Effects of Exercise on Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Abstract

With exercise being more frequently utilized in treatment for obstructive sleep apnea (OSA), a systematic review of the intervention efficacy of exercise on OSA is necessary. PubMed, EBSCO, Web of Science, VIP, and CNKI databases were searched to collect randomized controlled trials (RCTs) of exercise applied to OSA from January 2000 to January 2022. The literature screening, data extraction, and risk of bias assessment of included studies were conducted independently by two reviewers. Meta-analysis was then performed using Rev Man 5.4 software. A total of 9 RCTs were included, including 444 patients. Compared with the control group, exercise made an improvement in apnea–hypopnea index (AHI) [MD = −6.65, 95% CI (−7.77, −5.53), p < 0.00001], minimum oxygen saturation (SaO2min%) [MD = 1.67, 95% CI (0.82, 2.52), p = 0.0001], peak oxygen uptake (VO2peak) [SMD = 0.54, 95% CI (0.31, 0.78), p < 0.00001], Pittsburgh sleep quality index (PSQI) [MD = −2.08, 95% CI (−3.95, −0.21), p = 0.03], and Epworth Sleepiness Scale (ESS) values [MD = −1.64, 95% CI, (−3.07, −0.22), p = 0.02]. However, there were no significant changes in body mass index (BMI). As for the results of subgroup analysis, aerobic exercise combined with resistance exercise [MD = −7.36, 95% CI (−8.64, −6.08), p < 0.00001] had a better effect on AHI reduction than aerobic exercise alone [MD = −4.36, 95% CI (−6.67, −2.06), p = 0.0002]. This systematic review demonstrates that exercise reduces the severity of OSA with no changes in BMI, and the effect of aerobic exercise combined with resistance training is better than aerobic exercise alone in AHI reduction. Exercise also improves cardiopulmonary fitness, sleep quality, and excessive daytime sleepiness.

A Pilot Randomized Trial of Combined Cognitive-Behavioral Therapy and Exercise Training Versus Exercise Training Alone for the Management of Chronic Insomnia in Obstructive Sleep Apnea

“…After 8 weeks of exercise training, individuals with COMISA who exercised (EX group) demonstrated a moderate improvement in their cardiorespiratory fitness (indicated by a significant increase in VO 2peak during CPET) whereas those who did 8 weeks of relaxation training (CBTi-EX group) did not display such a change. While improvements in cardiorespiratory fitness after exercise training have been reported in OSA alone 64,65 , our results extend these findings to individuals with COMISA. Furthermore, the fact that our exercise intervention was of moderate intensity and followed a hybrid format of supervised and unsupervised sessions suggests that it would be applicable in a ‘real world’ setting.…”

“…Participants in the CBTi-EX group had no change in daytime sleepiness from T1 to T2 (g'<0.1) but experienced a small reduction in daytime sleepiness from T2 to T3, (-1.66 ± 3.55 points; g'=0.23; T1 vs T3: g'=0.22; Table S3). 64,65 , our results extend these findings to individuals with COMISA. Furthermore, the fact that our exercise intervention was of moderate intensity and followed a hybrid format of supervised and unsupervised sessions suggests that it would be applicable in a 'real world' setting.…”

An individualized mobile health intervention to promote physical activity in adults with obstructive sleep apnea: An intervention mapping approach

“…Despite the benefit of PA in the context of OSA, 10 – 13 , 16 – 41 , 125 few studies have incorporated an outcome associated with PA level to measure the effect of interventions on the PA behavior itself. 24 – 29 , 40 , 41 The results are nevertheless heterogeneous, and more RCTs that integrate behavioral outcomes are needed.…”

“…Among the systematic reviews and meta-analyses examining the effect of PA in the context of OSA, 10 , 11 , 13 , 16 – 23 only one focused on an outcome associated with PA behavior (i.e. number of steps).…”

Physical Activity and Sleep in Adults and Older Adults in Southern Brazil

“…Over the past decade, studies have investigated the effects of PA on patients with sleep disorders such as sleep apnea [13]. Physical exercise has several reported effects on chronic insomnia, including improvements in sleep quality, sleep efficiency and duration, as well as decreases in sleep onset latency and wakefulness after sleep onset [12].…”