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Obstructive Sleep Apnea Syndrome, Objectively Measured Physical Activity and Exercise Training Interventions: A Systematic Review and Meta-Analysis
Open accessAbstract
A systematic review of English and French articles using Pubmed/Medline and Embase included studies assessing objectively-measured physical activity levels of OSA patients and exploring the effects of exercise training on OSA severity, body mass index, sleepiness and cardiorespiratory fitness (VO2peak). Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence. For objectively-measured physical activity levels, 8 studies were included. The mean number of steps per day across studies was 5,388 (95% CI: 3,831 to 6,945; p<0.001), which was by far lower than the recommended threshold of 10,000 steps per day. For exercise training, 6 randomized trials were included. There was a significant decrease in apnea-hypopnea-index following exercise training (mean decrease of 8.9 events/h; 95% CI: -13.4 to -4.3; p<0.01), which was accompanied by a reduction in subjective sleepiness, an increase in VO2peak and no change in BMI. OSA patients present low levels of physical activity and exercise training is associated with improved outcomes. Future interventions (including exercise training) focusing on increasing physical activity levels may have important clinical impacts on both OSA severity and the burden of associated co-morbidities. Objective measurement of physical activity in routine OSA management and well-designed clinical trials are recommended.
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![Figure 3 Forest plot presenting steps per day before and after interventions [continuous positive airway pressure (CPAP) and exercise]. Ref (16–18, 20–22).](/paper-figures/308c91bdb31e4a5b9b7af34fbef5bd6a/obstructive-sleep-apnea-syndrome-objectively-measured-physical-activity-and-figure-3.jpg)





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“Finally, self-reported physical activity or exercise interventions may have potential beneficial effects to lower the incidence of depression20 and lower the severity of obstructive sleep apnea and associated comorbidities21.”
From Association of step counts over time with the risk of chronic disease in the All of Us Research Program (2022) · cites this paper as [21]
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Result
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“, 2020, 2021) and 12 other studies (Mendelson et al., 2018) have shown that the AHI improves after intervention with these exercise programmes.”
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Vitacca, M., Paneroni, M., Braghiroli, A., Balbi, B., Aliani, M., Guido, P., Fanfulla, F., Pertosa, M., Ceriana, P., Zampogna, E., et al. (2020) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.8258 · Cited by 27
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Giannaki, C. D., Sakkas, G. K., Hadjigeorgiou, G. M., Manconi, M., & Bargiotas, P. (2024) · European Journal of Applied Physiology · doi:10.1007/s00421-024-05556-6 · Cited by 23
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“Studies in different populations have already shown that subjects with obstructive sleep apnea pre-sent low levels of PADL (Mendelson et al., 2018).”
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What should the recommendations be for lifestyle factors in obstructive sleep apnea?
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“In the current standpoint, different forms of exercise training involving aerobic exercises and resisted exercises, are emphasized as an adjunct to the traditional CPAP treat-ment for OSA [14].”
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“For example, Mendelson et al 9 highlight the need to include analysis of patients with OSA who are the most likely to succeed with the exercise training.”
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“In all these analyses, 19 – 22 AHI reduction was accompanied by an improvement in terms of daytime sleepiness, sleep ef fi ciency, and/or quality of life, which is an added value to the exercise program.”
Physical activity: the key to cardiometabolic risk reduction in obstructive sleep apnoea
Mendelson, M., & Flore, P. (2018) · European Respiratory Journal · doi:10.1183/13993003.01775-2018 · Cited by 6
Self-citationHou, Y., Cui, E., Lim, K. O., Chow, L. S., Howell, M. J., Ikramuddin, S., & Zhang, R. (2026) · Communications Medicine · doi:10.1038/s43856-025-01372-x · Cited by 5
Harding, C. D., Holloway, B. M., DeYoung, P. N., Kwan, C., Djonlagic, I. E., Ancoli‐Israel, S., Banks, S. J., & Malhotra, A. (2025) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.11648 · Cited by 4
“For example, day-time sleepiness in apneic patients can affect physical activity, 45 which is a protective factor against cognitive decline.”
