Rehabilitation and therapeutic exercise in obstructive sleep apnea: a perspective beyond the apnea-hypopnea index.

Abstract

Introduction Obstructive sleep apnea (OSA) is a multisystem disease whose clinical impact extends beyond nocturnal respiratory events. Although the apnea hypopnea index (AHI) is widely used to classify disease severity, this parameter does not adequately reflect the functional, symptomatic, and quality-of-life burden experienced by individuals with OSA. In this context, rehabilitative interventions have emerged as relevant therapeutic strategies within the comprehensive management of the disease. Objective To synthesize the available scientific evidence on the role of rehabilitation in individuals with OSA, highlighting its clinical impact beyond the AHI and its contribution to patient-centered outcomes. Methods A narrative review with structured bibliographic search was conducted in PubMed, Embase/Scopus, and Google Scholar. Randomized controlled trials, systematic reviews, and meta-analyses evaluating rehabilitative interventions in adult populations with OSA were included. The search covered exercise training, oropharyngeal myofunctional therapy, inspiratory muscle training, and interdisciplinary lifestyle programs using a comprehensive, multi-term search syntax. Results The evidence indicates that rehabilitative interventions lead to consistent improvements in daytime sleepiness, sleep quality, functional capacity, cognitive performance, and quality of life, even when changes in the AHI are modest or variable. Interdisciplinary programs demonstrated the most robust effects, including reductions in AHI exceeding 50% in selected subgroups (INTERAPNEA trial). A recent umbrella review confirmed that structured physical activity achieved the greatest improvements in quality of life among all non-pharmacological interventions evaluated. Conclusion Rehabilitation represents an essential component of the comprehensive management of OSA, providing clinically meaningful benefits beyond the AHI and reinforcing a therapeutic approach centered on patient functionality and quality of life.