Longer‐term effects of supervised physical activity on obstructive sleep apnea and subsequent health consequences

Abstract

Although recent trials have shown promising benefits of exercise on obstructive sleep apnea (OSA) severity, the long‐term effect of these interventions remains unknown. The aim of this study was to assess the effect of a 9‐month community physical activity program on OSA severity one year later in free‐living conditions. OSA patients, previously included in a 9‐month randomized controlled trial (EXESAS study) evaluating the effects of supervised community physical activity on OSA severity, were invited to participate in an extra one‐year observational study. Twenty‐eight patients completed the study. Although OSA severity did not significantly worsen over the real‐life period (9 to 21 months of follow‐up), reductions in apnea‐hypopnea index (AHI) and oxygen desaturation index were no longer significant after 21 months of follow‐up compared to baseline (baseline AHI: 22.2 ± 6.3 /h; 9 months: 16.3 ± 6.4 /h; 21 months: 18.7 ± 8.9 /h). Benefits observed at 9 months on daytime sleepiness and mental health were preserved at 21 months, whereas cardiorespiratory fitness slightly decreased. Per‐protocol analysis revealed that patients who stopped exercise at 9 months had worsened OSA severity compared to those who continued exercise during the real‐life period (AHI: +9.0 ± 8.8 vs. −1.3 ± 5.3 /h; p < .01). In conclusion, our study suggested that improvements in OSA severity remain transient and is dependent on long‐term adherence to regular physical activity practice.

The Exercising Brain: An Overlooked Factor Limiting the Tolerance to Physical Exertion in Major Cardiorespiratory Diseases?

“…Whether any amelioration in neuromuscular abnormalities (e.g., with rehabilitative exercise training) do translate into improved functional capacity and better health-related quality of life remains unclear at this point in time. Owing to the fact that improvements in exercise tolerance after exercise reconditioning are typically lost over time in patients with chronic cardiorespiratory diseases (Holland et al, 2008;Rochester and Spruit, 2017;Berger et al, 2021), future research should also focus on the best strategies to promote sustainable behavioral changes toward a more active lifestyle.…”

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

“…Only one trial observed increased PA levels after the intervention in patients with OSA and coronary artery disease. 25 Since the publication of this meta-analysis, three studies have measured PA levels, 27 – 29 but only Black et al 28 and Berger et al 29 evaluated this outcome (i.e. PA questionnaire and accelerometer: unit in counts) before and after the intervention.…”

“…Both studies showed an increase in PA following the intervention, which then decreased after 12 months. 29 Many studies have focused on the effects of PA interventions on the parameters associated with OSA. 12 , 24 , 25 , 27 , 28 , 30 – 41 By contrast, few have explicitly investigated the effect of a PA intervention on PA behavior itself using objective 26 or subjective measurements.…”

“… 12 , 24 , 25 , 27 , 28 , 30 – 41 By contrast, few have explicitly investigated the effect of a PA intervention on PA behavior itself using objective 26 or subjective measurements. 29 This limited number of studies integrating the outcome of PA is surprising insofar as CPAP, as the first-line treatment of OSA, has a limited impact on cardiometabolic risk factors, whereas exercise training has a well-documented effect on numerous cardiometabolic risk factors. 11 …”

Resistance Training of Inspiratory Muscles After Coronary Artery Disease May Improve Obstructive Sleep Apnea in Outpatient Cardiac Rehabilitation: RICAOS Study

“…Excessive relaxation of the tongue and soft palate evidenced by a decrease in the EMG pattern of the genioglossus and tensor of the palate muscles ( Fogel et al, 2005 ; Oliven et al, 2019 ) partly explains the OSA pathogenesis. While physical activity has shown relative effectiveness in improving apnea-hypopnea index (AHI; Kline et al, 2011 ; Aiello et al, 2016 ; Berger et al, 2018 , 2021 ; Hupin et al, 2018 ), specific exercises of the oropharyngeal area could have a more targeted impact. Thus, Guimarães et al (2009) have shown that strengthening oropharyngeal muscles by mouth, tongue, and pronunciation exercises reduce AHI in patients with moderate OSA by 8.7 events.h −1 .…”