Aerobic exercise training and obstructive sleep apnea: dose-response meta-analyses

Several studies have shown that aerobic exercise training improves obstructive sleep apnea (OSA) severity. However, a dose-response relationship has never been shown. This study aimed to quantify any dose-response relationships between time spent per week in aerobic exercise and key sleep apnea outcomes.

Randomized controlled trials (RCT) were selected from literature search studying the effects of supervised aerobic exercise training on patients with OSA. Dose-response meta-analyses were performed, where the 'dose' was the total weekly duration of aerobic exercise training. Primary outcomes were apnea hypopnea index (AHI), cardiorespiratory fitness (maximum oxygen consumption or VO₂peak) and Epworth Sleepiness Scale (ESS).

Analysis of data from 11 RCTs showed a non-linear dose-response relationship between the total weekly duration of aerobic exercise training and mean differences in AHI. Maximum effects on AHI (-10.92 (95%CIs: -15.57; -6.27)) were observed when the weekly duration of aerobic exercise reached 100 min/week. Similar non-linear dose-response trend was observed in the mean differences in VO₂peak. Studies in which aerobic exercise training lasted ≥ 12 weeks showed greater proportional changes in mean AHI differences with maximal effects reaching a peak at ∼ 70 min/week of aerobic exercise training. ESS and total weekly duration of aerobic exercise training showed a linear dose-response relationship based on 4 RCTs.

Based on these analyses, aerobic exercise training of 70-100 min/week over 3 or 5 days a week should be recommended as adjunctive treatment for patients with OSA.