Active conservative interventions for obstructive sleep apnea: An umbrella review and meta-meta-analysis of...

Obstructive sleep apnea (OSA) is a prevalent condition with significant health consequences and limited adherence to standard treatments, such as Continuous Positive Airway Pressure (CPAP). Active conservative interventions, such as exercise and myofunctional training, may offer alternative or complementary options.

To evaluate and compare the effectiveness and certainty of the evidence of active conservative interventions for OSA through an umbrella review of meta-analyses.

A systematic search of six databases was conducted. Meta-analyses assessing moderate aerobic exercise (MAE), concurrent exercise (CE), respiratory muscle training (RMT), and oropharyngeal myofunctional therapy (OMT) were also included. Methodological quality was assessed using AMSTAR-2, evidence certainty using GRADE, and overlap with the Corrected Covered Area (CCA).

Ten meta-analyses were included in this study CE showed the most consistent effect in reducing The Apnea-Hypopnea Index (AHI), followed by OMT. These improvements occurred independently of Body Mass Index (BMI) changes and were often accompanied by better sleep quality and reduced daytime sleepiness. MAE showed variable results, and evidence for RMT was limited owing to methodological exclusion criteria. The overall certainty of the evidence was very low, with only one comparison (OMT vs. sham) reaching low certainty.

CE and OMT showed consistent but limited benefits among active conservative interventions for OSA. These findings, based on very low-certainty evidence, suggest that they may serve as adjuncts to standard care in selected patients. Further high-quality trials and systematic reviews are needed to confirm their clinical utility.