Effect of continuous positive airway pressure on maximal exercise capacity in patients with obstructive sleep apnea: a systematic review and meta-analysis

Hannah V Fletcher, Peter Siu Pan Cho, Stewart Lee Loong, Luis Estrada-Petrocelli, Amit S Patel, Surinder S Birring, Kai K Lee

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Study Objectives: Exercise capacity is impaired in obstructive sleep apnea (OSA). There are conflicting reports on the effect of continuous positive airway pressure (CPAP) on maximal exercise capacity. The objective of this review was to determine if there is a change in exercise capacity and anaerobic threshold following CPAP treatment in OSA patients. Methods: We conducted a systematic review and meta-analyses to summarize the changes in peak rate of oxygen uptake (VO 2 peak) or maximum rate of oxygen uptake (VO2 max) and anaerobic threshold (AT) during cardiopulmonary exercise testing following CPAP intervention in patients with OSA. A systematic literature review was conducted to identify published literature on markers of VO 2 peak, VO 2 max, and AT pre- vs post-CPAP using a web-based literature search of PubMed/MEDLINE, Embase, CINAHL, and Cochrane review (CENTRAL) databases. Two independent reviewers screened the articles for data extraction and analysis. Results: The total search of all the databases returned 470 relevant citations. Following application of eligibility criteria, 6 studies were included in the final meta-analysis for VO 2 peak, 2 studies for VO 2 max, and five studies for AT. The meta-analysis showed a mean net difference in VO 2 peak between pre- and post-CPAP of 2.69 mL$kg –1$min– 1, P = .02, favoring treatment with CPAP. There was no difference in VO 2 max or AT with CPAP treatment (mean net difference 0.66 mL$kg –1$min– 1 [P = .78] and –144.98 mL$min– 1 [P = .20] respectively). Conclusions: There is a paucity of high-quality studies investigating the effect of CPAP on exercise capacity. Our meta-analysis shows that VO 2 peak increases following CPAP treatment in patients with OSA, but we did not observe any change in VO 2 max or AT. Our findings should be considered preliminary and we recommend further randomized controlled trials to confirm our findings and to clarify the peak and maximum rates of oxygen uptake adaptations with CPAP therapy.

Original languageEnglish
Pages (from-to)1847-1855
Number of pages9
JournalJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
Issue number11
Early online date14 Jul 2020
Publication statusPublished - 15 Nov 2020


  • aerobic exercise
  • cardiopulmonary exercise test
  • continuous positive airway pressure
  • obstructive sleep apnea
  • physical activity


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