口咽肌功能治療（OMT）是阻塞型睡眠呼吸中止症（OSA）的一種治療方式，需要在數週內、每週反覆練習多次口咽肌肉訓練。在傳統的治療流程中，患者需要親自前往醫院的復健門診並且由物理治療師帶領進行訓練，但是每週回門診接受復健訓練在實務上有諸多不便、難以持續落實，因此需要仰賴患者進行居家訓練。然而居家訓練屬於非監督式，物理治療師無法客觀查核是否確實完成，導致訓練成效難以評估。市面上既有的口咽肌肉訓練專用的手機應用程式並未支援個人化處方調整、中文真人示範、與遠端檢視訓練紀錄。為克服此困境，本研究旨在開發一套智能遠距口咽肌肉訓練系統，並於國立成功大學醫學院附設醫院（NCKUH）臨床導入。系統包含手機應用程式（MyoGo）、治療師網頁平台、後端系統、訓練紀錄自動上傳，以及即時舌壓回饋。
本系統以 11 位正在接受 OMT 的 OSA 患者進行評估，採用兩階段設計，比較傳統院內流程與系統支援流程。在傳統院內階段，門診回診稀疏：11 人中僅 1 人達到建議的每週回診。在系統支援階段，系統為每位病人紀錄客觀訓練數據，每週訓練次數中位數為 4 次；11 人中有 6 人於兩週皆達到至少每週 3 次的處方下限，客觀紀錄也讓物理治療師能夠在流程中客觀檢視未達處方的使用情形。相較於傳統院內階段，系統支援階段中，記錄到的完成訓練次數顯著增加（Wilcoxon 符號等級檢定， p = 0.001），且 11 位病人皆較院內階段完成更多訓練次數，完成次數中位數由 1 次增加為 8 次。病人自述單次門診往返與候診時間中位數為 60 分鐘（範圍 20–150）以行動醫療應用程式可用性問卷（MAUQ）作為輔助證據評估病人使用 MyoGo 的可用性，結果正向（整體平均 6.41／7）。
本研究顯示，所開發的系統可支援患者的居家訓練，並成功使居家訓練得以被客觀記錄並能夠讓物理治療師遠端檢視，進而重組了 OMT 的流程，同時支持 MyoGo 的可用性。此外，MyoGo 的訓練內容在未來可依照研究團隊的需求進行調整，因此未來不僅適用於 OSA 患者，亦可延伸應用於同樣需反覆進行口咽肌肉訓練的高齡吞嚥困難族群，協助其居家訓練與遠端追蹤，為後續研究的重要方向。

Oropharyngeal myofunctional therapy (OMT) is a treatment for obstructive sleep apnea (OSA) that requires repeated oropharyngeal exercises several times per week over a period of several weeks. In the conventional treatment workflow, patients must visit the hospital rehabilitation clinic in person and receive training led by a physical therapist. However, weekly clinic-based rehabilitation is often inconvenient and difficult to sustain in practice, making home-based rehabilitation necessary. Home-based training, however, is unsupervised, and the physical therapist cannot objectively verify whether it has actually been performed, which makes the effectiveness of the home-based training difficult to assess. Existing mobile applications designed for oropharyngeal exercises do not support individualized prescription adjustment, Mandarin real-person demonstrations, or remote review of training records. To address these challenges, this study aimed to develop a smart telerehabilitation system for oropharyngeal exercises and deployed it clinically at National Cheng Kung University Hospital (NCKUH). The system comprises a mobile application (MyoGo), a therapist web platform, a backend system, automatic training-log upload, and real-time tongue-strength feedback.
The system was evaluated in 11 patients with OSA undergoing OMT using a two-stage design that compared the conventional in-clinic workflow with the home-based, system-supported workflow. In the conventional stage, clinic attendance was sparse: only 1 of the 11 patients reached the recommended weekly clinic visit. In the system-supported stage, completed sessions were recorded for every patient, with a median of 4 training sessions per week and 6 of the 11 patients reached the prescribed lower bound of at least 3 sessions per week in both weeks, and the objective records also enabled the therapist to review below-prescription use objectively within the workflow. Compared with the conventional in-clinic stage, the number of completed sessions increased significantly in the system-supported stage (Wilcoxon signed-rank test, p = 0.001), and all 11 patients completed more sessions than in the in-clinic stage (median completed sessions increased from 1 to 8). Patients self-reported a median travel and waiting time of 60 minutes per clinic visit (range 20–150). The usability of MyoGo was assessed as supplementary evidence using the mHealth App Usability Questionnaire (MAUQ), with positive results (overall mean 6.41 of 7).
