Effect of pharyngeal musculature and genioglossus exercising on obstructive sleep apnea following uvulopalatopharyngoplasty

Effect of pharyngeal musculature and genioglossus exercising on obstructive sleep apnea following uvulopalatopharyngoplasty | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of pharyngeal musculature and genioglossus exercising on obstructive sleep apnea following uvulopalatopharyngoplasty Pingping Zhang, Tongfei Qu, Xiaona Zhang, Runze Zhu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8075856/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aimed to evaluate the effectiveness of pharyngeal musculature and genioglossus exercising as a postoperative rehabilitation intervention for patients with obstructive sleep apnea (OSA) following uvulopalatopharyngoplasty (UPPP)—a setting with limited prior evidence. Methods This is a retrospective cohort study conducted in the first people's Hospital of Linping District, Hangzhou. They included 120 patients of OSAHS who received UPPP between October 2022 and October 2024. Sixty patients who received pharyngeal and genioglossal muscle exercises were matched with the cohort who did not receive any exercise in a 1:1 ratio. The main outcome was the clinical efficacy 6 months after operation. The secondary outcomes were the changes of apnea hypopnea index (AHI), lowest oxygen saturation during sleep (LSaO2), Pittsburgh sleep quality index (PSQI), and the World Health Organisation Quality of Life tool (WHOQOL-BREF) score. Results Six months after operation, the clinical effective rate of the exercise group was significantly higher than that of the non-exercise group ( p 0.05). Six months after operation, the AHI,LSaO2, PSQI and WHOQOL-BREF scores of the two groups were significantly improved, and the AHI, LSaO2, PSQI, physical and psychological scores of the exercise group were better than those of the non-exercise group (all p 0.05). Conclusions Pharyngeal musculature and genioglossus exercising may improve postoperative outcomes and quality of life in patients undergoing UPPP, and could be considered a promising rehabilitation strategy in clinical practice. pharyngeal cavity genioglossus muscle exercise obstructive sleep apnea and hypopnea syndrome uvulopalatopharyngoplasty Figures Figure 1 INTRODUCTION ​Obstructive sleep apnea and hypopnea syndrome (OSAHS) is a recurrent upper airway collapse and obstruction in sleep disorders. [ 1 , 2 ] OSAHS can cause hypoxemia and sleep structural disorder at night, which can lead to multiple system complications. Such as cardiovascular and cerebrovascular diseases, metabolic disorders and cognitive dysfunction, which seriously reduce the quality of life of patients. [ 2 , 3 ] The survey found that the prevalence of OSAHS in Chinese adults was 11%, and increased with the increase of body mass index (BMI). [ 3 ] OSAHS has become a serious public health problem. [ 4 ] ​ However, several studies have shown that although UPPP has short-term efficacy, its long-term effectiveness is often compromised. [ 5 , 6 ] Recurrence of OSA symptoms postoperatively may be attributed to factors such as upper airway tissue relaxation, postoperative scarring, weight gain, or progression of neuromuscular dysfunction over time. [ 7 ] A recent 8-year follow-up study by Sundman et al. demonstrated a significant rebound in apnea–hypopnea index (AHI) several years after UPPP, especially in patients with high BMI or increasing weight post-surgery. [ 8 ] Meanwhile, oropharyngeal muscle training has gained increasing attention as a non-invasive intervention in OSA populations. In a recent randomized controlled trial, Marzouqah et al. applied structured oropharyngeal exercises to post-stroke OSA patients and reported significant improvements in AHI, oxygen desaturation, and sleep quality. [ 8 , 9 ] Although these findings support the efficacy of targeted upper airway exercises, evidence for their use in the postoperative recovery phase of UPPP remains limited. Our study addresses this gap by investigating the clinical effects of pharyngeal and genioglossus muscle training as a postoperative rehabilitation strategy in patients undergoing UPPP. Uvulopalatopharyngoplasty (UPPP) is one of the most commonly used surgical procedures for the treatment of OSAHS. He et al. [ 10 ] conducted a meta-analysis of UPPP related studies and found that UPPP can achieve good results both in the short-term and long-term after surgery. UPPP can improve the upper airway obstruction by removing part of the velopharyngeal tissue and enlarging the pharyngeal cavity. [ 10 , 11 ] However, the relaxation and collapse of pharyngeal muscles (such as palatoglossus and genioglossus) will occur again due to scar contraction, poor recovery of muscle function and weight gain, especially in obese patients. [ 10 – 12 ] Therefore, how to improve the efficacy of UPPP and reduce the recurrence rate of adjuvant therapy has become an urgent problem to be solved. Brown et al. [ 13 ] also found that the decrease of upper airway muscle tension and strength was the main cause of OSAHS; In addition, Braga et al. [ 14 ] showed that the greater the anterior lingual muscle strength measured before UPPP surgery, the better the surgical effect. This indicates that increasing the physiological tension and strength of the pharyngeal muscles and genioglossal muscles may help to maintain the patency of the pharyngeal cavity after UPPP, thereby improving the efficiency of surgical treatment. [ 13 – 15 ] At present, the clinical evidence-based evidence about the influence of pharyngeal cavity and genioglossal muscle functional exercise on the effect of UPPP is still weak. Therefore, the clinical data of pharyngeal cavity and genioglossal muscle function exercise in patients with OSAHS after UPPP operation were retrospectively analyzed. In order to provide new ideas for the selection of surgical methods and personalized and precise treatment of OSAHS patients.​ MATERIALS AND METHODS Patients This is a retrospective cohort study conducted in the first people's Hospital of Linping District, Hangzhou. They included 120 patients of OSAHS who received UPPP between October 2022 and October 2024. Sixty patients who received pharyngeal and genioglossal muscle exercises were matched with the cohort who did not receive any exercise in a 1:1 ratio. The matching conditions are gender, age BMI、 Education level, neck circumference, apnea hypopnea index (AHI) and lowest oxygen saturation during sleep (LSaO2). AHI and LSaO2 were recorded by polysomnography (PSG). All patients underwent two overnight polysomnography (PSG) assessments: the first at baseline (prior to initiation of the exercise program), and the second at 6 months postoperatively. The exercise training began approximately 1 month after UPPP, when the surgical site was confirmed to be healed. The 6-month PSG was scheduled after a 5-month training period, with both tests conducted in the same sleep laboratory using standardized procedures. Inclusion criteria - It meets the diagnostic criteria of OSAHS; [1] - AHI ≥ 15 times/hour, LSaO2＜85%; [16] - 18-65 years old; - The occlusive plane was in oropharyngeal region; - The clinical data are complete. Exclusion criteria - Patients with central sleep apnea syndrome; - Severe cardiovascular and cerebrovascular diseases; - Airway obstruction was not at oropharyngeal level; - Scar constitution; - Overlap syndrome; - Recurrence occurred during the follow-up period. According to the 2011 revised Guidelines for the Diagnosis and Treatment of Obstructive Sleep Apnea–Hypopnea Syndrome (OSAHS) issued by the Sleep-Disordered Breathing Group of the Chinese Thoracic Society (Chinese Medical Association), moderate OSAHS is defined as an AHI >15 to ≤30 events per hour; an AHI of exactly 15 events/h falls within the mild range. [16] Therefore, the inclusion criterion of AHI ≥ 15 was set to ensure that only moderate to severe OSAHS patients were enrolled, which is consistent with the indications for UPPP. In addition, all patients had a lowest oxygen saturation (LSaO2) < 85%, further confirming disease severity. In fact, the median AHI of both groups exceeded 40, indicating that the vast majority of included patients were in the severe category. This inclusion threshold is widely accepted in clinical research and has been adopted in previous studies and surgical outcome evaluations for OSAHS. [5] Preoperative airway assessment All patients underwent a standardized preoperative evaluation before UPPP. This included a detailed clinical history, physical otolaryngologic examination, and overnight polysomnography to confirm the diagnosis and severity of OSAHS. Upper airway obstruction at the oropharyngeal level was assessed by experienced otolaryngologists using awake nasopharyngoscopy in all patients, and Müller’s maneuver was performed in selected cases to further evaluate dynamic pharyngeal collapse. Drug-induced sleep endoscopy (DISE) was not routinely performed due to resource limitations, but surgical candidacy for UPPP was determined based on the comprehensive clinical and endoscopic findings. Data collection The following clinical data were collected for all participants at baseline and 6 months postoperatively: (1) demographic characteristics including age, gender, body mass index (BMI), neck circumference, and education level; (2) polysomnography parameters such as apnea–hypopnea index (AHI) and lowest oxygen saturation during sleep (LSaO2); (3) sleep quality scores measured by the Pittsburgh Sleep Quality Index (PSQI); (4) health-related quality of life scores assessed by the WHOQOL-BREF questionnaire; (5) treatment response categorized by AHI-based efficacy grading. UPPP General anesthesia via nasal intubation. The fat, bilateral tonsils, palatoglossal arch and palatopharyngeal arch in the palatine velum space were excised. The palatopharyngeal muscle was suspended and sutured; Tension free contraposition suture of mucosa; Truncate the hypertrophic uvula; Enlarge the left-right and anterior posterior diameters of pharyngeal cavity. After the operation, the patients were instructed to reduce weight, quit smoking and alcohol, and try to sleep on their sides only. All surgeries were performed by the same otolaryngology team using a standardized surgical technique, ensuring procedural consistency across patients. Pharyngeal musculature and genioglossus exercising The terminology " pharyngeal musculature and genioglossus exercising " was selected to reflect the anatomical and functional regions targeted by the intervention, including the genioglossus, palatoglossus, pharyngeal constrictors, and buccinator muscles. These exercises were designed to enhance neuromuscular tone in the upper airway and simulate functional actions such as breathing and swallowing. One month after UPPP, if the suture at the surgical site fell off cleanly, the mucosa recovered well, and there was no bleeding, pain, or swallowing discomfort, the exercise program was initiated. Patients were instructed to open their mouth and extend their tongue 10 times each morning and evening. Submental massage was performed using the thumb pulp for 1 minute, followed by forward and upward chin pressure with the thumb for 10 repetitions (5 seconds each). Patients were also asked to perform 10 cheek-puffing maneuvers (buccal ballooning), where the cheeks were puffed while the lips were closed, holding each for 5 seconds. Then, they pinched their nose and closed their mouth 10 times (5 seconds each), followed by deep nasal breathing with the mouth closed for 20 repetitions. These exercises were selected based on previous studies that demonstrated their effectiveness in targeting upper airway dilator muscles. [17,18] Specifically, they activate the genioglossus, palatoglossus, platysma, and pharyngeal constrictors. These maneuvers simulate tongue protrusion, soft palate movement, and pharyngeal wall tightening, which are crucial for maintaining airway patency. Regular repetition aims to strengthen muscle tone, reduce airway collapsibility, and improve sleep-related respiratory function. After each training session, patients were required to submit photos or videos via the WeChat application as daily check-ins. Medical staff reviewed these submissions weekly to evaluate compliance, provide feedback, and issue reminders as needed. This approach ensured objective documentation and continuous supervision. Patients were also followed up at least once a month to monitor progress and reinforce adherence. Main outcome The main outcome was clinical efficacy. 