Lung

, Volume 192, Issue 1, pp 175–184

Effects of Exercise Training on Sleep Apnea: A Meta-analysis

  • Imran H. Iftikhar
  • Christopher E. Kline
  • Shawn D. Youngstedt
Article

Abstract

Background

Several studies have shown a favorable effect of supervised exercise training on obstructive sleep apnea (OSA). This meta-analysis was conducted to analyze the data from these studies on the severity of OSA (primary outcome) in adults. Secondary outcomes of interest included body mass index (BMI), sleep efficiency, daytime sleepiness and cardiorespiratory fitness.

Methods

Two independent reviewers searched PubMed and Embase (from inception to March 6, 2013) to identify studies on the effects of supervised exercise training in adults with OSA. Pre- and postexercise training data on our primary and secondary outcomes were extracted.

Results

A total of 5 studies with 6 cohorts that enrolled a total of 129 study participants met the inclusion criteria. The pooled estimate of mean pre- to postintervention (exercise) reduction in AHI was −6.27 events/h (95 % confidence interval [CI] −8.54 to −3.99; p < 0.001). The pooled estimates of mean changes in BMI, sleep efficiency, Epworth sleepiness scale and VO2 peak were −1.37 (95 % CI −2.81 to 0.07; p = 0.06), 5.75 % (95 % CI 2.47–9.03; p = 0.001), −3.3 (95 % CI −5.57 to −1.02; p = 0.004), and 3.93 mL/kg/min (95 % CI 2.44–5.42; p < 0.001), respectively.

Conclusions

This meta-analysis shows a statistically significant effect of exercise in reducing the severity of sleep apnea in patients with OSA with minimal changes in body weight. Additionally, the significant effects of exercise on cardiorespiratory fitness, daytime sleepiness, and sleep efficiency indicate the potential value of exercise in the management of OSA.

Keywords

Exercise Obstructive sleep apnea Cardiorespiratory fitness Daytime sleepiness 

Supplementary material

408_2013_9511_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 13 kb)

