Efficacy of therapies based on muscle strength training among individual with obstructive sleep apnea - a systematic review and meta-analysis.

BACKGROUND

Exercise modalities that target upper-airway and respiratory muscles may modify obstructive sleep apnea (OSA) severity.

OBJECTIVE

To synthesize randomized controlled trials (RCTs) of resistance training (RT), oropharyngeal training (OT), and respiratory muscle training (RMT) on OSA severity (apnea-hypopnea index, AHI) and daytime sleepiness (Epworth Sleepiness Scale, ESS).

METHODS

PubMed, EBSCO, and Scopus were searched (1 Jan 2015-31 Jan 2025). Of 1805 records identified, 13 RCTs (n = 429) met eligibility. Random-effects meta-analyses were performed within modality.

RESULTS

OT reduced AHI (mean difference, MD -7.55 events·h-1, 95% CI -13.39 to -1.71; p = 0.02). RMT reduced AHI (MD -3.73 events·h-1, -7.44 to -0.03; p = 0.049). RT showed no significant change (MD -5.88 events·h-1, -17.25 to 5.49; p = 0.16). Across modalities, ESS showed no consistent, clinically meaningful improvement. Heterogeneity was substantial for RT trials for AHI and for OT trials in ESS, reflecting variability in protocols, duration, and participant characteristics.

CONCLUSIONS

When analyzed within modality, OT and RMT are associated with reductions in AHI, whereas RT alone does not demonstrate a significant effect. Symptom change measured by ESS was not consistently observed. These findings support OT and RMT as adjunctive options for reducing physiological OSA severity, while underscoring the need for standardized protocols, longer follow-up, and patient-important outcomes.