1) Cured (AHI < 5 times/h); 2) Markedly effective (AHI < 20 times/h and the decreased range ≥ 50%); 3) Effective ( AHI decreased ≥ 50%, but not reduced to less than 20 times/h); 4) Ineffective ( AHI decreased by<50%). Total effective rate= (cured + markedly effective + effective) / total number. These efficacy thresholds were adapted from the “Guidelines for the Diagnosis and Treatment of Obstructive Sleep Apnea–Hypopnea Syndrome (OSAHS)” issued by the Sleep-Disordered Breathing Group of the Chinese Thoracic Society (Chinese Medical Association) and are also consistent with efficacy grading systems used in previous domestic studies. [5] An AHI < 5/h is commonly accepted as a normalized level, while a ≥50% reduction is considered a clinically meaningful response in both Chinese and international literature. [18] These criteria were selected to facilitate interpretation of therapeutic outcomes. Secondary outcomes The secondary outcomes were AHI, changes in sleep quality and quality of life, recurrence and adverse reactions. 1) Pittsburgh sleep quality index (PSQI) was used to evaluate sleep quality: it was composed of 19 self-rated items and 5 other rated items, of which 18 items were composed of 7 factors, and each factor was scored according to the 0-3 score level; The cumulative score of each factor component is the total score of PSQI, and the total score range is 0-21 points; The higher the score, the worse the sleep quality. 2) The quality of life was assessed using the World Health Organisation Quality of Life tool (WHOQOL-BREF) score; The scale is divided into four dimensions: physical, psychological, environmental and social domains, with a single dimension of 0-100 points; The higher the score, the higher the quality of life. Statistical methods We used SPSS statistical software Windows version 25.0 (IBM, USA) for statistical analysis. The baseline demographic and clinical characteristics of the two groups were compared by Pearson chi square test. According to the normality of the data, the independent sample t test and Mann Whitney test were used to compare the continuous variables. The normality of continuous variables is tested by Shapiro Wilks test. If the normality is violated, we use Mann Whitney test. For the measurement of classification results, we use Pearson chi square test (or Fisher exact test, if the expected frequency of any cell in the contingency table is less than 1) to compare the differences between groups. Double sided p < 0.05 was considered statistically significant. In addition to hypothesis testing, effect sizes with 95% confidence intervals were calculated to quantify the magnitude of between-group differences. For approximately normally distributed continuous variables analyzed with t tests, we report mean differences (exercise − non-exercise) with parametric 95% CIs. For non-normally distributed continuous variables compared using the Mann–Whitney U test, we report the Hodges–Lehmann median difference (HL MD) with bias‑corrected bootstrap 95% CIs (B = 1000). For binary outcomes, we report risk ratios (RRs) with Katz 95% CIs. For r × c categorical variables, we report Cramér’s V with bootstrap 95% CIs. All effect sizes and their confidence intervals are presented in Table I-IV. As this was a retrospective cohort study, no a priori power calculation was performed. Instead, all eligible patients during the study period were included, and 1:1 group matching was conducted based on key variables (gender, age, BMI, education level, neck circumference, AHI, and LSaO2) to improve comparability. In future prospective trials, formal sample size estimation will be conducted to enhance statistical rigor. RESULTS From October 2022 to October 2024, we enrolled 231 OSAHS patients who received UPPP, excluded 84 cases, and finally 207 cases met the conditions of this study. Among them, 95 cases received pharyngeal cavity and genioglossal muscle functional exercise after UPPP (exercise group), and 112 cases did not receive any exercise (non-exercise group). The two groups were matched in a ratio of 1:1, with 60 patients in each group (Fig. 1 ); The matching conditions are gender, age, BMI, education level, neck circumference, etc. There was no significant difference in demographic characteristics and baseline AHI and LSaO2 scores between the two groups (all p > 0.05) (Table I). Additionally, effect sizes for baseline comparisons are provided in Table I to facilitate understanding of between-group equivalence prior to intervention. As shown in Table II, six months after operation, the clinical effective rate of the exercise group was 88.3% (53/60), and that of the non-exercise group was 70.0% (42/60). The clinical effective rate of the exercise group was significantly higher than that of the non-exercise group ( χ 2 = 6.114, p < 0.05 ).​ The between-group risk ratio (RR) for clinical effectiveness was also calculated and is shown in Table II, indicating a favorable effect of the intervention. As shown in Table III, there was no significant difference in baseline AHI, LSaO2, and PSQI levels between the two groups (all p > 0.05). At 6 months postoperatively, the exercise group showed significantly lower AHI and PSQI scores and higher LSaO2 compared to the non-exercise group (all p < 0.05). Importantly, the between-group effect size for AHI was a Hodges–Lehmann median difference of -5.0 events/h (95% CI: -9.0 to -1.0), and for PSQI was − 1.8 points (95% CI: -2.9 to -0.6). These improvements are considered both statistically and clinically meaningful. LSaO2 also improved, with a median difference of 2.6% (95% CI: -0.2 to 5.8), approaching clinically relevant thresholds. As shown in Table IV, there were no significant differences in baseline WHOQOL-BREF domain scores between the groups. At 6 months, both groups showed improvements across all domains (all p < 0.05). However, the exercise group demonstrated significantly greater improvements in the physical and psychological domains. The effect size for physical health was 7.0 points (95% CI: 3.0 to 10.0) and for psychological health was 3.4 points (95% CI: 0.7 to 6.1). These differences reflect meaningful functional and emotional benefits. No significant between-group differences were found in environmental and social domain scores.​ DISCUSSION Our findings demonstrated that patients who engaged in pharyngeal musculature and genioglossus exercising after UPPP achieved significantly greater clinical efficacy, improved sleep quality, and better quality of life compared to those who did not exercise. These improvements were reflected across AHI, PSQI, and WHOQOL-BREF scores, aligning with previous studies reporting benefits of upper airway muscle training in OSAHS management. [ 17 , 19 , 20 ] From a pathophysiological perspective, the beneficial effects of pharyngeal musculature and genioglossus exercising observed in our study are likely mediated by improvements in upper airway neuromuscular function. Repetitive activation of the genioglossus, soft palate, and pharyngeal constrictor muscles may increase baseline muscle tone and endurance, enhance coordination between dilator muscles, and thereby reduce pharyngeal collapsibility during sleep. These mechanisms are consistent with previous randomized and feasibility trials showing that oropharyngeal muscle training can reduce AHI, improve oxygenation, and enhance sleep-related quality of life in patients with moderate OSA or post-stroke OSA. [ 9 , 18 ] Strengthening the upper airway dilator muscles may thus represent a physiologically targeted and non-invasive strategy to support postoperative airway stability after UPPP. In addition to statistical significance, the observed differences demonstrated meaningful effect sizes with clinical implications. For example, the exercise group showed a median AHI reduction of 5.0 events/h compared to the non-exercise group (HL MD: -5.0; 95% CI: -9.0 to -1.0), which may correspond to a shift in OSAHS severity classification for many patients. The PSQI score also improved significantly (mean difference: -1.8; 95% CI: -2.9 to -0.6), which exceeds the threshold typically considered meaningful for subjective sleep quality improvement. Furthermore, improvements in WHOQOL-BREF domains, especially in the physical (HL MD: 7.0; 95% CI: 3.0 to 10.0) and psychological (mean difference: 3.4; 95% CI: 0.7 to 6.1) dimensions, suggest not only enhanced function but also potential gains in patients’ daily performance and well-being. These results support the practical value of pharyngeal musculature and genioglossus exercising as a postoperative adjunct therapy after UPPP. The oropharyngeal exercise protocol adopted in our study was based on prior evidence from Tang et al. [ 17 ] , Guimarães et al. [ 18 ] , and others, which targeted upper airway dilator muscles such as the genioglossus, palatine, and platysma. These exercises were initiated one month after UPPP when wound healing was confirmed. The intervention was simple, noninvasive, and supported by daily WeChat-based adherence monitoring. The potential mechanism may involve enhanced muscle tone and reduced pharyngeal compliance, contributing to postoperative airway stability. [ 17 , 18 , 20 – 23 ] We recommend implementing such exercises for at least three months after UPPP to support functional recovery and long-term efficacy maintenance. [ 24 – 26 ] However, there was no significant difference in the scores of environmental and social domains between the two groups at 6 months after operation. This may be related to the selection of subjects, exercise methods and intensity, follow-up time and other factors. Six months after surgery, it may only cover the short-term rehabilitation stage, while the overall improvement of social function (such as returning to work, social circle reconstruction) usually lags behind the recovery of physiological function. [ 27 , 28 ] The environmental field may be dominated by personal and family economic conditions. In addition, friberg et al. [ 29 ] showed that one third of patients had side effects after UPPP, including hysteria ball, mucus, voice and dysphagia, especially elderly patients. However, this study did not analyze the side effects and recurrence rate of patients. This is mainly because the beginning of pharyngeal musculature and genioglossus exercising was reviewed one month after operation, excluding patients with bleeding, pain, dysphagia and so on. Although this study confirmed that pharyngeal musculature and genioglossus exercising effectively improved the therapeutic outcomes of UPPP in patients with OSAHS, several limitations must be acknowledged. First, the current study was a single-center, retrospective analysis with a relatively small sample size, which may limit the generalizability of the findings. Second, although improvements in AHI, LSaO2, and quality of life were observed, no direct assessments of muscle-level function (e.g., tongue pressure or electromyography) were performed. This restricts our ability to elucidate the physiological mechanisms underlying the clinical