References

  1. 1.
    Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165(9):1217–1239CrossRefPubMedGoogle Scholar
  2. 2.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235CrossRefPubMedGoogle Scholar
  3. 3.
    Parish JM, Somers VK (2004) Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc 79(8):1036–1046CrossRefPubMedGoogle Scholar
  4. 4.
    Levinson PD, McGarvey ST, Carlisle CC, Eveloff SE, Herbert PN, Millman RP (1993) Adiposity and cardiovascular risk factors in men with obstructive sleep apnea. Chest 103(5):1336–1342CrossRefPubMedGoogle Scholar
  5. 5.
    Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D et al (2006) Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 29(3):375–380PubMedGoogle Scholar
  6. 6.
    Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman J Jr et al (2006) Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep 29(2):240–243PubMedGoogle Scholar
  7. 7.
    Peppard PE, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284(23):3015–3021CrossRefPubMedGoogle Scholar
  8. 8.
    Schwartz AR, Gold AR, Schubert N, Stryzak A, Wise RA, Permutt S et al (1991) Effect of weight loss on upper airway collapsibility in obstructive sleep apnea. Am Rev Respir Dis 144(3 Pt 1):494–498CrossRefPubMedGoogle Scholar
  9. 9.
    Smith PL, Gold AR, Meyers DA, Haponik EF, Bleecker ER (1985) Weight loss in mildly to moderately obese patients with obstructive sleep apnea. Ann Intern Med 103(6 Pt 1):850–855CrossRefPubMedGoogle Scholar
  10. 10.
    Bridgman SA, Dunn KM (2000) Surgery for obstructive sleep apnoea. Cochrane Database Syst Rev 2:CD001004PubMedGoogle Scholar
  11. 11.
    Sundaram S, Bridgman SA, Lim J, Lasserson TJ (2005) Surgery for obstructive sleep apnoea. Cochrane Database Syst Rev 4:CD001004PubMedGoogle Scholar
  12. 12.
    Morgenthaler TI, Kapen S, Lee-Chiong T, Alessi C, Boehlecke B, Brown T et al (2006) Practice parameters for the medical therapy of obstructive sleep apnea. Sleep 29(8):1031–1035PubMedGoogle Scholar
  13. 13.
    Aurora RN, Casey KR, Kristo D, Auerbach S, Bista SR, Chowdhuri S et al (2010) Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep 33(10):1408–1413PubMedCentralPubMedGoogle Scholar
  14. 14.
    Yamamoto U, Mohri M, Shimada K, Origuchi H, Miyata K, Ito K et al (2007) Six-month aerobic exercise training ameliorates central sleep apnea in patients with chronic heart failure. J Card Fail 13(10):825–829CrossRefPubMedGoogle Scholar
  15. 15.
    Ueno LM, Drager LF, Rodrigues AC, Rondon MU, Braga AM, Mathias W Jr et al (2009) Effects of exercise training in patients with chronic heart failure and sleep apnea. Sleep 32(5):637–647PubMedCentralPubMedGoogle Scholar
  16. 16.
    Quan SF, O’Connor GT, Quan JS, Redline S, Resnick HE, Shahar E et al (2007) Association of physical activity with sleep-disordered breathing. Sleep Breath 11(3):149–157CrossRefPubMedGoogle Scholar
  17. 17.
    Awad KM, Malhotra A, Barnet JH, Quan SF, Peppard PE (2012) Exercise is associated with a reduced incidence of sleep-disordered breathing. Am J Med 125(5):485–490PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Peppard PE, Young T (2004) Exercise and sleep-disordered breathing: an association independent of body habitus. Sleep 27(3):480–484PubMedGoogle Scholar
  19. 19.
    Giebelhaus V, Strohl KP, Lormes W, Lehmann M, Netzer N (2000) Physical exercise as an adjunct therapy in sleep apnea: an open trial. Sleep Breath 4(4):173–176PubMedGoogle Scholar
  20. 20.
    Kline CE, Crowley EP, Ewing GB, Burch JB, Blair SN, Durstine JL et al (2011) The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Sleep 34(12):1631–1640PubMedCentralPubMedGoogle Scholar
  21. 21.
    Sengul YS, Ozalevli S, Oztura I, Itil O, Baklan B (2011) The effect of exercise on obstructive sleep apnea: a randomized and controlled trial. Sleep Breath 15(1):49–56CrossRefPubMedGoogle Scholar
  22. 22.
    Hong S, Dimsdale JE (2003) Physical activity and perception of energy and fatigue in obstructive sleep apnea. Med Sci Sports Exerc 35(7):1088–1092CrossRefPubMedGoogle Scholar
  23. 23.
    Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283(15):2008–2012CrossRefPubMedGoogle Scholar
  24. 24.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151(4):W65–W94CrossRefPubMedGoogle Scholar
  25. 25.
    Anandam A, Akinnusi M, Kufel T, Porhomayon J, El-Solh AA (2013) Effects of dietary weight loss on obstructive sleep apnea: a meta-analysis. Sleep Breath 17(1):227–234CrossRefPubMedGoogle Scholar
  26. 26.
    Thomasouli MA, Brady EM, Davies MJ, Hall AP, Khunti K, Morris DH et al (2013) The impact of diet and lifestyle management strategies for obstructive sleep apnoea in adults: a systematic review and meta-analysis of randomised controlled trials. Sleep Breath 17(3):925–935CrossRefPubMedGoogle Scholar
  27. 27.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545PubMedGoogle Scholar
  28. 28.
    Servantes DM, Pelcerman A, Salvetti XM, Salles AF, de Albuquerque PF, de Salles FC et al (2012) Effects of home-based exercise training for patients with chronic heart failure and sleep apnoea: a randomized comparison of two different programmes. Clin Rehabil 26(1):45–57CrossRefPubMedGoogle Scholar
  29. 29.
    Kline CE, Crowley EP, Ewing GB, Burch JB, Blair SN, Durstine JL et al (2012) Blunted heart rate recovery is improved following exercise training in overweight adults with obstructive sleep apnea. Int J Cardiol 167(4):1610–1615PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Kline CE, Ewing GB, Burch JB, Blair SN, Durstine JL, Davis JM et al (2012) Exercise training improves selected aspects of daytime functioning in adults with obstructive sleep apnea. J Clin Sleep Med 8(4):357–365PubMedCentralPubMedGoogle Scholar
