NEW YORK (Reuters Health) – Exercises involving the tongue and soft palate may reduce the severity and symptoms of moderate obstructive sleep apnea (OSA), sleep specialists report in the American Journal of Respiratory and Critical Care Medicine for May 15.

A recent study showed that playing the didgeridoo to train the upper airway muscles “significantly ameliorated OSA syndrome severity and associated symptoms,” according to principal investigator Dr. Geraldo Lorenzi-Filho and associates at the University of Sao Paulo Medical School in Brazil. A didgeridoo is a wind instrument used by Australian Aborigines consisting of a long thick hollowed-out wooden pipe that makes a deep reverberating sound.

With this in mind, the researchers chose a set of isometric and isotonic oropharyngeal exercises derived from speech therapy training that involved suction, swallowing, chewing, breathing and speech. In a clinical trial, 31 patients were randomized to the exercise regimen, to be performed for 30 minutes each day for 3 months, or to a sham “deep breathing” therapy.

At the end of 3 months, the mean apnea-hypopnea index had decreased significantly from 22.4 to 13.7 events per hour (p < 0.01) in the exercise group. In addition, the Pittsburgh Sleep Quality score improved from 10.2 to 6.9 points and snoring intensity was reduced from "very loud” to "similar to breathing,” (p = 0.001 for both), and Epworth Sleepiness Scale scores dropped from 14 to 8 (p = 0.006). Furthermore, neck circumference fell from 39.6 to 38.5 cm (p = 0.01), “suggesting that the exercises induced upper airway remodeling.” By contrast, no significant changes had occurred in the control group, the authors report. “Our results,” Dr. Lorenzi-Filho and his team conclude, “suggest that this set of oropharyngeal exercises is a promising alternative for the treatment of moderate OSA.” In an accompanying commentary, Dr. Catriona M. Steele from the University of Toronto summarizes the tasks included in the exercise protocol. Many of the exercises she dismisses as unlikely to induce muscle change. However, she believes that balloon inflation and didgeridoo playing require enough air pressure to change the tone or strength of the underlying musculature, as well as the “tongue press-to-palate task.” Future research, she concludes, should investigate nasopharyngeal and tongue pressure resistance exercises to see if they can ameliorate upper airway collapsibility during sleep and determine the optimal treatment elements, such as intensity, frequency, and duration.