Bughin, F., Mendelson, M., Jaffuel, D., Pépin, J., Gagnadoux, F., Goutorbe, F., Abril, B., Ayoub, B., Aranda, A., Alagha, K., et al. (2023) · Digital Health · doi:10.1177/20552076231167009 · Cited by 5
“21 Exercise training reduces the severity of OSAS and improves daytime sleepiness 22,23 while weight loss interventions improve BP, insulin resistance, hypertriglyceridemia and in fl ammation in obese patients with severe OSAS.”
BackgroundSelf-citationLatrille, C., Chapel, B., Héraud, N., Bughin, F., Hayot, M., & Boiché, J. (2023) · Digital Health · doi:10.1177/20552076221150744 · Cited by 6
“This limited number of studies integrating the outcome of PA is surprising insofar as CPAP, as the first-line treatment of OSA, has a limited impact on cardiometabolic risk factors, whereas exercise training has a well-documented effect on numerous cardiometabolic risk factors.(11) In individuals with chronic disease,…”
BackgroundInfluentialToward Patient-Centric Digital Monitoring of Obstructive Sleep Apnea: Mixed Methods Study
Timmis, J. K., Schorr, K. A., Yüksel, R., van den Broek, T., Overeem, S., Smid, D. J., van den Brink, W. J., & Haring, N. L. (2025) · Journal of Medical Internet Research · doi:10.2196/82460 · Cited by 4
Obstruktive Schlafapnoe – Einfluss auf kardiovaskuläres System und Kognition
Schneider, G. (2023) · Laryngo-Rhino-Otologie · doi:10.1055/a-1963-9957 · Cited by 7
“In OSA patients, the negative effects add up through a cycle of daytime sleepiness, fatigue, and reduction in physical activity and weight gain [109].”
BackgroundTkáčová, R. (2018) · Medical Hypotheses · doi:10.1016/j.mehy.2018.08.012 · Cited by 4
Kubitz, K. A., Park, H.-J., Patil, S. P., Papandreou, C., & Dobrosielski, D. A. (2022) · Sleep and Biological Rhythms · doi:10.1007/s41105-022-00433-1 · Cited by 5
“, sleep fragmentation and hypoxemia) are improved with exercise training [14].”
BackgroundKnowlden, A. P., Winchester, L. J., MacDonald, H. V., Geyer, J. D., & Higginbotham, J. C. (2024) · JMIR Formative Research · doi:10.2196/54792 · Cited by 4
Exploring Exercise Interventions for Obstructive Sleep Apnea: A Scoping Review
Themistocleous, I.-C., Hadjisavvas, S., Papamichael, E., Michailidou, C., Efstathiou, M. A., & Stefanakis, M. (2025) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk10030253 · Cited by 4
“The therapeutic exercise section included 14 studies, involving RCTs [65–70], single-arm studies [71], non-RCT studies [72], and meta-analyses [64,73–77].”
Sleep and obesity—known interactions and open questions
Schmickl, C. N., Gomez, R., Sunwoo, B. Y., Mesarwi, O. A., Kumar, A., & Malhotra, A. (2026) · Journal of Clinical Sleep Medicine · doi:10.1007/s44470-026-00130-7 · Cited by 3
“Recent meta-analyses showed that exercise training can significantly improve OSA severity, with reductions in apnea–hypopnea index (AHI) by 5.2 to 8.9 events per hour despite no improvement in BMI [101, 102].”
InfluentialActivités physiques et réadaptation respiratoire
Chéhère, B., Pernot, J., & Costes, F. (2021) · Revue des Maladies Respiratoires · doi:10.1016/j.rmr.2021.09.004 · Cited by 5
Obstructive sleep apnea and its relation with temporomandibular disorders: A narrative review
Ab‐Ghani, Z., Zwiri, A. M. A., Husein, A., Phaik, K. S., Kassim, N. K., Zainal, S. A., & Samsudin, A. (2020) · Journal of international oral health · doi:10.4103/jioh.jioh_246_19 · Cited by 3
“Journal of International Oral Health ¦ Volume 12 ¦ Issue 1 ¦ January‐February 2020 11 and enhances the ventilation drive.[37,38] Although CPAP is considered as the gold standard treatment option for the patients with OSA,[39] a major drawback is the interface, that is, mask and inadequate adherence of the equipment.”
