Background: Myofunctional therapy has emerged as a treatment option for obstructive sleep apnea (OSA). The Iowa Oral Performance Instrument (IOPI) enables objective measurement of lingual and orofacial muscle strength, although it was originally designed for evaluating dysphagia. OSA is frequently associated with a hypotonic phenotype characterized by reduced strength in upper airway muscles, but its identification remains unclear. Objective: We evaluated the usefulness of IOPI measurements in identifying hypotonic phenotypes among patients with obstructive sleep apnea (OSA). Methods: We carried out a cross-sectional study analyzing the relationship between IOPI scores, sleep polygraphy metrics—such as the apnea–hypopnea index (AHI)—and findings from physical examination. In addition to the standard IOPI protocol, we introduced novel maneuvers aimed at providing a more comprehensive assessment of oropharyngeal muscle function. Results: Although IOPI conventional maneuvers showed no clear association with AHI or ODI, the inferior tongue maneuver showed higher awake tongue strength, with a statistically significant correlation to both AHI (r = 0.2873; p = 0.008) and ODI (r = 0.2495; p = 0.032). Performing each exercise three times yielded highly consistent results across trials (r > 0.94), but did not significantly alter the overall outcome. Interestingly, lower tongue strength values were observed in patients with a high-arched palate (p < 0.05), whereas no relevant associations were found with the presence of a restricted lingual frenulum or CPAP use. Conclusions: Incorporating specific IOPI maneuvers, especially the inferior tongue exercise, may provide additional insight into muscle function in OSA. Selective repetition is advisable for borderline values.

Background: Studies have shown that complete concentric circular collapse (CCC) at the velum is a frequent finding in drug-induced sleep endoscopy, implying a worse prognosis for surgical outcomes in the treatment of obstructive sleep apnea syndrome (OSAS). Our group evaluated the results of pharyngoplasties with barbed sutures for this indication. We selected 48 patients with OSAS and CCC who underwent pharyngoplasty with barbed sutures in 8 tertiary centers. The outcome results were measured by polygraphy or polysomnography and Epworth Symptoms Scale (ESS) at least 6 months after surgery. Results: Apnea Hypopnea Index (AHI) improved from 34.9/h [21.2] to 12.7/h [10.6]. The success rate according to Sher’s criteria was 86.7%, the cure rate was 23.9%, and an AHI < 10 occurred in 42.2% of the cases. The oxygen desaturation index improved from 32.5/h [29.9] to 12.5/h SD [11.6], and the ESS improved from 10.2 [5.2] to 6 [3.5]. Conclusions: Pharyngoplasty with barbed sutures seems to be a good alternative for patients with OSAS and CCC findings in drug-induced sleep endoscopy.

Tonsillectomy is considered the standard of care in patients with obstructive sleep apnea (OSA) and large tonsils; however, there are selected cases where this procedure should not be considered. We present two patients with tonsil grade 4 and severe OSA where tonsillectomy was not the solution for their problem and could be a superfluous procedure. In our experience, a preoperatory drug-induced sleep endoscopy (DISE) and proper patient phenotyping will prevent this type of surgical failure.

Ankyloglossia causes impairment of normal tongue motility and disrupts the average balance of the muscle forces that form the orofacial complex. Inadequate swallowing from birth can cause long-term anatomical and functional consequences in adult life. Using the video presented herein, we describe the current knowledge about the long-term implications of ankyloglossia. After a literature review of the Medline, Google Scholar, and Embase databases on the relations between ankyloglossia and sleep-disordered breathing, we designed and created a three-dimensional (3D) video using Adobe After Effects based on the anatomical and functional changes produced by repeated deglutition, with and without ankyloglossia, from childhood to adulthood. The animated video (Blender 3D, Amsterdam, The Netherlands, 2024) presented herein was based on the most recent literature review of dentition, breathing, posture, and abnormal swallowing, emphasizing the importance of the potential consequences of sleep-disordered breathing. The resulting animated 3D video includes dynamic sequences of a growing child, demonstrating the anatomy and physiology of deglutition with and without ankyloglossia, and its potential consequences for the surrounding structures during growth due to untreated ankyloglossia. This visual instructional video regarding the impacts of ankyloglossia on deglutition/swallowing may help motivate early childhood diagnosis and treatment of ankyloglossia. This instrument addresses the main myofunctional aspects of normal deglutition based on the importance of free tongue motion and can be used by students or professionals training in myofunctional disorders.

Intraoral examinations are essential in the evaluation of the upper airway in patients with obstructive sleep apnea (OSA). The morphology of the anatomic structures of the soft palate, the tonsillar fossae, and the palatoglossus and palatopharyngeal muscles is an important determinant of the size and collapsibility of the velum and oropharynx. The Palatopharyngeal Arch Staging System (PASS) is a systematic way to explore the oropharynx and report anatomic variations in the visible part of the palatopharyngeal muscle. In this prospective study, 30 sleep surgeons evaluated the reliability of the PASS using a selection of 23 videos of oropharyngeal examinations of healthy patients. The corresponding score on the PASS scale was graded for each examination. For internal structure and internal agreement, the Cronbach and Krippendorff alpha values were 0.96 and 0.46, which corresponded to a nearly perfect interrelationship and a moderate agreement, respectively. These findings suggest that the PASS is a valuable tool for evaluating the position of the palatopharyngeus muscle during oropharyngeal examinations and may be useful for creating a common language for sleep surgeons when evaluating the palatopharyngeal muscle.