This study demonstrates that the developed system can support patients’ home-based training and enables home training to be objectively recorded and remotely reviewed by therapists, thereby reorganizing the OMT workflow while supporting the usability of MyoGo. Moreover, the training content of MyoGo can be adapted in the future according to the needs of the research team. The system is therefore not limited to patients with OSA but could also be extended to elders with dysphagia who likewise require repeated oropharyngeal exercises, supporting their home-based training and remote monitoring, which represents an important direction for future research.

Bascuñana-Ambrós, H., Renom-Guiteras, M., Nadal-Castells, M. J., Beranuy-Rodríguez, M., Perrot-González, J. C., Ramirez-Mirabal, E., Trejo-Omeñaca, A., & Monguet-Fierro, J. M. (2024). Swallowing muscle training for oropharyngeal dysphagia: A non-inferiority study of online versus face-to-face therapy. Journal of telemedicine and telecare, 30(1), 116–120.
Benjafield, A. V., Ayas, N. T., Eastwood, P. R., Heinzer, R., Ip, M. S., Morrell, M. J., Nunez, C. M., Patel, S. R., Penzel, T., & Pépin, J.-L. (2019). Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. The Lancet respiratory medicine, 7(8), 687–698.
Bhutada, A. M., Broughton, W. A., & Garand, K. L. (2020). Obstructive sleep apnea syndrome (OSAS) and swallowing function—a systematic review. Sleep and Breathing, 24(3), 791–799.
Chou, T. T.-C., Hsu, H.-C., Twu, C.-W., Huang, W.-K., Huang, H.-M., Weng, S.-H., & Chen, M.-C. (2023). Prevalence of obstructive sleep apnea using home sleep test in Taiwan during the coronavirus disease pandemic. Nature and Science of Sleep, 1107–1116.
Cottrell, M. A., Galea, O. A., O’Leary, S. P., Hill, A. J., & Russell, T. G. (2017). Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clinical rehabilitation, 31(5), 625–638.
De Felício, C. M., da Silva Dias, F. V., & Trawitzki, L. V. V. (2018). Obstructive sleep apnea: focus on myofunctional therapy. Nature and Science of Sleep, 271–286.
Dempsey, J. A., Veasey, S. C., Morgan, B. J., & O'Donnell, C. P. (2010). Pathophysiology of sleep apnea. Physiological reviews, 90(1), 47–112.
Erturk, N., Calik-Kutukcu, E., Arikan, H., Savci, S., Inal-Ince, D., Caliskan, H., Saglam, M., Vardar-Yagli, N., Firat, H., & Celik, A. (2020). The effectiveness of oropharyngeal exercises compared to inspiratory muscle training in obstructive sleep apnea: A randomized controlled trial. Heart & Lung, 49(6), 940–948.
Franciotti, R., Di Maria, E., D’Attilio, M., Aprile, G., Cosentino, F. G., & Perrotti, V. (2022). Quantitative measurement of swallowing performance using Iowa Oral Performance Instrument: a systematic review and meta-analysis. Biomedicines, 10(9), 2319.
Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., Patel, V., & Haines, A. (2013). The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS medicine, 10(1), e1001362.
Guimarães, K. C., Drager, L. F., Genta, P. R., Marcondes, B. F., & Lorenzi-Filho, G. (2009). Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. American journal of respiratory and critical care medicine, 179(10), 962–966.
Hwang, N. K., Yoon, T. H., Chang, M. Y., & Park, J. S. (2025). Dysphagia rehabilitation using digital technology: A scoping review. Journal of Evidence‐Based Medicine, 18(1), e70009.
Kim, H., Cho, N.-B., Kim, J., Kim, K. M., Kang, M., Choi, Y., Kim, M., You, H., Nam, S. I., & Shin, S. (2020). Implementation of a home-based mHealth app intervention program with human mediation for swallowing tongue pressure strengthening exercises in older adults: Longitudinal observational study. JMIR mHealth and uHealth, 8(10), e22080.