BackgroundBeatty, C., Landry, S. A., Lee, J., Joosten, S. A., Turton, A., O’Driscoll, D. M., Wong, A., Thomson, L. D. J., Edwards, B. A., & Hamilton, G. S. (2020) · Sleep and Biological Rhythms · doi:10.1007/s41105-020-00291-9 · Cited by 3
Lifestyle Behaviour and Obstructive Sleep Apnea (OSA): An Association Study Among Young Adults
Jyothi, R. K., Mathangi, D. C., & Chellaiyan, V. G. (2022) · National Journal of Community Medicine · doi:10.55489/njcm.13062022628 · Cited by 3
Karkala, A., Baxevanidis, A., Chasiotou, A., Siopi, D., Mameletzi, D. N., Kouidi, E. J., Chloros, D. A., Pitsiou, G., & Boutou, A. (2024) · Sleep And Breathing · doi:10.1007/s11325-024-03148-4 · Cited by 3
“However, on a recent meta-analysis on OSAS patients, CPAP use did not exert any effect on their physical activity [ 20].”
da Fonseca, M. A., Moreira, A. K. S., Lima, R. B. D. S., Oliveira, M. D. A., Santos‐de‐Araújo, A. D., Rêgo, A. S., Penha, L. R. L. N., Ferreira, P. R., Gonçalves, M. C., & Dibai, D. B. (2021) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.20210232 · Cited by 3
Obstructive sleep apnoea and exercise functional capacity: time to move?
Farré, N., & Lorenzi‐Filho, G. (2018) · European Respiratory Journal · doi:10.1183/13993003.01031-2018 · Cited by 3
Hnatiak, J., Galkova, L. Z., Winnige, P., Baťalík, L., Dosbaba, F., Ludka, O., & Krejčí, J. (2023) · Biomedical Papers · doi:10.5507/bp.2023.022 · Cited by 3
Olagunju, A., Yamani, N., Unzek, S., Lee‐Iannotti, J. K., Mookadam, F., & Mookadam, M. (2022) · Journal of Clinical Exercise Physiology · doi:10.31189/2165-6193-11.3.80 · Cited by 2
González-Devesa, D., Sánchez-Lastra, M. A., Pérez-Fernández, P., Diz-Gómez, J. C., & Ayán, C. (2024) · Sleep And Breathing · doi:10.1007/s11325-024-03176-0 · Cited by 3
“…On a final note, it’s worth noting that none of the reviewed studies explored the effects of exercise on individ - uals with diabetes who also have obstructive sleep apnea—a syndrome linked to insulin resistance and glucose intolerance, for which exercise is considered an effective therapy [44].”
Kline, C. E. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-815373-4.00020-4 · Cited by 2
Participation in physical activity is associated with reduced nocturnal hypoxaemia in males
Stevens, D. J., Appleton, S., Melaku, Y. A., Martin, S., Adams, R., & Wittert, G. (2021) · ERJ Open Research · doi:10.1183/23120541.00852-2020 · Cited by 2
Katsagoni, C. N., Kokkinos, P. F., & Sidossis, L. S. (2023) · Wiley eBooks · doi:10.1002/9781119833475.ch19 · Cited by 2
Latrille, C., Hayot, M., Bosselut, G., Bughin, F., & Boiché, J. C. S. (2024) · Journal of Behavioral Medicine · doi:10.1007/s10865-024-00474-6 · Cited by 1
“Regarding BMI, results in the literature seem to support a negative relationship with PA (Mendelson et al., 2018a, 2018b) but these results are based on populations of obese people without an OSA diagnosis (DeLany et al., 2013).”
