Effects of six different exercise therapies on sleep indices, cardiopulmonary endurance, and body composition in patients with sleep-related breathing disorders: network meta-analysis of 40 RCTs.

Abstract

<h4>Background</h4>Sleep apnea syndrome is a common sleep disorder that frequently leads to multi-systemic damage. Traditional therapies have limitations, while exercise interventions show potential; however, the efficacy of different exercise modalities remains unclear.<h4>Methods</h4>Six databases (PubMed, Web of Science, EBSCO, Embase, Cochrane Library, and China National Knowledge Infrastructure) were systematically searched. A total of 40 randomized controlled trials involving 1790 patients with Sleep Apnea Syndrome were included. The outcomes comprised key indexes for evaluating sleep indices, cardiorespiratory fitness, and body composition. A network meta-analysis was conducted using Stata 18.0 to assess the relative effectiveness of each exercise intervention and to evaluate the consistency between direct and indirect evidence.<h4>Results</h4>Network meta-analysis demonstrated that High-Intensity Interval Training (HIIT) was the most effective intervention for improving sleep indices (SUCRA = 98.9, PrBest=95.1%) and cardiorespiratory fitness (SUCRA = 87.9, PrBest=67.8%). Aerobic Training (AT) ranked highest for improving body composition (SUCRA = 92.7, PrBest=71.4%). Significant heterogeneity was observed in several comparisons, particularly regarding body composition outcomes. Direct comparisons revealed that Aerobic Combined with Resistance Training (ACRT) was significantly more effective than Respiratory Exercise (RE) in improving sleep indices (SMD = -2.97, 95% CI [-4.11, -1.82], P < 0.0001).<h4>Conclusion</h4>This analysis indicates that exercise interventions differentially improve outcomes in SAS. HIIT appears optimal for sleep and cardiorespiratory benefits, while AT best targets body composition. Clinical application should be personalized based on patient-specific treatment priorities.<h4>Systematic review registration</h4>https://www.crd.york.ac.uk/prospero/, identifier CRD420251253035.