Lin, H.-Y., Chang, C.-J., Chiang, C.-C., Su, P.-L., Lin, C.-Y., & Hung, C.-H. (2020). Effects of a comprehensive physical therapy on moderate and severe obstructive sleep apnea-a preliminary randomized controlled trial. Journal of the Formosan Medical Association, 119(12), 1781–1790.
Lin, H.-Y., Su, P.-L., Lin, C.-Y., & Hung, C.-H. (2020). Models of anatomically based oropharyngeal rehabilitation with a multilevel approach for patients with obstructive sleep apnea: a meta-synthesis and meta-analysis. Sleep and Breathing, 24(4), 1279–1291.
Mari, A., Calabrese, F., Pasta, A., Lorenzon, G., Weusten, B., Keller, J., Visaggi, P., Roman, S., Marabotto, E., & Dickman, R. (2025). Esophageal and oropharyngeal dysphagia: clinical recommendations from the United European Gastroenterology and European Society for Neurogastroenterology and Motility. United European gastroenterology journal, 13(6), 855–901.
Marin, J. M., Carrizo, S. J., Vicente, E., & Agusti, A. G. (2005). Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. The Lancet, 365(9464), 1046–1053.
O'Connor-Reina, C., Garcia, J. M. I., Ruiz, E. R., Dominguez, M. D. C. M., Barrios, V. I., Jardin, P. B., Morente, J. C. C., Iriarte, M. T. G., & Plaza, G. (2020). Myofunctional therapy app for severe apnea–hypopnea sleep obstructive syndrome: Pilot randomized controlled trial. JMIR mHealth and uHealth, 8(11), e23123.
O’Connor-Reina, C., Ignacio Garcia, J. M., Rodriguez Alcala, L., Rodríguez Ruiz, E., Garcia Iriarte, M. T., Casado Morente, J. C., Baptista, P., & Plaza, G. (2021). Improving adherence to myofunctional therapy in the treatment of sleep-disordered breathing. Journal of Clinical Medicine, 10(24), 5772.
Puangdech, J., Thitisakulchai, P., Kuptniratsaikul, V., & Onkampa, W. (2025). Effect of a video-guided swallowing exercise program on adherence in stroke patients with dysphagia: a randomized controlled trial. Dysphagia, 1–10.
Ramar, K., Dort, L. C., Katz, S. G., Lettieri, C. J., Harrod, C. G., Thomas, S. M., & Chervin, R. D. (2015). Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015: an American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 11(7), 773–827.
Reverberi, C., Gottardo, G., Battel, I., & Castagnetti, E. (2021). The neurogenic dysphagia management via telemedicine: a systematic review. European Journal of physical and rehabilitation Medicine, 58(2), 179.
Smaoui, S., Langridge, A., & Steele, C. M. (2020). The Effect of Lingual Resistance Training Interventions on Adult Swallow Function: A Systematic Review: S. Smaoui et al.: Effects of Lingual Resistance Training on Adult Swallowing. Dysphagia, 35(5), 745–761.
Wall, L. R., Ward, E. C., Cartmill, B., Hill, A. J., Isenring, E., Byrnes, J., & Porceddu, S. V. (2020). Prophylactic swallowing therapy for patients with head and neck cancer: a three‐arm randomized parallel‐group trial. Head & neck, 42(5), 873–885.
Weaver, T. E., & Grunstein, R. R. (2008). Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proceedings of the American Thoracic Society, 5(2), 173–178.
Wirth, M., Unterhuber, D., von Meyer, F., Hofauer, B., Ott, A., Edenharter, G., Eckert, D. J., & Heiser, C. (2020). Hypoglossal nerve stimulation therapy does not alter tongue protrusion strength and fatigability in obstructive sleep apnea. Journal of Clinical Sleep Medicine, 16(2), 285–292.
Yang, W., Du, Y., Chen, M., Li, S., Zhang, F., Yu, P., & Xu, X. (2023). Effectiveness of home-based telerehabilitation interventions for dysphagia in patients with head and neck cancer: systematic review. Journal of Medical Internet Research, 25, e47324.
Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., & Badr, S. (1993). The occurrence of sleep-disordered breathing among middle-aged adults. New England journal of medicine, 328(17), 1230–1235.
Zhou, L., Bao, J., Setiawan, I. M. A., Saptono, A., & Parmanto, B. (2019). The mHealth app usability questionnaire (MAUQ): development and validation study. JMIR mHealth and uHealth, 7(4), e11500.