean difference, 2.02; t, 3.7308; P =.0022).

At follow-up the oropharyngeal cohort compared with the PNF group differed significantly for PSQI (t, -2.288; P =.0299), ACE-III (t, -2.9526; P =.0063), TMT-B (t, 1.921; P =.065), and DST (t, -1.9481; P =.0615).

This study was limited by its sample size, lack of a control group, or of a combinatorial therapy treatment.

These data indicated patients with OSA may benefit from either oropharyngeal stimulation or tongue PNF therapies, in which blood glucose, sleep quality, awareness, and cognition may be improved.


Bhore V, Chitra J, Parikh J. Effect of Oropharyngeal stimulation and tongue PNF on cognition, quality of sleep and Hba1c in patients with obstructive sleep apnea – A randomized clinical trial. J Sleep Disord Ther. 2020;9(6):320. doi:10.35248/2167-0277.20.9.320

This article originally appeared on Psychiatry Advisor