Obstructive Sleep Apnea Syndrome, Objectively Measured Physical Activity and Exercise Training Interventions: A Systematic Review and Meta-Analysis

Abstract

A systematic review of English and French articles using Pubmed/Medline and Embase included studies assessing objective physical activity levels of obstructive sleep apnea (OSA) patients and exploring the effects of exercise training on OSA severity, body mass index (BMI), sleepiness, and cardiorespiratory fitness [peak oxygen consumption (VO2peak)]. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. For objective physical activity levels, eight studies were included. The mean number of steps per day across studies was 5,388 (95% CI: 3,831–6,945; p < 0.001), which was by far lower than the recommended threshold of 10,000 steps per day. For exercise training, six randomized trials were included. There was a significant decrease in apnea–hypopnea-index following exercise training (mean decrease of 8.9 events/h; 95% CI: −13.4 to −4.3; p < 0.01), which was accompanied by a reduction in subjective sleepiness, an increase in VO2peak and no change in BMI. OSA patients present low levels of physical activity and exercise training is associated with improved outcomes. Future interventions (including exercise training) focusing on increasing physical activity levels may have important clinical impacts on both OSA severity and the burden of associated co-morbidities. Objective measurement of physical activity in routine OSA management and well-designed clinical trials are recommended.Registration # CRD42017057319 (Prospero).

Cardiorespiratory fitness and long‐term risk of sleep apnea: A national cohort study

“…Prior studies have suggested that high physical activity or exercise levels are associated with reduced symptoms and improved outcomes in patients with existing OSA, irrespective of body weight or BMI (Aiello et al., ; Iftikhar et al., ; Mendelson et al., ; Murillo et al., ; da Silva et al., ). For example, three meta‐analyses of small clinical trials reported that exercise training was independently associated with reduced severity of apnea symptoms in patients with OSA (Aiello et al., ; Iftikhar et al., ; Mendelson et al., ). The underlying mechanisms are not established, but may potentially involve improved strength of pharyngeal dilator muscles, decreased overnight rostral fluid redistribution and stabilization of sympathetic outflow (Iftikhar et al., ; Redolfi et al., ).…”

“…TA B L E 1 Characteristics of 18-year-old men who were or were not subsequently diagnosed with sleep apnea, Sweden, 1969Sweden, -2012 To our knowledge, this is the first study to examine CRF in relation to the risk of sleep apnea. Prior studies have suggested that high physical activity or exercise levels are associated with reduced symptoms and improved outcomes in patients with existing OSA, irrespective of body weight or BMI (Aiello et al, 2016;Iftikhar et al, 2014;Mendelson et al, 2018;Murillo et al, 2016;da Silva et al, 2017). For example, three meta-analyses of small clinical trials reported that exercise training was independently associated with reduced severity of apnea symptoms in patients with OSA (Aiello et al, 2016;Iftikhar et al, 2014;Mendelson et al, 2018).…”

“…Because obesity is the only established risk factor that is modifiable, and up to half of all OSA cases may occur in non-obese persons (Young, Peppard, & Taheri, 2005), there is a pressing need to identify other modifiable risk factors that may help guide better prevention. Selfreported high physical activity or exercise has been associated with improved symptoms and outcomes in patients with existing OSA, irrespective of weight loss (Aiello et al, 2016;Iftikhar, Kline, & Youngstedt, 2014;Mendelson et al, 2018). However, few studies have examined physical activity in relation to the risk of developing OSA (Murillo et al, 2016;da Silva et al, 2017), and none has examined objectively measured cardiorespiratory fitness (CRF).…”

Maximal exercise capacity in patients with obstructive sleep apnoea syndrome: a systematic review and meta-analysis

“…Only a small number of studies [10,11,13,31] included in the present meta-analysis reported physical activity levels in OSA and controls. Therefore, we cannot exclude the possibility that patients with OSA had lower levels of physical activity than controls and that this contributed to their lower V′O 2 peak [47].…”

Obstructive sleep apnoea and exercise functional capacity: time to move?

“…On the other hand, physical activity was not a significant predictor of mortality after adjusting for CRF [8]. Interestingly, MENDELSON et al [22] have recently showed in a meta-analysis that OSA patients presented low levels of physical activity, with a mean number of steps per day of 5388 (95% CI 3831-6945), far below the recommended threshold of 10 000 steps per day. Moreover, exercise training was associated with significant decrease in apnoea−hypopnoea index, reduction in subjective sleepiness and, notably, increase in V′O 2 peak but no change in BMI [22].…”