  31. 31.
    Norman JF, Von Essen SG, Fuchs RH, McElligott M (2000) Exercise training effect on obstructive sleep apnea syndrome. Sleep Res Online 3(3):121–129PubMedGoogle Scholar
  32. 32.
    Sutton AAK, Jones D, Sheldon T, Song F (2000) Methods for meta-analysis in medical research Wiley series in probability and statistics. Wiley, New YorkGoogle Scholar
  33. 33.
    Huedo-Medina TB, Sanchez-Meca J, Marin-Martinez F, Botella J (2006) Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods 11(2):193–206CrossRefPubMedGoogle Scholar
  34. 34.
    Sterne JA, Egger M, Smith GD (2001) Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. BMJ 323(7304):101–105PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101CrossRefPubMedGoogle Scholar
  36. 36.
    Barnes M, Goldsworthy UR, Cary BA, Hill CJ (2009) A diet and exercise program to improve clinical outcomes in patients with obstructive sleep apnea—a feasibility study. J Clin Sleep Med 5(5):409–415PubMedCentralPubMedGoogle Scholar
  37. 37.
    Iftikhar IH, Hays ER, Iverson MA, Magalang UJ, Maas AK (2013) Effect of oral appliances on blood pressure in obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med 9(2):165–174PubMedCentralPubMedGoogle Scholar
  38. 38.
    Greenburg DL, Lettieri CJ, Eliasson AH (2009) Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. Am J Med 122(6):535–542CrossRefPubMedGoogle Scholar
  39. 39.
    Sui X, LaMonte MJ, Laditka JN, Hardin JW, Chase N, Hooker SP et al (2007) Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA 298(21):2507–2516PubMedCentralCrossRefPubMedGoogle Scholar
  40. 40.
    Rodway GW, Weaver TE, Mancini C, Cater J, Maislin G, Staley B et al (2010) Evaluation of sham-CPAP as a placebo in CPAP intervention studies. Sleep 33(2):260–266PubMedCentralPubMedGoogle Scholar
  41. 41.
    McArdle N, Douglas NJ (2001) Effect of continuous positive airway pressure on sleep architecture in the sleep apnea-hypopnea syndrome: a randomized controlled trial. Am J Respir Crit Care Med 164(8 Pt 1):1459–1463CrossRefPubMedGoogle Scholar
  42. 42.
    Giles TL, Lasserson TJ, Smith BH, White J, Wright J, Cates CJ (2006) Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 3:CD001106PubMedGoogle Scholar
  43. 43.
    Marshall NS, Barnes M, Travier N, Campbell AJ, Pierce RJ, McEvoy RD et al (2006) Continuous positive airway pressure reduces daytime sleepiness in mild to moderate obstructive sleep apnoea: a meta-analysis. Thorax 61(5):430–434PubMedCentralCrossRefPubMedGoogle Scholar
  44. 44.
    Haxhiu MA, van Lunteren E, Mitra J, Cherniack NS, Strohl KP (1984) Comparison of the responses of the diaphragm and upper airway muscles to central stimulation of the sciatic nerve. Respir Physiol 58(1):65–76CrossRefPubMedGoogle Scholar
  45. 45.
    O’Donnell DE, McGuire M, Samis L, Webb KA (1998) General exercise training improves ventilatory and peripheral muscle strength and endurance in chronic airflow limitation. Am J Respir Crit Care Med 157(5 Pt 1):1489–1497CrossRefPubMedGoogle Scholar
  46. 46.
    Mirrakhimov AE (2013) Physical exercise related improvement in obstructive sleep apnea. Look for the rostral fluid shift. Med Hypotheses 80(2):125–128CrossRefPubMedGoogle Scholar
  47. 47.
    Redolfi S, Yumino D, Ruttanaumpawan P, Yau B, Su MC, Lam J et al (2009) Relationship between overnight rostral fluid shift and obstructive sleep apnea in nonobese men. Am J Respir Crit Care Med 179(3):241–246CrossRefPubMedGoogle Scholar
  48. 48.
    Redolfi S, Arnulf I, Pottier M, Bradley TD, Similowski T (2011) Effects of venous compression of the legs on overnight rostral fluid shift and obstructive sleep apnea. Respir Physiol Neurobiol 175(3):390–393CrossRefPubMedGoogle Scholar
  49. 49.
    Redolfi S, Arnulf I, Pottier M, Lajou J, Koskas I, Bradley TD et al (2011) Attenuation of obstructive sleep apnea by compression stockings in subjects with venous insufficiency. Am J Respir Crit Care Med 184(9):1062–1066CrossRefPubMedGoogle Scholar
  50. 50.
    Shiota S, Ryan CM, Chiu KL, Ruttanaumpawan P, Haight J, Arzt M et al (2007) Alterations in upper airway cross-sectional area in response to lower body positive pressure in healthy subjects. Thorax 62(10):868–872PubMedCentralCrossRefPubMedGoogle Scholar
  51. 51.
    Jafari B, Mohsenin V (2011) Overnight rostral fluid shift in obstructive sleep apnea: does it affect the severity of sleep-disordered breathing? Chest 140(4):991–997CrossRefPubMedGoogle Scholar
  52. 52.
    Ratnavadivel R, Chau N, Stadler D, Yeo A, McEvoy RD, Catcheside PG (2009) Marked reduction in obstructive sleep apnea severity in slow wave sleep. J Clin Sleep Med 5(6):519–524PubMedCentralPubMedGoogle Scholar
  53. 53.
    McSharry DG, Saboisky JP, Deyoung P, Matteis P, Jordan AS, Trinder J et al (2013) A mechanism for upper airway stability during slow wave sleep. Sleep 36(4):555–563PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Imran H. Iftikhar
    • 1
  • Christopher E. Kline
    • 2
  • Shawn D. Youngstedt
    • 3
    • 4
  1. 1.Division of Pulmonary, Critical Care and Sleep Medicine, Department of MedicineUniversity of South CarolinaColumbiaUSA
  2. 2.Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghUSA
  3. 3.Departments of Exercise Science and PsychologyUniversity of South CarolinaColumbiaUSA
  4. 4.WJB Dorn VA Medical CenterColumbiaUSA

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