Mouth exercises vs. CPAP: new study aims to ease sleep apnea without machines

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Age 18 years or older. * Mild-to-moderate OSA (AHI 5.0-29.9 events/hour) confirmed by Type I polysomnography. * Protrusive excursion of at least 5 mm measured with the George Gauge. * No previous treatment with CPAP or OMT. * Ability to perform oropharyngeal exercises. * Written informed consent. Exclusion Criteria: * Severe obstructive sleep apnea (AHI 30 events/hour or higher) or urgent need for CPAP * Suspected or confirmed obesity hypoventilation syndrome, chronic ventilatory failure, or severe obesity associated with daytime hypercapnia or hypoxemia * Clinically significant insomnia, defined as an Insomnia Severity Index (ISI) score \> 14 at screening. * Uncontrolled psychiatric or neurological conditions likely to substantially affect sleep quality or daytime symptoms independently of OSA (e.g., major depressive episode, severe anxiety disorder, chronic disabling migraine)., as judged by the investigator. * Current use of medications likely to affect sleep architecture, respiratory drive, or PAP tolerance, including chronic opioid therapy and other sedative medications judged incompatible with study participation. * Unstable or severe cardiovascular disease requiring priority standard management, including poorly controlled arrhythmia, nocturnal angina, decompensated heart failure, treatment-resistant hypertension, or recent acute coronary syndrome * Uncontrolled diabetes mellitus requiring treatment intensification, for example - HbA1c greater than 10% and/or symptomatic hyperglycemia * Neurological or ear-nose-throat disease affecting the upper airway * Craniofacial abnormalities * Maxillofacial surgery within the previous 6 months * Temporomandibular pain preventing completion of exercises * Active periodontitis * Pregnancy * Foreseeable non-adherence to the intervention * Inability to use CPAP despite standard fitting and troubleshooting, or any contraindication to CPAP treatment. * Ongoing CPAP or OMT at inclusion