{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T14:22:04Z","timestamp":1793110924566,"version":"4.5.0"},"reference-count":60,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Myofunctional therapy has emerged as a treatment option for obstructive sleep apnea (OSA). The Iowa Oral Performance Instrument (IOPI) enables objective measurement of lingual and orofacial muscle strength, although it was originally designed for evaluating dysphagia. OSA is frequently associated with a hypotonic phenotype characterized by reduced strength in upper airway muscles, but its identification remains unclear. Objective: We evaluated the usefulness of IOPI measurements in identifying hypotonic phenotypes among patients with obstructive sleep apnea (OSA). Methods: We carried out a cross-sectional study analyzing the relationship between IOPI scores, sleep polygraphy metrics\u2014such as the apnea\u2013hypopnea index (AHI)\u2014and findings from physical examination. In addition to the standard IOPI protocol, we introduced novel maneuvers aimed at providing a more comprehensive assessment of oropharyngeal muscle function. Results: Although IOPI conventional maneuvers showed no clear association with AHI or ODI, the inferior tongue maneuver showed higher awake tongue strength, with a statistically significant correlation to both AHI (r = 0.2873; p = 0.008) and ODI (r = 0.2495; p = 0.032). Performing each exercise three times yielded highly consistent results across trials (r &gt; 0.94), but did not significantly alter the overall outcome. Interestingly, lower tongue strength values were observed in patients with a high-arched palate (p &lt; 0.05), whereas no relevant associations were found with the presence of a restricted lingual frenulum or CPAP use. Conclusions: Incorporating specific IOPI maneuvers, especially the inferior tongue exercise, may provide additional insight into muscle function in OSA. Selective repetition is advisable for borderline values.<\/jats:p>","DOI":"10.3390\/jcm14134781","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T06:03:13Z","timestamp":1751868193000},"page":"4781","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A Novel Approach to the Study of Pathophysiology in Patients with Obstructive Sleep Apnea Using the Iowa Oral Performance Instrument (IOPI)"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0593-6257","authenticated-orcid":false,"given":"Andr\u00e9s","family":"Navarro","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, C.P. 28042 Madrid, Spain"},{"name":"Department of Otorhinolaryngology, Hospital Universitario Sanitas La Zarzuela, C.P. 28023 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8427-9624","authenticated-orcid":false,"given":"Gabriela","family":"Bosco","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, C.P. 28042 Madrid, Spain"},{"name":"Department of Otorhinolaryngology, Hospital Universitario Sanitas La Zarzuela, C.P. 28023 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e1rbara","family":"Serrano","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Complejo Hospitalario Universitario de Toledo, C.P. 45007 Toledo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6601-5331","authenticated-orcid":false,"given":"Peter","family":"Baptista","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Al Zahra Hospital, Dubai 124412, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1670-4235","authenticated-orcid":false,"given":"Carlos","family":"O\u2019Connor-Reina","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Hospital Quironsalud Marbella, C.P. 29603 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6409-4921","authenticated-orcid":false,"given":"Guillermo","family":"Plaza","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, C.P. 28042 Madrid, Spain"},{"name":"Department of Otorhinolaryngology, Hospital Universitario Sanitas La Zarzuela, C.P. 28023 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"101829","DOI":"10.1016\/j.smrv.2023.101829","article-title":"Systematic review and meta-analysis of the prevalence of obstructive sleep apnea in Indian adults","volume":"71","author":"Suri","year":"2023","journal-title":"Sleep Med. 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