benefits. Third, the exercise intervention was patient-led, and individual differences in execution or compliance may have affected outcome consistency. Fourth, while the intervention appeared effective in the short term, long-term outcomes, including recurrence rates after UPPP, remain unclear. Muscle adaptation may require extended time, and further studies with prolonged follow-up are needed to assess sustained efficacy. Additionally, we acknowledge that clinical efficacy definitions based on AHI reduction are not yet standardized internationally, which may limit cross-study comparisons. In the future, well-designed, multi-center, prospective randomized controlled trials are warranted to validate these findings and to explore the use of oropharyngeal muscle training as a standardized postoperative rehabilitation strategy for OSAHS patients following UPPP. ​​ CONCLUSION Pharyngeal musculature and genioglossus exercising following UPPP may improve AHI, sleep quality, and overall quality of life in patients with OSAHS. While these findings are promising, the retrospective and single-center design limits generalizability. Future large-scale, high-quality prospective studies are needed to validate these results and assess long-term outcomes. Abbreviations OSAHS obstructive sleep apnea and hypopnea syndrome UPPP uvulopalatopharyngoplasty AHI apnea hypopnea index LSaO2 lowest oxygen saturation during sleep PSQI Pittsburgh sleep quality index WHOQOL-BREF World Health Organisation Quality of Life tool BMI body mass index. Declarations Ethics approval and consent to participate The ethics committee of The First People’s Hospital of Linping District, Hangzhou City approved this study. All procedures involving human subjects adhered to the 1964 Declaration of Helsinki and its subsequent amendments or equivalent ethical standards. Given the retrospective nature of the study, informed consent was waived by the Ethical Committee of The First People’s Hospital of Linping District, Hangzhou City. All data were stored securely, and confidentiality was maintained throughout the study. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding 2024 Zhejiang medical and health science and technology plan project (special innovation guidance 2024649698). Author Contribution All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. Acknowledgements Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Brodie KD, Goldberg AN. Obstructive Sleep Apnea: A Surgeon's Perspective. Med Clin North Am. 2021;105(5):885–900. 10.1016/j.mcna.2021.05.010 . Malhotra A, Mesarwi O, Pepin JL, Owens RL. Endotypes and phenotypes in obstructive sleep apnea. Curr Opin Pulm Med. 2020;26(6):609–14. 10.1097/MCP.0000000000000724 . Su XF, Liu L, Zhong L, Qian XS, Han JM. Prevalence of obstructive sleep apnea syndrome in China: a meta-analysis. China J Evidence-Based Med. 2021;21(10):1187–94. 10.7507/1672-2531.202106103 . Read N, Jennings C, Hare A. Obstructive sleep apnoea-hypopnoea syndrome. Emerg Top Life Sci. 2023;7(5):467–76. 10.1042/ETLS20180939 . Li M, Zheng H, Chen S, Chen D, Wang W. [Effect of denervating duration on the surgical outcome of laryngeal reinnervation in patients with unilateral vocal fold paralysis]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016;51(1):57–62. 10.3760/cma.j.issn.1673-0860.2016.01.009 . He M, Yin G, Zhan S, Xu J, Cao X, Li J, et al. Long-term Efficacy of Uvulopalatopharyngoplasty among Adult Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2019;161(3):401–11. 10.1177/0194599819840356 . Koay CB, Freeland AP, Stradling JR. Short- and long-term outcomes of uvulopalatopharyngoplasty for snoring. Clin Otolaryngol Allied Sci. 1995;20(1):45–8. 10.1111/j.1365-2273.1995.tb00010.x . Sundman J, Browaldh N, Fehrm J, Friberg D. Eight-Year Follow-up of Modified Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea. Laryngoscope. 2021;131(1):E307–13. 10.1002/lary.28960 . Marzouqah R, Dharmakulaseelan L, Colelli DR, Lindo CJ, Costa YS, Jairam T, et al. Strengthening oropharyngeal muscles as an approach to treat post-stroke obstructive sleep apnea: A feasibility randomised controlled trial. J Sleep Res. 2024;33(4):e14086. 10.1111/jsr.14086 . He M, Yin G, Zhan S, Xu J, Cao X, Li J, et al. Long-term Efficacy of Uvulopalatopharyngoplasty among Adult Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2019;161(3):401–11. 10.1177/0194599819840356 . Sheen D, Abdulateef S, Uvulopalatopharyngoplasty. Oral Maxillofac Surg Clin North Am. 2021;33(2):295–303. 10.1016/j.coms.2021.01.001 . Choi JH, Cho SH, Kim SN, Suh JD, Cho JH. Predicting Outcomes after Uvulopalatopharyngoplasty for Adult Obstructive Sleep Apnea: A Meta-analysis. Otolaryngol Head Neck Surg. 2016;155(6):904–13. 10.1177/0194599816661481 . Brown EC, Cheng S, McKenzie DK, Butler JE, Gandevia SC, Bilston LE. Respiratory Movement of Upper Airway Tissue in Obstructive Sleep Apnea. Sleep . 2013;36(7):1069–1076. Published 2013 Jul 1. 10.5665/sleep.2812 Braga A, Grechi TH, Eckeli A, Vieira BB, Itikawa CE, Küpper DS, et al. Predictors of uvulopalatopharyngoplasty success in the treatment of obstructive sleep apnea syndrome. Sleep Med. 2013;14(12):1266–71. 10.1016/j.sleep.2013.08.777 . Tang S, Wang Y, Qing J, Jiang Y, Lu X, Yao S, et al. [Exercise pharynx and genioglossus to treat obstructive sleep apnea and hypopnea syndrome]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013;27(15):822–6. Chinese. PMID: 24364108. Chinese Thoracic Society, Sleep-Disordered Breathing Group. Guidelines for the diagnosis and treatment of obstructive sleep apnea–hypopnea syndrome (2011 revision). Chin J Tuberculosis Respiratory Dis. 2012;35(1):9–12. 10.3760/cma.j.issn.1001-0939.2012.01.007 . Tang SX, Qing J, Wang YW, Chai L, Zhang WM, Ye XW, et al. Clinical analysis of pharyngeal musculature and genioglossus exercising to treat obstructive sleep apnea and hypopnea syndrome. J Zhejiang Univ Sci B. 2015;16(11):931–9. 10.1631/jzus.B1500100 . Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009;179(10):962–6. 10.1164/rccm.200806-981OC . Wu C, Lu Z, Chen L, Nie G, Lu Y, Tao J. [Effects of orofacial myofunctional therapy on postoperative outcomes of upper airway surgery for adults with severe obstructive sleep apnea]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022;36(12):916–20. 10.13201/j.issn.2096-7993.2022.12.005 . Chinese. Arslan E, Şevgin Ö. The effects of Aerobic and oropharyngeal exercises on sleep quality of patients with obstructive sleep Apnoea syndrome: a randomized controlled study. Sleep Breath. 2024;28(6):2729–36. 10.1007/s11325-024-03157-3 . Verma RK, Johnson JJR, Goyal M, Banumathy N, Goswami U, Panda NK. Oropharyngeal exercises in the treatment of obstructive sleep apnoea: our experience. Sleep Breath. 2016;20(4):1193–201. 10.1007/s11325-016-1332-1 . Paolucci T, Ferrillo M, Pezzi L, Agostini F, Di Matteo A, Prosperi P, et al. Efficacy of orofacial myofunctional therapy combined with myofascial release in patients with mild obstructive sleep apnoea: a randomized controlled trial. J Oral Rehabil. 2023;50(7):555–65. 10.1111/joor.13456 . Zhang F, Tian Z, Shu Y, Zou B, Yao H, Li S, et al. Efficiency of oro-facial myofunctional therapy in treating obstructive sleep apnoea: A meta-analysis of observational studies. J Oral Rehabil. 2022;49(7):734–45. 10.1111/joor.13325 . Pawar M, Venkatesan P, Mysore S, Bhat G. Effect of comprehensive rehabilitation on apnea hypopnea index in patients with obstructive sleep apnea: a protocol for randomized controlled trial. Sleep Breath. 2024;28(3):1099–104. 10.1007/s11325-023-02982-2 . Hnatiak J, Zikmund Galkova L, Winnige P, Batalik L, Dosbaba F, Ludka O, et al. Obstructive Sleep Apnea and a Comprehensive Remotely Supervised Rehabilitation Program: Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2023;12:e47460. 10.2196/47460 . Ahmed MM, Shahid N, Mumtaz N, Saqulain G. Association of social and psychological aspects of quality of life and educational level of patients with different orofacial cleft. J Pak Med Assoc. 2022;72(11):2237–40. 10.47391/JPMA.5125 . Sharples LD, Clutterbuck-James AL, Glover MJ, Bennett MS, Chadwick R, Pittman MA, et al. Meta-analysis of randomised controlled trials of oral mandibular advancement devices and continuous positive airway pressure for obstructive sleep apnoea-hypopnoea. Sleep Med Rev. 2016;27:108–24. 10.1016/j.smrv.2015.05.003 . Vimal J, Dutt P, Singh N, Singh BP, Chand P, Jurel S. To compare different non-surgical treatment modalities on treatment of obstructive sleep apnea: A systematic review and meta-analysis. J Indian Prosthodont Soc. 2022;22(4):314–27. 10.4103/jips.jips_261_22 . Friberg D, Sundman J, Browaldh N. Long-term evaluation of satisfaction and side effects after modified uvulopalatopharyngoplasty. Laryngoscope. 2020;130(1):263–8. 10.1002/lary.27917 . Tables Table I Comparison of basic population characteristics between the two groups Index Exercise group (n=60) Non-exercise group (n=60) HL MD/RR/V (95%CI) χ 2 /t/Z P Gender, n (%) Male 34 (56.7) 38 (63.3) 1.15 (0.80-1.64) 0.556 0.456 Female 26 (43.3) 22 (36.7) Age (years) , M(IQR) 38.5 (28.8, 52.0) 44.5 (35.0, 53.2) -3.5 (-8.0-1.0) -1.540 0.123 BMI (kg/m²), M(IQR) 26.35 (24.65-28.9) 26.3 (24.95-29.95) -0.4 (-2.1-0.8) -0.596 0.551 Education level, n (%) 0.050 (0.019-0.263) 0.300 0.861 Primary school 10 (16.7) 9 (15.0) Junior high school 29 (48.3) 32 (53.3) High school and above 21 (35.0) 19 (31.7) Neck circumference (cm) , M(IQR) 41.0 (38.8, 44.0) 41.0 (37.8, 43.2) 1.0 (-1.0-2.0) 0.682 0.494 Baseline AHI (times), M(IQR) 42 (35-56.5) 41.5 (32.5-46.5) 3.0 (-1.0-8.0) -1.211 0.226 Baseline LSaO2 (%), M(IQR) 71 (62.95-77.65) 74.85 (65.25-78.65) -1.9 (-5.2-1.3) -1.205 0.228 Notes: Continuous variables are presented as mean ± SD (if normally distributed; Student/Welch t test) or median (IQR) (Mann–Whitney U, Z reported). Effect sizes are reported as a single measure with 95% CI: Mean diff for t tests; HL MD (Hodges–Lehmann median difference) for Mann–Whitney; RR for 2×2 categorical; V (Cramér’s V) for r×c categorical. Differences are computed as exercise − non-exercise. Normality by Shapiro–Wilk; homogeneity by Levene. Chi-square uses the expected-count rule (≥80% cells ≥5 and all ≥1); otherwise Fisher exact test is used for 2×2 tables. HL MD CI via bootstrap (B=1000); RR CI via Katz; V CI via bootstrap. AHI, apnea hypopnea index; LSaO2, lowest oxygen saturation during sleep. Table II Comparison of clinical efficiency between the two groups Group Cured Markedly effective Effective Ineffective Total effective rate Exercise group (n=60) 8 (13.3) 30 (50.0) 15 (25.0) 7 (11.7) 53 (88.3) Non-exercise group (n=60) 4 (6.7) 24 (40.0) 14 (23.3) 18 (30.0) 42 (70.0) RR(95% CI) 1.26 (1.04–1.53) χ 2 6.114 P 0.013 Notes: Values are n (%). Total effective rate = cured + markedly effective + effective. For the 2×2 comparison, Pearson’s chi-square is used when the expected-count rule is met (≥80% of cells ≥5 and all ≥1); otherwise Fisher’s exact test is applied. Effect size is the risk ratio (RR) with Katz 95% CI. Table III Comparison of AHI, LSaO2 and PSQI scores between the two groups Index Exercise group (n=60) Non-exercise group (n=60) HL MD/ Mean diff (95%CI) Z/t P Baseline AHI (times),M(IQR) 42 (35-56.5) 41.5 (32.5-46.5) 3.0 (-1.0-8.0) -1.211 0.226 LSaO2(%),M(IQR) 71 (62.95-77.65) 74.85 (65.25-78.65) -1.9 (-5.2-1.3) -1.205 0.228 PSQI (score),M(IQR) 15 (12-17.5) 15 (13-18) 0.0 (-2.0-1.0) -0.701 0.483 Postoperative AHI,M(IQR) 13 (8-24) * 20 (13-30) * -5.0 (-9.0- -1.0) -2.505 0.012 LSaO2(%),M(IQR) 84.6 (79.65-89.25) * 82.4 (72.5-86.7) * 2.6 (-0.2-5.8) -2.197 0.028 PSQI,mean±SD 10.6±3.4 * 12.4±2.9 * -1.8 (-2.9- -0.6) -3.054 0.003 Note: Compared with before treatment in the same group, * P<0.05. Between-group tests at each time point use Welch t for approximately normal data (otherwise Mann–Whitney U; Z reported). Effect size is reported as a single measure with 95% CI: Mean diff for t tests; HL MD (Hodges–Lehmann median difference) for Mann–Whitney U. AHI, apnea–hypopnea index; LSaO2, lowest arterial oxygen saturation; PSQI, Pittsburgh Sleep Quality Index; SD, standard deviation; M(IQR), median (IQR). Differences are computed as exercise − non-exercise. Table IV Comparison of WHOQOL-BREF scores between the two groups Index Exercise group (n=60) Non-exercise group (n=60) HL MD/ Mean diff (95%CI) t/Z P Baseline Physical, mean±SD 72.7±6.7 70.5±8.2 2.2 (-0.5–4.9) 1.605 0.111 Psychological,M(IQR) 72 (66-77) 68.5 (63.5-77) 2.0 (-1.0–5.0) -1.358 0.174 Environmental,M(IQR) 72.5 (68-77) 70.5 (65.5-79) 2.0 (-1.0–5.0) -1.253 0.210 Social, mean±SD 73.5±7.1 72.0±8.2 1.5 (-1.3–4.2) 1.207 0.230 Postoperative Physical,M(IQR) 87 (81.5-92) * 78.5 (73.5-89) * 7.0 (3.0–10.0) -3.647 <0.001 Psychological, mean±SD 83.7±7.3 * 80.3±7.9 * 3.4 (0.7–6.1) 2.453 0.016 Environmental,M(IQR) 84.5 (80-89) * 83 (76.5-89.5) * 2.6 (-0.3–5.5) -1.424 0.155 Social,M(IQR) 86 (80.5-91) * 83 (79.5-89.5) * 2.0 (-1.0–5.0) -1.531 0.126 Note: Compared with before treatment in the same group, * p < 0.05. Between-group tests at each time point use Welch t for approximately normal data (otherwise Mann–Whitney U; Z reported). Effect size is reported as a single measure with 95% CI: Mean diff for t tests; HL MD (Hodges–Lehmann median difference) for Mann–Whitney U. WHOQOL-BREF domains: Physical, Psychological, Environmental, Social. SD, standard deviation; M(IQR), median (IQR). Differences are computed as exercise − non-exercise. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8075856","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":587744509,"identity":"4af08f0c-da43-4794-967f-8e7150f6ec2c","order_by":0,"name":"Pingping Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAs0lEQVRIiWNgGAWjYDCCA4wPPnyosOHhZ28gWguz4cwZZ9JkJHsOkKBlNm/bYRuDGw5E6uC7kczYzNt2nofhBgPjh485RGiRBGppnHPuNg/j7AZmyZnbiNBicDv/+IM3Zbd5mGUOsDHzEqclmbGBh+0cD5tEAglaGnnaDvDwEK1F8v5jxsYZZ5J5JHgONhPnF74zhxkbPlTY2dsfbz744SMxWpAAYwNp6kfBKBgFo2AU4AYAZxQ7ZVZkTMQAAAAASUVORK5CYII=","orcid":"","institution":"The First People’s Hospital of Linping District, Hangzhou City","correspondingAuthor":true,"prefix":"","firstName":"Pingping","middleName":"","lastName":"Zhang","suffix":""},{"id":587744510,"identity":"50606e14-f006-43bf-bf1f-a6e669ba6bcd","order_by":1,"name":"Tongfei Qu","email":"","orcid":"","institution":"The First People’s Hospital of Linping District, Hangzhou City","correspondingAuthor":false,"prefix":"","firstName":"Tongfei","middleName":"","lastName":"Qu","suffix":""},{"id":587744511,"identity":"47e65434-85ff-4cbe-ba80-ba85563f7ed8","order_by":2,"name":"Xiaona Zhang","email":"","orcid":"","institution":"The First People’s Hospital of Linping District, Hangzhou City","correspondingAuthor":false,"prefix":"","firstName":"Xiaona","middleName":"","lastName":"Zhang","suffix":""},{"id":587744512,"identity":"20351249-206c-4abc-847d-bbefe9b91a14","order_by":3,"name":"Runze Zhu","email":"","orcid":"","institution":"The First People’s Hospital of Linping District, Hangzhou City","correspondingAuthor":false,"prefix":"","firstName":"Runze","middleName":"","lastName":"Zhu","suffix":""}],"badges":[],"createdAt":"2025-11-10 10:27:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8075856/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8075856/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102239243,"identity":"ee663d80-c4ef-4049-ad8a-2df06298b5e5","added_by":"auto","created_at":"2026-02-09 16:43:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":454608,"visible":true,"origin":"","legend":"\u003cp\u003ePatient screening flow chart. UPPP, Uvulopalatopharyngoplasty; OSAHS, obstructive sleep apnea and hypopnea syndrome.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8075856/v1/f2a64cd7f60e0a52022586d1.png"},{"id":106413391,"identity":"f0fc3eb4-95f9-4bd9-a0b3-f6e82c2babd2","added_by":"auto","created_at":"2026-04-08 10:04:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1069838,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8075856/v1/dc75cba0-6743-4348-aa01-cd8e11b4731f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of pharyngeal musculature and genioglossus exercising on obstructive sleep apnea following uvulopalatopharyngoplasty","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003e​Obstructive sleep apnea and hypopnea syndrome (OSAHS) is a recurrent upper airway collapse and obstruction in sleep disorders.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e OSAHS can cause hypoxemia and sleep structural disorder at night, which can lead to multiple system complications. Such as cardiovascular and cerebrovascular diseases, metabolic disorders and cognitive dysfunction, which seriously reduce the quality of life of patients.\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e The survey found that the prevalence of OSAHS in Chinese adults was 11%, and increased with the increase of body mass index (BMI).\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e OSAHS has become a serious public health problem.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e​\u003c/p\u003e \u003cp\u003eHowever, several studies have shown that although UPPP has short-term efficacy, its long-term effectiveness is often compromised.\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e Recurrence of OSA symptoms postoperatively may be attributed to factors such as upper airway tissue relaxation, postoperative scarring, weight gain, or progression of neuromuscular dysfunction over time.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e A recent 8-year follow-up study by Sundman et al. demonstrated a significant rebound in apnea\u0026ndash;hypopnea index (AHI) several years after UPPP, especially in patients with high BMI or increasing weight post-surgery.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMeanwhile, oropharyngeal muscle training has gained increasing attention as a non-invasive intervention in OSA populations. In a recent randomized controlled trial, Marzouqah et al. applied structured oropharyngeal exercises to post-stroke OSA patients and reported significant improvements in AHI, oxygen desaturation, and sleep quality.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e Although these findings support the efficacy of targeted upper airway exercises, evidence for their use in the postoperative recovery phase of UPPP remains limited. Our study addresses this gap by investigating the clinical effects of pharyngeal and genioglossus muscle training as a postoperative rehabilitation strategy in patients undergoing UPPP.\u003c/p\u003e \u003cp\u003eUvulopalatopharyngoplasty (UPPP) is one of the most commonly used surgical procedures for the treatment of OSAHS. He et al. \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e conducted a meta-analysis of UPPP related studies and found that UPPP can achieve good results both in the short-term and long-term after surgery. UPPP can improve the upper airway obstruction by removing part of the velopharyngeal tissue and enlarging the pharyngeal cavity.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e However, the relaxation and collapse of pharyngeal muscles (such as palatoglossus and genioglossus) will occur again due to scar contraction, poor recovery of muscle function and weight gain, especially in obese patients.\u003csup\u003e[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e Therefore, how to improve the efficacy of UPPP and reduce the recurrence rate of adjuvant therapy has become an urgent problem to be solved. Brown et al. \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e also found that the decrease of upper airway muscle tension and strength was the main cause of OSAHS; In addition, Braga et al. \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e showed that the greater the anterior lingual muscle strength measured before UPPP surgery, the better the surgical effect. This indicates that increasing the physiological tension and strength of the pharyngeal muscles and genioglossal muscles may help to maintain the patency of the pharyngeal cavity after UPPP, thereby improving the efficiency of surgical treatment.\u003csup\u003e[\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAt present, the clinical evidence-based evidence about the influence of pharyngeal cavity and genioglossal muscle functional exercise on the effect of UPPP is still weak. Therefore, the clinical data of pharyngeal cavity and genioglossal muscle function exercise in patients with OSAHS after UPPP operation were retrospectively analyzed. In order to provide new ideas for the selection of surgical methods and personalized and precise treatment of OSAHS patients.​\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e\u003cem\u003ePatients\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis is a retrospective cohort study conducted in the first people's Hospital of Linping District, Hangzhou. They included 120 patients of OSAHS who received UPPP between October 2022 and October 2024. Sixty patients who received pharyngeal and genioglossal muscle exercises were matched with the cohort who did not receive any exercise in a 1:1 ratio. The matching conditions are gender, age BMI、\u0026nbsp;Education level, neck circumference, apnea hypopnea index (AHI) and lowest oxygen saturation during sleep (LSaO2). AHI and LSaO2 were recorded by polysomnography (PSG). All patients underwent two overnight polysomnography (PSG) assessments: the first at baseline (prior to initiation of the exercise program), and the second at 6 months postoperatively. The exercise training began approximately 1 month after UPPP, when the surgical site was confirmed to be healed. The 6-month PSG was scheduled after a 5-month training period, with both tests conducted in the same sleep laboratory using standardized procedures.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInclusion criteria\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e- It meets the diagnostic criteria of OSAHS;\u003csup\u003e[1]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e- AHI ≥ 15 times/hour, LSaO2＜85%;\u003csup\u003e[16]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e- 18-65 years old;\u003c/p\u003e\n\u003cp\u003e- The occlusive plane was in oropharyngeal region;\u003c/p\u003e\n\u003cp\u003e- The clinical data are complete.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eExclusion criteria\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e- Patients with central sleep apnea syndrome;\u003c/p\u003e\n\u003cp\u003e- Severe cardiovascular and cerebrovascular diseases;\u003c/p\u003e\n\u003cp\u003e- Airway obstruction was not at oropharyngeal level;\u003c/p\u003e\n\u003cp\u003e- Scar constitution;\u003c/p\u003e\n\u003cp\u003e- Overlap syndrome;\u003c/p\u003e\n\u003cp\u003e- Recurrence occurred during the follow-up period.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to the 2011 revised Guidelines for the Diagnosis and Treatment of Obstructive Sleep Apnea–Hypopnea Syndrome (OSAHS) issued by the Sleep-Disordered Breathing Group of the Chinese Thoracic Society (Chinese Medical Association), moderate OSAHS is defined as an AHI \u0026gt;15 to\u0026nbsp;≤30 events per hour; an AHI of exactly 15 events/h falls within the mild range.\u003csup\u003e[16]\u003c/sup\u003e Therefore, the inclusion criterion of AHI\u0026nbsp;≥\u0026nbsp;15 was set to ensure that only moderate to severe OSAHS patients were enrolled, which is consistent with the indications for UPPP. In addition, all patients had a lowest oxygen saturation (LSaO2) \u0026lt; 85%, further confirming disease severity. In fact, the median AHI of both groups exceeded 40, indicating that the vast majority of included patients were in the severe category. This inclusion threshold is widely accepted in clinical research and has been adopted in previous studies and surgical outcome evaluations for OSAHS.