Exercise and weight loss have long been a part of the standard treatment for Obstructive Sleep Apnea (OSA) and, even when weight loss is not warranted, exercise is often recommended to improve overall sleep quality. Several studies have suggested that the effect of exercise on the apnea-hypopnea index (AHI, a measure of the severity of the OSA) is independent of any associated weight loss. A prospective study reported in the December issue of Sleep, the official journal of the American Academy of Sleep Medicine, investigated the independent role of exercise in OSA therapy.
Thirty-seven adults, mean age: 46.9 years, with at least moderate OSA (AHI >15), completed the study. All were overweight to obese (mean BMI: 34.8), sedentary, and had no history of significant cardiovascular, pulmonary, or metabolic disease other than controlled hypertension.
Subjects were randomly assigned to an exercise group or a control group that participated in a stretching routine. The exercise group met four days per week with aerobic exercise on each day and additional resistance exercise on two of the days. The stretching control group met twice a week. The program lasted for 12 weeks.
Although it was not possible to “blind” the participants as to which group they were assigned, the researchers presented both treatments as active treatments with the potential of improving OSA and there was no statistically significant difference in the participants expectations.
The exercise group had a significant reduction in AHI, compared to either the stretching control group and to their own baseline. This reduction was independent of sleep stages, body position, or pulmonary function measures. The exercise group did not have a significant change in body weight or circumference measures but did have a reduction in total body fat. The exercise group subjectively reported improved sleep quality, which was consistent with actigraphy data, and their bed partners reported noticeable reductions in snoring.
This study reports improvement in AHI attributable to exercise alone. Although the OSA was not resolved, in a clinical setting any recommendation would be for ongoing exercise, not just a 12 week intervention, and it is not unreasonable to expect further improvement. Continued exercise would also probably result in eventual weight loss.
This study is consistent with the view that OSA is a problem of respiratory control and not merely an anatomical “plumbing” problem. It also gives hope for those OSA patients hoping to ultimately get off their CPAP machines.
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