Tongue Function: An Underrecognized Component in the Treatment of Obstructive Sleep Apnea with Mandibular Repositioning Appliance

Obstructive sleep apnea (OSA) is a common but still underrecognized disorder. A mandibular repositioning appliance (MRA) is used to treat OSA by advancing the mandible and thereby reducing the collapsibility of the upper airway. It has been found that an MRA increases the volume of the upper airway, especially the velopharyngeal area, in OSA patients. We hypothesize that this increase in the velopharyngeal volume is associated with an anterior displacement of the tongue, but likely not with a stretching of the soft tissue connecting the soft palate, lateral pharynx, palatopharyngeal arch, and mandible. Since the function and structure of the genioglossus and hypoglossal nerve are always abnormal in patients with OSA, the tongue does not always move simultaneously with the mandible when an MRA is being used. Oropharyngeal exercises, especially tongue exercises, can improve the quality of life of OSA patients, including reduction of daytime sleepiness and snoring, better quality of sleep, and partial decrease in the AHI. Further, in animal models, tongue exercise is also found to be effective in tongue function recovery and in the remodeling of the hypoglossal nucleus. We suggest that a combination of tongue exercises along with MRA is a promising approach for patients who do not respond to an MRA alone.