Vigorous physical activity is associated with reduced sleep fragmentation in obstructive sleep apnea: A sex-specific analysis.

BACKGROUND

Sleep fragmentation is a key pathophysiological feature of obstructive sleep apnea (OSA) and is associated with adverse clinical outcomes. Although physical activity is known to improve sleep, the dose-specific effects of vigorous-intensity physical activity on objective sleep fragmentation in OSA remain incompletely established.

OBJECTIVE

To evaluate whether vigorous-intensity physical activity is associated with polysomnography-derived sleep fragmentation and other sleep parameters in adults with OSA, and to determine whether these associations differ by sex.

METHODS

We conducted a retrospective cross-sectional study of adults who underwent polysomnography at a tertiary sleep center between September 2025 and January 2026. Physical activity was assessed using the International Physical Activity Questionnaire-Short Form, and vigorous activity was defined based on frequency and duration criteria. Sleep parameters, including arousal index, wake after sleep onset (WASO), sleep efficiency, total sleep time, and sleep latency, were analyzed. Sex-stratified analyses were performed using multivariable linear regression models adjusted for relevant clinical covariates.

RESULTS

A total of 343 participants were included. Among patients with OSA, vigorous-intensity physical activity was associated with improved sleep continuity, particularly in females. In this subgroup, vigorous activity was significantly associated with lower arousal index, lower WASO, higher sleep efficiency, and longer total sleep time. In contrast, no significant association with arousal index was observed in males. A significant interaction between sex and vigorous activity was identified for arousal index.

CONCLUSIONS

Vigorous-intensity physical activity was associated with reduced sleep fragmentation in OSA, with a more pronounced association in females. The findings of the current study indicate that exercise intensity may potentially be a modifiable factor in sleep fragmentation associated with OSA.