InfluentialMessaoud, R. B., Baillieul, S., Tamisier, R., Terrail, R., Bailly, S., Joyeux‐Faure, M., & Pépin, J. (2024) · BMC Digital Health · doi:10.1186/s44247-024-00077-w · Cited by 1
Self-citationKrzykawski, K., Maciejczyk, T., Mól, P., Sadowski, J., Zabawa, B., Dołęga, J., Papież, Ł. S., Hudzińska, P., Sieńko, A., & Łabuś, M. (2024) · Quality in Sport · doi:10.12775/qs.2024.36.56515 · Cited by 1
Physical activity phenotypes in obstructive sleep apnea: real-world data
Mendelson, M., Baillieul, S., Tondo, P., Louis, R., Wang, K.-P., Tamisier, R., Pépin, J., & Bailly, S. (2026) · Annals of the American Thoracic Society · doi:10.1093/annalsats/aaoag004 · Cited by 1
Self-citationFank, F., Artismo, R. S., da Rocha, A. G. R., Santana, M. G., Esteves, A. M., Lins-Filho, O., Matte, D. L., & Mazo, G. Z. (2026) · Sleep Medicine · doi:10.1016/j.sleep.2026.108967 · Cited by 1
Tkáčová, R., Paraničová, I., Timkova, E., Vonkova, D., & Joppa, P. (2018) · Journal of Health Psychology · doi:10.1177/1359105318788695 · Cited by 1
“…CPAP alone has prompted researchers and clinicians to seek strategies to promote weight loss in overweight and obese patients with OSA (Abuzaid et al., 2017; Barbé et al., 2012; Bratton et al., 2014; Drager et al., 2015; McEvoy et al., 2016; Mendelson et al., 2018; Shechter, 2016; Yu et al., 2017).”
BackgroundEuropean Respiratory Society International Congress 2020: highlights from best-abstract awardees
Britton, N., Elbehairy, A. F., Mensink‐Bout, S. M., Blondeel, A., Liu, Y., Cruz, J., & Brandt, J. D. (2020) · Breathe · doi:10.1183/20734735.0270-2020 · Cited by 1
“In patients with OSA, a combined treatment strategy is needed, including physical activity and exercise training, aiming to also address the cardiovascular and metabolic risk [24].”
BackgroundBerger, M., Bayon, V., Hirotsu, C., Haba‐Rubio, J., Barthélemy, J., Roche, F., & Heinzer, R. C. (2020) · Médecine du Sommeil · doi:10.1016/j.msom.2019.11.006 · Cited by 1
Kızılırmak, D., Karadoğan, D., Yıldırım, H., Akyıl, F. T., Eyüboğlu, T. Ş., Emiralioğlu, N., Sertçelik, Ü. Ö., Günaydın, F. E., Ataoğlu, Ö., Oguz, M. S., et al. (2022) · Turkish Thoracic Journal · doi:10.5152/turkthoracj.2022.21081 · Cited by 1
Hou, Y., Cui, E., Ikramuddin, S., & Zhang, R. (2024) · medRxiv · doi:10.1101/2024.11.11.24317124 · Cited by 1
Zhang, R., Hou, Y., Cui, E., Lim, K. O., Chow, L. S., Howell, M. J., & Ikramuddin, S. (2025) · Research Square · doi:10.21203/rs.3.rs-6263507/v1 · Cited by 1
The benefits of cardiac rehabilitation for patients with sleep apnea.
Komasi, S. (2018) · Europe PMC (PubMed Central) · doi:10.22122/arya.v14i4.1798
Metadata
- Authors
- Mendelson, M., Bailly, S., Marillier, M., Flore, P., Borel, J. C., Vivodtzev, I., Doutreleau, S., Verges, S., Tamisier, R., & Pépin, J.-L.
- Affiliations
- Inserm (FR)
- Corresponding author
- Mendelson, Monique
- ORCID
- Venue
- Frontiers in Neurology
- Publisher
- Frontiers Media SA
- Published
- 2018-02-22
- Volume
- 9
- Pages
- 73-73
- ISSN
- 1664-2295 (ISSN-L)
- PMC
- PMC5827163
- OpenAlex
- W2791102933
- Cited by
- 134
- References
- 87
- Citations by year
- 2026: 11 · 2025: 17 · 2024: 18 · 2023: 14 · 2022: 15 · 2021: 20 · 2020: 22 · 2019: 7 · 2018: 9
- FWCI
- 1.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Frontiers in Neurology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Fondation Air Liquide
- ResMed
- Agence Nationale de la Recherche (IDEX-02, ANR‐15‐IDEX‐02, ANR-15-IDEX-0002, 15-IDEX-02)
- Agir pour les Maladies Chroniques
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Keywords
- obstructive sleep apnea, physical activity, exercise training, step count, apnea-hypopnea index, daytime sleepiness, cardiorespiratory fitness, body mass index, OSA severity
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