Effects of aerobic exercise and resistance training on obstructive sleep apnea: a systematic review and meta-analysis

Abstract

Study objectives: We investigated the therapeutic effects of exercise in patients with obstructive sleep apnea, aiming to identify the subgroups that benefit the most and determine the optimal exercise protocol.

Methods: Major databases were searched for randomized controlled trials involving patients with obstructive sleep apnea performing aerobic exercise and/or resistance training. The investigated outcomes included apnea-hypopnea index (AHI), Epworth Sleepiness Scale, body mass index, and peak oxygen consumption during exercise (VO₂peak). The pre- and postintervention unstandardized mean difference (USMD) of these parameters was compared between the exercise and control groups.

Results: Twelve studies involving 526 patients were included. Exercise training significantly reduced AHI (USMD = -7.08 events/h, 95% confidence interval: -9.98 to -4.17, P < .00001), Epworth Sleepiness Scale (USMD = -2.37, 95% confidence interval: -3.21 to -1.54, P < .00001), and body mass index (USMD = -0.72 kg/m², 95% confidence interval: -1.22 to -0.22, P = .005) and enhanced VO₂peak (USMD = 3.46 ml·kg^-1·min^-1, 95% confidence interval: 1.20 to 5.71, P = .003). Subgroup analyses revealed that in continuous positive airway pressure-adherent patients, exercise significantly improved VO₂peak but did not reduce AHI and Epworth Sleepiness Scale. A trend was observed that combining resistance training with aerobic exercise resulted in greater AHI reduction and VO₂peak enhancement. Notably, exercise improved AHI, Epworth Sleepiness Scale, body mass index, and VO₂peak regardless of the baseline AHI or body mass index.

Conclusions: Exercise, including resistance and aerobic training, should be part of treatment for patients with obstructive sleep apnea of all severities, regardless of obesity status, and even for those who are already under continuous positive airway pressure.

Citation: Lin C-F, Ho N-H, Hsu W-L, Lin C-H, Wang Y-H, Wang Y-P. Effects of aerobic exercise and resistance training on obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med. 2024;20(11):1839-1849.

Keywords: obstructive sleep apnea; oxygen consumption; resistance training; sleepiness.

Figure 1. Results of the meta-analysis of the pooled effects of exercise on AHI.

AHI = apnea-hypopnea index, CI = confidence interval, MD = pre- and postintervention mean difference, n = number of patients, SD = standard deviation, USMD = unstandardized mean difference, W% = weight percent of study.

Figure 2. Results of subgroup analyses of the effects of exercise on AHI.

AHI = apnea-hypopnea index, BMI = body mass index, CI = confidence interval, CPAP = continuous positive airway pressure, N = number of studies, USMD = unstandardized mean difference.

Figure 3. Results of subgroup analyses of the effects of exercise on ESS and VO₂peak.

AHI = apnea-hypopnea index, BMI = body mass index, CI = confidence interval, CPAP = continuous positive airway pressure, ESS = Epworth Sleepiness Scale, N = number of studies, USMD = unstandardized mean difference, VO₂peak = peak oxygen consumption during exercise.