\u003csup\u003e[5]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePreoperative airway assessment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll patients underwent a standardized preoperative evaluation before UPPP. This included a detailed clinical history, physical otolaryngologic examination, and overnight polysomnography to confirm the diagnosis and severity of OSAHS. Upper airway obstruction at the oropharyngeal level was assessed by experienced otolaryngologists using awake nasopharyngoscopy in all patients, and Müller’s maneuver was performed in selected cases to further evaluate dynamic pharyngeal collapse. Drug-induced sleep endoscopy (DISE) was not routinely performed due to resource limitations, but surgical candidacy for UPPP was determined based on the comprehensive clinical and endoscopic findings.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData collection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe following clinical data were collected for all participants at baseline and 6 months postoperatively: (1) demographic characteristics including age, gender, body mass index (BMI), neck circumference, and education level; (2) polysomnography parameters such as apnea–hypopnea index (AHI) and lowest oxygen saturation during sleep (LSaO2); (3) sleep quality scores measured by the Pittsburgh Sleep Quality Index (PSQI); (4) health-related quality of life scores assessed by the WHOQOL-BREF questionnaire; (5) treatment response categorized by AHI-based efficacy grading.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eUPPP\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eGeneral anesthesia via nasal intubation. The fat, bilateral tonsils, palatoglossal arch and palatopharyngeal arch in the palatine velum space were excised. The palatopharyngeal muscle was suspended and sutured; Tension free contraposition suture of mucosa; Truncate the hypertrophic uvula; Enlarge the left-right and anterior posterior diameters of pharyngeal cavity. After the operation, the patients were instructed to reduce weight, quit smoking and alcohol, and try to sleep on their sides only. All surgeries were performed by the same otolaryngology team using a standardized surgical technique, ensuring procedural consistency across patients.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePharyngeal musculature and genioglossus exercising\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe terminology \"\u003cem\u003epharyngeal musculature and genioglossus exercising\u003c/em\u003e\" was selected to reflect the anatomical and functional regions targeted by the intervention, including the genioglossus, palatoglossus, pharyngeal constrictors, and buccinator muscles. These exercises were designed to enhance neuromuscular tone in the upper airway and simulate functional actions such as breathing and swallowing.\u003c/p\u003e\n\u003cp\u003eOne month after UPPP, if the suture at the surgical site fell off cleanly, the mucosa recovered well, and there was no bleeding, pain, or swallowing discomfort, the exercise program was initiated. Patients were instructed to open their mouth and extend their tongue 10 times each morning and evening. Submental massage was performed using the thumb pulp for 1 minute, followed by forward and upward chin pressure with the thumb for 10 repetitions (5 seconds each). Patients were also asked to perform 10 cheek-puffing maneuvers (buccal ballooning), where the cheeks were puffed while the lips were closed, holding each for 5 seconds. Then, they pinched their nose and closed their mouth 10 times (5 seconds each), followed by deep nasal breathing with the mouth closed for 20 repetitions. These exercises were selected based on previous studies that demonstrated their effectiveness in targeting upper airway dilator muscles.\u003csup\u003e[17,18]\u003c/sup\u003e Specifically, they activate the genioglossus, palatoglossus, platysma, and pharyngeal constrictors. These maneuvers simulate tongue protrusion, soft palate movement, and pharyngeal wall tightening, which are crucial for maintaining airway patency. Regular repetition aims to strengthen muscle tone, reduce airway collapsibility, and improve sleep-related respiratory function. After each training session, patients were required to submit photos or videos via the WeChat application as daily check-ins. Medical staff reviewed these submissions weekly to evaluate compliance, provide feedback, and issue reminders as needed. This approach ensured objective documentation and continuous supervision. Patients were also followed up at least once a month to monitor progress and reinforce adherence.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMain outcome\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe main outcome was clinical efficacy. 1) Cured (AHI \u0026lt; 5 times/h); 2) Markedly effective (AHI \u0026lt; 20 times/h and the decreased range ≥ 50%); 3) Effective ( AHI decreased ≥ 50%, but not reduced to less than 20 times/h); 4) Ineffective ( AHI decreased by\u0026lt;50%). Total effective rate= (cured + markedly effective + effective) / total number.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese efficacy thresholds were adapted from the “Guidelines for the Diagnosis and Treatment of Obstructive Sleep Apnea–Hypopnea Syndrome (OSAHS)” issued by the Sleep-Disordered Breathing Group of the Chinese Thoracic Society (Chinese Medical Association) and are also consistent with efficacy grading systems used in previous domestic studies.\u003csup\u003e[5]\u0026nbsp;\u003c/sup\u003eAn AHI \u0026lt; 5/h is commonly accepted as a normalized level, while a\u0026nbsp;≥50% reduction is considered a clinically meaningful response in both Chinese and international literature.\u003csup\u003e[18]\u003c/sup\u003e These criteria were selected to facilitate interpretation of therapeutic outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSecondary outcomes\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe secondary outcomes were AHI, changes in sleep quality and quality of life, recurrence and adverse reactions. 1) Pittsburgh sleep quality index (PSQI) was used to evaluate sleep quality: it was composed of 19 self-rated items and 5 other rated items, of which 18 items were composed of 7 factors, and each factor was scored according to the 0-3 score level; The cumulative score of each factor component is the total score of PSQI, and the total score range is 0-21 points; The higher the score, the worse the sleep quality. 2) The quality of life was assessed using the World Health Organisation Quality of Life tool (WHOQOL-BREF) score; The scale is divided into four dimensions: physical, psychological, environmental and social domains, with a single dimension of 0-100 points; The higher the score, the higher the quality of life.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical methods\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe used SPSS statistical software Windows version 25.0 (IBM, USA) for statistical analysis. The baseline demographic and clinical characteristics of the two groups were compared by Pearson chi square test. According to the normality of the data, the independent sample t test and Mann Whitney test were used to compare the continuous variables. The normality of continuous variables is tested by Shapiro Wilks test. If the normality is violated, we use Mann Whitney test. For the measurement of classification results, we use Pearson chi square test (or Fisher exact test, if the expected frequency of any cell in the contingency table is less than 1) to compare the differences between groups. Double sided \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05 was considered statistically significant. In addition to hypothesis testing, effect sizes with 95% confidence intervals were calculated to quantify the magnitude of between-group differences. For approximately normally distributed continuous variables analyzed with t tests, we report mean differences (exercise − non-exercise) with parametric 95% CIs. For non-normally distributed continuous variables compared using the Mann–Whitney U test, we report the Hodges–Lehmann median difference (HL MD) with bias‑corrected bootstrap 95% CIs (B = 1000). For binary outcomes, we report risk ratios (RRs) with Katz 95% CIs. For r × c categorical variables, we report Cramér’s V with bootstrap 95% CIs. All effect sizes and their confidence intervals are presented in Table I-IV. As this was a retrospective cohort study, no a priori power calculation was performed. Instead, all eligible patients during the study period were included, and 1:1 group matching was conducted based on key variables (gender, age, BMI, education level, neck circumference, AHI, and LSaO2) to improve comparability. In future prospective trials, formal sample size estimation will be conducted to enhance statistical rigor.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eFrom October 2022 to October 2024, we enrolled 231 OSAHS patients who received UPPP, excluded 84 cases, and finally 207 cases met the conditions of this study. Among them, 95 cases received pharyngeal cavity and genioglossal muscle functional exercise after UPPP (exercise group), and 112 cases did not receive any exercise (non-exercise group). The two groups were matched in a ratio of 1:1, with 60 patients in each group (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e); The matching conditions are gender, age, BMI, education level, neck circumference, etc. There was no significant difference in demographic characteristics and baseline AHI and LSaO2 scores between the two groups (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table I). Additionally, effect sizes for baseline comparisons are provided in Table I to facilitate understanding of between-group equivalence prior to intervention.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table II, six months after operation, the clinical effective rate of the exercise group was 88.3% (53/60), and that of the non-exercise group was 70.0% (42/60). The clinical effective rate of the exercise group was significantly higher than that of the non-exercise group ( \u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.114, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ).​ The between-group risk ratio (RR) for clinical effectiveness was also calculated and is shown in Table II, indicating a favorable effect of the intervention.\u003c/p\u003e \u003cp\u003eAs shown in Table III, there was no significant difference in baseline AHI, LSaO2, and PSQI levels between the two groups (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). At 6 months postoperatively, the exercise group showed significantly lower AHI and PSQI scores and higher LSaO2 compared to the non-exercise group (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Importantly, the between-group effect size for AHI was a Hodges\u0026ndash;Lehmann median difference of -5.0 events/h (95% CI: -9.0 to -1.0), and for PSQI was \u0026minus;\u0026thinsp;1.8 points (95% CI: -2.9 to -0.6). These improvements are considered both statistically and clinically meaningful. LSaO2 also improved, with a median difference of 2.6% (95% CI: -0.2 to 5.8), approaching clinically relevant thresholds.\u003c/p\u003e \u003cp\u003eAs shown in Table IV, there were no significant differences in baseline WHOQOL-BREF domain scores between the groups. At 6 months, both groups showed improvements across all domains (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, the exercise group demonstrated significantly greater improvements in the physical and psychological domains. The effect size for physical health was 7.0 points (95% CI: 3.0 to 10.0) and for psychological health was 3.4 points (95% CI: 0.7 to 6.1). These differences reflect meaningful functional and emotional benefits. No significant between-group differences were found in environmental and social domain scores.