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Physical activity improves AHI in sleep apnoea patients

Presented by
Prof. Monique Mendelson, University of Grenoble, France
ERS 2020
Cohort study, EPISONO

Exercise should play a key role in the multi-componential treatment of patients with sleep apnoea syndrome as it can positively influence the Apnoea-Hypopnoea Index (AHI) and risk factors for diseases like diabetes [1].

The current gold standard for treatment of sleep apnoea is continuous positive airway pressure (CPAP) [1]. It leads to improvements such as reduced daytime sleepiness and augmented quality of life, but it has limited impact on the cardiovascular (CV) risk of patients [2]. Thus, researchers have set a focus on the development of combined modality strategies for therapy.

The EPISONO cohort study found that physical activity is not only able to reduce the risk of developing sleep apnoea but is also a protective factor decreasing the risk of type-2 diabetes in these patients [3]. A meta-analysis assessing observational studies that objectively measured physical activity demonstrated a rather low mean activity level of 5,388 instead of the recommended 10,000 steps per day in patients with sleep apnoea [4]. “That is why there is a real need for strategies to accompany these patients to increase their physical activity levels,” advocated Prof. Monique Mendelson (University of Grenoble, France).

The same meta-analysis found that structured exercise training was able to lower the AHI by 32% equalling -8.9 events per hour [4]. In untreated sleep apnoea patients, exercise training led to improved sleepiness and exercise capacity but not to a change in body weight. “Studies have consistently shown that AHI improves in the absence of BMI, indicating that loss of body fat in particular around the neck is unlikely to be the main mechanism explaining improvement of sleep apnoea with exercise,” explained Prof. Mendelson.

Alternatively, the concept of fluid shift has been proposed as underlying pathophysiology of sleep apnoea [5]. In this concept, the fluid that is accumulated in the legs during daytime shifts upwards to chest and neck during the night and exerts pressure on the upper airway leading to apnoea and hypopnoea. A randomised controlled trial measured this fluid shift using segmental bioelectrical impedance analysis and compared the change in AHI of sleep apnoea patients between a group that walked 30 minutes 5 days a week for 4 weeks and a control group [6]. The AHI in the exercise group was significantly reduced by about 30%, besides a significant improvement in the overnight change of leg fluid.

In light of these findings, Prof. Mendelson concluded that physical activity should be part of a multicomponent and individualised management programme of sleep apnoea syndrome.


    1. Mendelson M. Physical activity and exercise training as therapeutic interventions for sleep apnoea. Abstract 4198, ERS International Virtual Congress 2020, 7-9 Sept.
    2. McNicholas WT, et al. Lancet Respir Med. 2018;6:170-172.

    1. Mônico-NetoM, et al. Eur Respir J. 2018;52:1701972.
    2. Mendelson M, et al. Front Neurol. 2018;9:73.
    3. White L, et al. J Physiol. 2013;591:1179-1193.
    4. Mendelson M, et al. Eur Respir J. 2016;48:142-150.

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