Effects of combined exercise and sleep hygiene on obstructive sleep apnea severity in older adults: a randomized controlled trial

To evaluate the effects of a combined physical exercise program associated with sleep hygiene on obstructive sleep apnea (OSA) severity in older adults. This randomized controlled trial included adults aged 60–79 years with moderate-to-severe OSA (apnea–hypopnea index ≥ 15 events/hour). Participants were randomized to an exercise group or a control group. The exercise group completed a 12-week combined aerobic and resistance exercise program with sleep hygiene education, while the control group received sleep hygiene education only. OSA severity was assessed by home sleep apnea testing at baseline and after 12 weeks. The primary outcome was change in the apnea–hypopnea index (AHI). Analyses followed the intention-to-treat principle. Twenty-five participants were randomized. After 12 weeks, AHI decreased by 8.4 events/hour in the exercise group (from 40.7 to 32.3 events/hour) and increased by 8.1 events/hour in the control group, yielding a between-group difference in change of 16.5 events/hour (p = 0.001). Changes occurred independently of significant alterations in body composition, although neck circumference was reduced. Baseline body mass index was identified as an independent predictor of apnea–hypopnea index reduction. Adherence to the exercise intervention was high. A 12-week combined exercise and sleep hygiene program reduced OSA severity in older adults, independent of changes in body composition. These findings highlight physical exercise as a safe, feasible, and clinically relevant nonpharmacological strategy for OSA management in aging populations, particularly for individuals with limited adherence to continuous positive airway pressure therapy. Brazilian Registry of Clinical Trials (ReBEC) - RBR-9hk6pgz. • Evidence on exercise-based interventions for OSA in older adults remains limited. • Combined exercise plus sleep hygiene reduced AHI by 31% in older adults. • Exercise effects on OSA severity occurred independent of body composition changes. • Baseline BMI independently predicted reductions in apnea–hypopnea index. • High adherence supports exercise as a feasible non-pharmacological OSA therapy.