​\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur findings demonstrated that patients who engaged in pharyngeal musculature and genioglossus exercising after UPPP achieved significantly greater clinical efficacy, improved sleep quality, and better quality of life compared to those who did not exercise. These improvements were reflected across AHI, PSQI, and WHOQOL-BREF scores, aligning with previous studies reporting benefits of upper airway muscle training in OSAHS management.\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFrom a pathophysiological perspective, the beneficial effects of pharyngeal musculature and genioglossus exercising observed in our study are likely mediated by improvements in upper airway neuromuscular function. Repetitive activation of the genioglossus, soft palate, and pharyngeal constrictor muscles may increase baseline muscle tone and endurance, enhance coordination between dilator muscles, and thereby reduce pharyngeal collapsibility during sleep. These mechanisms are consistent with previous randomized and feasibility trials showing that oropharyngeal muscle training can reduce AHI, improve oxygenation, and enhance sleep-related quality of life in patients with moderate OSA or post-stroke OSA.\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e Strengthening the upper airway dilator muscles may thus represent a physiologically targeted and non-invasive strategy to support postoperative airway stability after UPPP.\u003c/p\u003e \u003cp\u003eIn addition to statistical significance, the observed differences demonstrated meaningful effect sizes with clinical implications. For example, the exercise group showed a median AHI reduction of 5.0 events/h compared to the non-exercise group (HL MD: -5.0; 95% CI: -9.0 to -1.0), which may correspond to a shift in OSAHS severity classification for many patients. The PSQI score also improved significantly (mean difference: -1.8; 95% CI: -2.9 to -0.6), which exceeds the threshold typically considered meaningful for subjective sleep quality improvement. Furthermore, improvements in WHOQOL-BREF domains, especially in the physical (HL MD: 7.0; 95% CI: 3.0 to 10.0) and psychological (mean difference: 3.4; 95% CI: 0.7 to 6.1) dimensions, suggest not only enhanced function but also potential gains in patients\u0026rsquo; daily performance and well-being. These results support the practical value of pharyngeal musculature and genioglossus exercising as a postoperative adjunct therapy after UPPP.\u003c/p\u003e \u003cp\u003eThe oropharyngeal exercise protocol adopted in our study was based on prior evidence from Tang et al. \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, Guimar\u0026atilde;es et al. \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, and others, which targeted upper airway dilator muscles such as the genioglossus, palatine, and platysma. These exercises were initiated one month after UPPP when wound healing was confirmed. The intervention was simple, noninvasive, and supported by daily WeChat-based adherence monitoring. The potential mechanism may involve enhanced muscle tone and reduced pharyngeal compliance, contributing to postoperative airway stability.\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e We recommend implementing such exercises for at least three months after UPPP to support functional recovery and long-term efficacy maintenance.\u003csup\u003e[\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHowever, there was no significant difference in the scores of environmental and social domains between the two groups at 6 months after operation. This may be related to the selection of subjects, exercise methods and intensity, follow-up time and other factors. Six months after surgery, it may only cover the short-term rehabilitation stage, while the overall improvement of social function (such as returning to work, social circle reconstruction) usually lags behind the recovery of physiological function.\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e The environmental field may be dominated by personal and family economic conditions. In addition, friberg et al. \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e showed that one third of patients had side effects after UPPP, including hysteria ball, mucus, voice and dysphagia, especially elderly patients. However, this study did not analyze the side effects and recurrence rate of patients. This is mainly because the beginning of pharyngeal musculature and genioglossus exercising was reviewed one month after operation, excluding patients with bleeding, pain, dysphagia and so on.\u003c/p\u003e \u003cp\u003eAlthough this study confirmed that pharyngeal musculature and genioglossus exercising effectively improved the therapeutic outcomes of UPPP in patients with OSAHS, several limitations must be acknowledged. First, the current study was a single-center, retrospective analysis with a relatively small sample size, which may limit the generalizability of the findings. Second, although improvements in AHI, LSaO2, and quality of life were observed, no direct assessments of muscle-level function (e.g., tongue pressure or electromyography) were performed. This restricts our ability to elucidate the physiological mechanisms underlying the clinical benefits. Third, the exercise intervention was patient-led, and individual differences in execution or compliance may have affected outcome consistency. Fourth, while the intervention appeared effective in the short term, long-term outcomes, including recurrence rates after UPPP, remain unclear. Muscle adaptation may require extended time, and further studies with prolonged follow-up are needed to assess sustained efficacy. Additionally, we acknowledge that clinical efficacy definitions based on AHI reduction are not yet standardized internationally, which may limit cross-study comparisons. In the future, well-designed, multi-center, prospective randomized controlled trials are warranted to validate these findings and to explore the use of oropharyngeal muscle training as a standardized postoperative rehabilitation strategy for OSAHS patients following UPPP.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e​​\u003c/h2\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003ePharyngeal musculature and genioglossus exercising following UPPP may improve AHI, sleep quality, and overall quality of life in patients with OSAHS. While these findings are promising, the retrospective and single-center design limits generalizability. Future large-scale, high-quality prospective studies are needed to validate these results and assess long-term outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOSAHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eobstructive sleep apnea and hypopnea syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUPPP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003euvulopalatopharyngoplasty\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAHI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eapnea hypopnea index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLSaO2\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elowest oxygen saturation during sleep\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePSQI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePittsburgh sleep quality index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHOQOL-BREF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organisation Quality of Life tool\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebody mass index.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e The ethics committee of The First People\u0026rsquo;s Hospital of Linping District, Hangzhou City approved this study. All procedures involving human subjects adhered to the 1964 Declaration of Helsinki and its subsequent amendments or equivalent ethical standards. Given the retrospective nature of the study, informed consent was waived by the Ethical Committee of The First People\u0026rsquo;s Hospital of Linping District, Hangzhou City. All data were stored securely, and confidentiality was maintained throughout the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003e2024 Zhejiang medical and health science and technology plan project (special innovation guidance 2024649698).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBrodie KD, Goldberg AN. Obstructive Sleep Apnea: A Surgeon's Perspective. Med Clin North Am. 2021;105(5):885\u0026ndash;900. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.mcna.2021.05.010\u003c/span\u003e\u003cspan address=\"10.1016/j.mcna.2021.05.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalhotra A, Mesarwi O, Pepin JL, Owens RL. Endotypes and phenotypes in obstructive sleep apnea. Curr Opin Pulm Med. 2020;26(6):609\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MCP.0000000000000724\u003c/span\u003e\u003cspan address=\"10.1097/MCP.0000000000000724\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSu XF, Liu L, Zhong L, Qian XS, Han JM. Prevalence of obstructive sleep apnea syndrome in China: a meta-analysis. China J Evidence-Based Med. 2021;21(10):1187\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7507/1672-2531.202106103\u003c/span\u003e\u003cspan address=\"10.7507/1672-2531.202106103\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRead N, Jennings C, Hare A. Obstructive sleep apnoea-hypopnoea syndrome. Emerg Top Life Sci. 2023;7(5):467\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1042/ETLS20180939\u003c/span\u003e\u003cspan address=\"10.1042/ETLS20180939\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi M, Zheng H, Chen S, Chen D, Wang W. [Effect of denervating duration on the surgical outcome of laryngeal reinnervation in patients with unilateral vocal fold paralysis]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016;51(1):57\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3760/cma.j.issn.1673-0860.2016.01.009\u003c/span\u003e\u003cspan address=\"10.3760/cma.j.issn.1673-0860.2016.01.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe M, Yin G, Zhan S, Xu J, Cao X, Li J, et al. Long-term Efficacy of Uvulopalatopharyngoplasty among Adult Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2019;161(3):401\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0194599819840356\u003c/span\u003e\u003cspan address=\"10.1177/0194599819840356\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoay CB, Freeland AP, Stradling JR. Short- and long-term outcomes of uvulopalatopharyngoplasty for snoring. Clin Otolaryngol Allied Sci. 1995;20(1):45\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1365-2273.1995.tb00010.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1365-2273.1995.tb00010.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSundman J, Browaldh N, Fehrm J, Friberg D. Eight-Year Follow-up of Modified Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea. Laryngoscope. 2021;131(1):E307\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/lary.28960\u003c/span\u003e\u003cspan address=\"10.1002/lary.28960\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarzouqah R, Dharmakulaseelan L, Colelli DR, Lindo CJ, Costa YS, Jairam T, et al. Strengthening oropharyngeal muscles as an approach to treat post-stroke obstructive sleep apnea: A feasibility randomised controlled trial. J Sleep Res. 2024;33(4):e14086. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jsr.14086\u003c/span\u003e\u003cspan address=\"10.1111/jsr.14086\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe M, Yin G, Zhan S, Xu J, Cao X, Li J, et al. Long-term Efficacy of Uvulopalatopharyngoplasty among Adult Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2019;161(3):401\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0194599819840356\u003c/span\u003e\u003cspan address=\"10.1177/0194599819840356\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheen D, Abdulateef S, Uvulopalatopharyngoplasty. Oral Maxillofac Surg Clin North Am. 2021;33(2):295\u0026ndash;303. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.coms.2021.01.001\u003c/span\u003e\u003cspan address=\"10.1016/j.coms.2021.01.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoi JH, Cho SH, Kim SN, Suh JD, Cho JH. Predicting Outcomes after Uvulopalatopharyngoplasty for Adult Obstructive Sleep Apnea: A Meta-analysis. Otolaryngol Head Neck Surg. 2016;155(6):904\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0194599816661481\u003c/span\u003e\u003cspan address=\"10.1177/0194599816661481\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrown EC, Cheng S, McKenzie DK, Butler JE, Gandevia SC, Bilston LE. Respiratory Movement of Upper Airway Tissue in Obstructive Sleep Apnea. \u003cem\u003eSleep\u003c/em\u003e. 2013;36(7):1069\u0026ndash;1076. Published 2013 Jul 1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5665/sleep.2812\u003c/span\u003e\u003cspan address=\"10.5665/sleep.2812\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraga A, Grechi TH, Eckeli A, Vieira BB, Itikawa CE, K\u0026uuml;pper DS, et al. Predictors of uvulopalatopharyngoplasty success in the treatment of obstructive sleep apnea syndrome. Sleep Med. 2013;14(12):1266\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.sleep.2013.08.777\u003c/span\u003e\u003cspan address=\"10.1016/j.sleep.2013.08.777\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTang S, Wang Y, Qing J, Jiang Y, Lu X, Yao S, et al. [Exercise pharynx and genioglossus to treat obstructive sleep apnea and hypopnea syndrome]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013;27(15):822\u0026ndash;6. Chinese. PMID: 24364108.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChinese Thoracic Society, Sleep-Disordered Breathing Group. Guidelines for the diagnosis and treatment of obstructive sleep apnea\u0026ndash;hypopnea syndrome (2011 revision). Chin J Tuberculosis Respiratory Dis. 2012;35(1):9\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3760/cma.j.issn.1001-0939.2012.01.007\u003c/span\u003e\u003cspan address=\"10.3760/cma.j.issn.1001-0939.2012.01.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTang SX, Qing J, Wang YW, Chai L, Zhang WM, Ye XW, et al. Clinical analysis of pharyngeal musculature and genioglossus exercising to treat obstructive sleep apnea and hypopnea syndrome. J Zhejiang Univ Sci B. 2015;16(11):931\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1631/jzus.B1500100\u003c/span\u003e\u003cspan address=\"10.1631/jzus.B1500100\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuimar\u0026atilde;es KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009;179(10):962\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1164/rccm.200806-981OC\u003c/span\u003e\u003cspan address=\"10.1164/rccm.200806-981OC\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu C, Lu Z, Chen L, Nie G, Lu Y, Tao J. [Effects of orofacial myofunctional therapy on postoperative outcomes of upper airway surgery for adults with severe obstructive sleep apnea]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022;36(12):916\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.13201/j.issn.2096-7993.2022.12.005\u003c/span\u003e\u003cspan address=\"10.13201/j.issn.2096-7993.2022.12.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Chinese.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArslan E, Şevgin \u0026Ouml;. The effects of Aerobic and oropharyngeal exercises on sleep quality of patients with obstructive sleep Apnoea syndrome: a randomized controlled study. Sleep Breath. 2024;28(6):2729\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11325-024-03157-3\u003c/span\u003e\u003cspan address=\"10.1007/s11325-024-03157-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerma RK, Johnson JJR, Goyal M, Banumathy N, Goswami U, Panda NK. Oropharyngeal exercises in the treatment of obstructive sleep apnoea: our experience. Sleep Breath. 2016;20(4):1193\u0026ndash;201. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11325-016-1332-1\u003c/span\u003e\u003cspan address=\"10.1007/s11325-016-1332-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaolucci T, Ferrillo M, Pezzi L, Agostini F, Di Matteo A, Prosperi P, et al. Efficacy of orofacial myofunctional therapy combined with myofascial release in patients with mild obstructive sleep apnoea: a randomized controlled trial. J Oral Rehabil. 2023;50(7):555\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/joor.13456\u003c/span\u003e\u003cspan address=\"10.1111/joor.13456\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang F, Tian Z, Shu Y, Zou B, Yao H, Li S, et al. Efficiency of oro-facial myofunctional therapy in treating obstructive sleep apnoea: A meta-analysis of observational studies. J Oral Rehabil. 2022;49(7):734\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/joor.13325\u003c/span\u003e\u003cspan address=\"10.1111/joor.13325\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePawar M, Venkatesan P, Mysore S, Bhat G. Effect of comprehensive rehabilitation on apnea hypopnea index in patients with obstructive sleep apnea: a protocol for randomized controlled trial. Sleep Breath. 2024;28(3):1099\u0026ndash;104. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11325-023-02982-2\u003c/span\u003e\u003cspan address=\"10.1007/s11325-023-02982-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHnatiak J, Zikmund Galkova L, Winnige P, Batalik L, Dosbaba F, Ludka O, et al. Obstructive Sleep Apnea and a Comprehensive Remotely Supervised Rehabilitation Program: Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2023;12:e47460. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2196/47460\u003c/span\u003e\u003cspan address=\"10.2196/47460\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed MM, Shahid N, Mumtaz N, Saqulain G. Association of social and psychological aspects of quality of life and educational level of patients with different orofacial cleft. J Pak Med Assoc. 2022;72(11):2237\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.47391/JPMA.5125\u003c/span\u003e\u003cspan address=\"10.47391/JPMA.5125\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharples LD, Clutterbuck-James AL, Glover MJ, Bennett MS, Chadwick R, Pittman MA, et al. Meta-analysis of randomised controlled trials of oral mandibular advancement devices and continuous positive airway pressure for obstructive sleep apnoea-hypopnoea. Sleep Med Rev. 2016;27:108\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.smrv.2015.05.003\u003c/span\u003e\u003cspan address=\"10.1016/j.smrv.2015.05.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVimal J, Dutt P, Singh N, Singh BP, Chand P, Jurel S. To compare different non-surgical treatment modalities on treatment of obstructive sleep apnea: A systematic review and meta-analysis. J Indian Prosthodont Soc. 2022;22(4):314\u0026ndash;27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/jips.jips_261_22\u003c/span\u003e\u003cspan address=\"10.4103/jips.jips_261_22\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFriberg D, Sundman J, Browaldh N. Long-term evaluation of satisfaction and side effects after modified uvulopalatopharyngoplasty. Laryngoscope. 2020;130(1):263\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/lary.27917\u003c/span\u003e\u003cspan address=\"10.1002/lary.27917\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable I Comparison of basic population characteristics between the two groups\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"634\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 214px;\"\u003e\n \u003cp\u003eIndex\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eExercise group (n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNon-exercise group (n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003eHL MD/RR/V\u003cbr\u003e\u0026nbsp;(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e/t/Z\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eGender, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e34 (56.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e38 (63.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e1.15 (0.80-1.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.456\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e26 (43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e22 (36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 214px;\"\u003e\n \u003cp\u003eAge (years) , M(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e38.5 (28.8, 52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e44.5 (35.0, 53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e-3.5 (-8.0-1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-1.540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 214px;\"\u003e\n \u003cp\u003eBMI (kg/m\u0026sup2;), M(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e26.35 (24.65-28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e26.3 (24.95-29.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e-0.4 (-2.1-0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-0.596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.551\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 214px;\"\u003e\n \u003cp\u003eEducation level, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e0.050 (0.019-0.263)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.861\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 214px;\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e10 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e9 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 214px;\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e29 (48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 214px;\"\u003e\n \u003cp\u003eHigh school and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e21 (35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e19 (31.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 214px;\"\u003e\n \u003cp\u003eNeck circumference (cm) , M(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e41.0 (38.8, 44.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e41.0 (37.8, 43.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e1.0 (-1.0-2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.682\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 214px;\"\u003e\n \u003cp\u003eBaseline AHI (times), M(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e42 (35-56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e41.5 (32.5-46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e3.0 (-1.0-8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-1.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 214px;\"\u003e\n \u003cp\u003eBaseline LSaO2 (%), M(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e71 (62.95-77.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e74.85 (65.25-78.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e-1.9 (-5.2-1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-1.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNotes: Continuous variables are presented as mean \u0026plusmn; SD (if normally distributed; Student/Welch t test) or median (IQR) (Mann\u0026ndash;Whitney U, Z reported). Effect sizes are reported as a single measure with 95% CI: Mean diff for t tests; HL MD (Hodges\u0026ndash;Lehmann median difference) for Mann\u0026ndash;Whitney; RR for 2\u0026times;2 categorical; V (Cram\u0026eacute;r\u0026rsquo;s V) for r\u0026times;c categorical. Differences are computed as exercise \u0026minus; non-exercise. Normality by Shapiro\u0026ndash;Wilk; homogeneity by Levene. Chi-square uses the expected-count rule (\u0026ge;80% cells \u0026ge;5 and all \u0026ge;1); otherwise Fisher exact test is used for 2\u0026times;2 tables. HL MD CI via bootstrap (B=1000); RR CI via Katz; V CI via bootstrap. AHI, apnea hypopnea index; LSaO2, lowest oxygen saturation during sleep.