Association of physical exercise characteristics with obstructive sleep apnea symptoms: A cross-sectional study

Obstructive sleep apnea (OSA) increases the risk of multiple chronic diseases such as diabetes and cardiovascular disease, posing a substantial threat to public health. Therefore, this study aimed to investigate the association between physical exercise and OSA symptoms. A representative sample of 7180 individuals aged 20 years and older was selected from the 2015 to 2018 United States National Health and Nutrition Examination Survey. Binary logistic regression was used to analyze the association between physical activity and OSA symptoms. Threshold effect analysis and restricted cubic spline curves were applied to evaluate the dose-response relationships of exercise duration and metabolic equivalents of tasks (METs) with OSA symptoms. After adjustment for all covariates in the multivariable analysis, exercise was significantly inversely associated with OSA symptoms (odds ratio [OR] = 0.84, 95% confidence interval [CI]: 0.76-0.93, P < .05). Compared with non-exercisers, moderate-intensity exercisers had OR = 0.89 (95% CI: 0.79-1.00, P = .059), while high-intensity exercisers showed a stronger association (OR = 0.79, 95% CI: 0.69-0.90, P < .05). Threshold analyses suggested potential statistical inflection points at approximately 75 minutes of exercise and 320 METs (P < .05). Physical activity was inversely associated with OSA symptoms, with high-intensity exercise associated with a relatively lower likelihood of OSA symptoms. The association between exercise and OSA symptoms showed a potential change near 75 minutes of exercise and 320 METs. Future population-based intervention studies should assess the clinical application of these activity levels in improving OSA outcomes.