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

Chien-Fu Lin; Nien-Hsuan Ho; Wen-Ling Hsu; Che-Hsuan Lin; Yuan-Hung Wang; Ying-Piao Wang

doi:10.5664/jcsm.11310

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

J Clin Sleep Med. 2024 Nov 1;20(11):1839-1849. doi: 10.5664/jcsm.11310.

Authors

Chien-Fu Lin¹, Nien-Hsuan Ho¹, Wen-Ling Hsu², Che-Hsuan Lin^{3

4}, Yuan-Hung Wang^{2

5}, Ying-Piao Wang^{1

6

7}

Affiliations

¹ Department of Otorhinolaryngology - Head and Neck Surgery, MacKay Memorial Hospital, Taipei, Taiwan.
² Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
³ Department of Otolaryngology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
⁴ Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁵ Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
⁶ School of Medicine, Mackay Medical College, New Taipei City, Taiwan.
⁷ Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan.

PMID: 39150699
PMCID: PMC11530989 (available on 2025-11-01)
DOI: 10.5664/jcsm.11310

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.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Exercise Therapy / methods
Exercise* / physiology
Humans
Randomized Controlled Trials as Topic
Resistance Training* / methods
Sleep Apnea, Obstructive* / physiopathology
Sleep Apnea, Obstructive* / therapy