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eTable II Comparison of clinical efficiency between the two groups\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eCured\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003eMarkedly effective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eEffective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eIneffective\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003eTotal effective rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003eExercise group (n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e8 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e30 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e15 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e7 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e53 (88.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003eNon-exercise group (n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e4 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e24 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e14 (23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e18 (30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e42 (70.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003eRR(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e1.26 (1.04\u0026ndash;1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e6.114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNotes: Values are n (%). Total effective rate = cured + markedly effective + effective. For the 2\u0026times;2 comparison, Pearson\u0026rsquo;s chi-square is used when the expected-count rule is met (\u0026ge;80% of cells \u0026ge;5 and all \u0026ge;1); otherwise Fisher\u0026rsquo;s exact test is applied. Effect size is the risk ratio (RR) with Katz 95% CI.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eTable III Comparison of AHI, LSaO2 and PSQI scores between the two groups\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"107%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eIndex\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eExercise group (n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eNon-exercise group (n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eHL MD/ Mean diff (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ/t\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eAHI (times),M(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e42 (35-56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e41.5 (32.5-46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e3.0 (-1.0-8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-1.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eLSaO2(%),M(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e71 (62.95-77.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e74.85 (65.25-78.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e-1.9 (-5.2-1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-1.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003ePSQI (score),M(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e15 (12-17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e15 (13-18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.0 (-2.0-1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.483\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eAHI,M(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e13 (8-24)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e20 (13-30)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e-5.0 (-9.0- -1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-2.505\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eLSaO2(%),M(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e84.6 (79.65-89.25)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e82.4 (72.5-86.7)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e2.6 (-0.2-5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-2.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003ePSQI,mean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e10.6\u0026plusmn;3.4\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e12.4\u0026plusmn;2.9\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e-1.8 (-2.9- -0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-3.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: Compared with before treatment in the same group,\u0026nbsp;\u003csup\u003e*\u003c/sup\u003eP\u0026lt;0.05. Between-group tests at each time point use Welch t for approximately normal data (otherwise Mann\u0026ndash;Whitney U; Z reported). Effect size is reported as a single measure with 95% CI: Mean diff for t tests; HL MD (Hodges\u0026ndash;Lehmann median difference) for Mann\u0026ndash;Whitney U. AHI, apnea\u0026ndash;hypopnea index; LSaO2, lowest arterial oxygen saturation; PSQI, Pittsburgh Sleep Quality Index; SD, standard deviation; M(IQR), median (IQR). Differences are computed as exercise \u0026minus; non-exercise.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable IV Comparison of WHOQOL-BREF scores between the two groups\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"109%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIndex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eExercise group (n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-exercise group (n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHL MD/ Mean diff (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003et/Z\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePhysical, mean±SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72.7±6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e70.5±8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.2 (-0.5–4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.605\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePsychological,M(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72 (66-77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e68.5 (63.5-77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.0 (-1.0–5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.358\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eEnvironmental,M(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72.5 (68-77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e70.5 (65.5-79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.0 (-1.0–5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.210\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSocial, mean±SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e73.5±7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72.0±8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.5 (-1.3–4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePhysical,M(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e87 (81.5-92)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e78.5 (73.5-89)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.0 (3.0–10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-3.647\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePsychological, mean±SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.7±7.3\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80.3±7.9\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.4 (0.7–6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eEnvironmental,M(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e84.5 (80-89)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83 (76.5-89.5)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.6 (-0.3–5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSocial,M(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e86 (80.5-91)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83 (79.5-89.5)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.0 (-1.0–5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: Compared with before treatment in the same group,\u0026nbsp;\u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05. Between-group tests at each time point use Welch t for approximately normal data (otherwise Mann–Whitney U; Z reported). Effect size is reported as a single measure with 95% CI: Mean diff for t tests; HL MD (Hodges–Lehmann median difference) for Mann–Whitney U. WHOQOL-BREF domains: Physical, Psychological, Environmental, Social. SD, standard deviation; M(IQR), median (IQR). Differences are computed as exercise − non-exercise.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"pharyngeal cavity, genioglossus muscle, exercise, obstructive sleep apnea and hypopnea syndrome, uvulopalatopharyngoplasty","lastPublishedDoi":"10.21203/rs.3.rs-8075856/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8075856/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to evaluate the effectiveness of pharyngeal musculature and genioglossus exercising as a postoperative rehabilitation intervention for patients with obstructive sleep apnea (OSA) following uvulopalatopharyngoplasty (UPPP)\u0026mdash;a setting with limited prior evidence.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis is a retrospective cohort study conducted in the first people's Hospital of Linping District, Hangzhou. They included 120 patients of OSAHS who received UPPP between October 2022 and October 2024. Sixty patients who received pharyngeal and genioglossal muscle exercises were matched with the cohort who did not receive any exercise in a 1:1 ratio. The main outcome was the clinical efficacy 6 months after operation. The secondary outcomes were the changes of apnea hypopnea index (AHI), lowest oxygen saturation during sleep (LSaO2), Pittsburgh sleep quality index (PSQI), and the World Health Organisation Quality of Life tool (WHOQOL-BREF) score.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSix months after operation, the clinical effective rate of the exercise group was significantly higher than that of the non-exercise group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Before operation, there was no significant difference in AHI, LSaO2, PSQI and WHOQOL-BREF scores between the two groups (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Six months after operation, the AHI,LSaO2, PSQI and WHOQOL-BREF scores of the two groups were significantly improved, and the AHI, LSaO2, PSQI, physical and psychological scores of the exercise group were better than those of the non-exercise group (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05); However, there was no significant difference in the scores of environment and social domains between the two groups (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePharyngeal musculature and genioglossus exercising may improve postoperative outcomes and quality of life in patients undergoing UPPP, and could be considered a promising rehabilitation strategy in clinical practice.\u003c/p\u003e","manuscriptTitle":"Effect of pharyngeal musculature and genioglossus exercising on obstructive sleep apnea following uvulopalatopharyngoplasty","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 16:43:40","doi":"10.21203/rs.3.rs-8075856/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b1d31136-acab-4d0a-ac70-1bebdf9d583c","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-08T09:49:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 16:43:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8075856","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8075856","identity":"rs-8075856","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}