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Ventilatory support or respiratory muscle training as adjuncts to exercise in obese CPAP-treated patients with obstructive sleep apnoea: a randomised controlled trial
  1. Isabelle Vivodtzev1,2,
  2. Renaud Tamisier1,
  3. Marilie Croteau3,
  4. Jean-Christian Borel1,
  5. Angélique Grangier1,
  6. Bernard Wuyam1,
  7. Patrick Lévy1,
  8. Caroline Minville3,
  9. Frédéric Sériès3,
  10. François Maltais3,
  11. Jean-Louis Pépin1
  1. 1 HP2 Laboratory, Centre Hospitalier Universitaire Grenoble Alpes, INSERM U1042, Grenoble Alps University, Grenoble, France
  2. 2 Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
  3. 3 Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, QC, Canada
  1. Correspondence to Dr Isabelle Vivodtzev, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Alps University, Grenoble 02138, France; ivivodtzev{at}


Background Obstructive sleep apnoea (OSA) and obesity are interdependent chronic diseases sharing reduced exercise tolerance and high cardiovascular risk.

Intervention A 3-month intervention with innovative training modalities would further improve functional capacity and cardiovascular health than usual cycle exercise training in already continuous positive airway pressure (CPAP)-treated obese patients with OSA.

Methods Fifty three patients (35<body mass index (BMI) <45 kg/m2) were randomly allocated to exercise training on a cycle ergometer, either alone (ERGO) or with respiratory muscle training (ERGO+RMT) or non-invasive ventilation (ERGO+NIV). Changes in 6 min walking distance (primary outcome), aerobic capacity (VO2peak), cardiovascular parameters, body composition and sleep quality were evaluated.

Measurements and main results All training modalities increased 6 min walking distance without differences between groups (P=0.97). ERGO+NIV and ERGO+RMT led to significantly higher improvement in VO2peak compared with ERGO (3.1 (95% CI 1.6 to 4.6) vs 2.3 (0.8 to 3.7) vs 0.5(−1.0 to 1.9) mL/min/kg, respectively, P=0.04) and ERGO+NIV significantly reduced self-measured blood pressure compared with ERGO+RMT and ERGO (systolic: −9.5 (95% CI −14.1 to −4.9) vs −13 (−5.8 to 3.1) vs −0.7 (−5.1 to 3.8) mm Hg, respectively, P=0.01). Waist and neck circumferences were reduced after ERGO+NIV compared with ERGO+RMT and ERGO (P=0.01).

Conclusions Combining RMT or NIV with cycling exercise training failed to provide further improvement in functional capacity as compared with cycling exercise training alone. However, the combination of NIV and exercise training demonstrated superiority for improving cardiometabolic risk factors in obese CPAP-treated patients with OAS.


  • sleep apnoea
  • pulmonary rehabilitation
  • respiratory muscles

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  • Contributors IV, J-LP, FM and J-CB were involved in the literature search, study design, data collection, data analysis and interpretation, preparation of figures and/or writing. MC, AG and CM were responsible for the study design and data collection. Data collection, data interpretation and critical revision of the manuscript were done by RT, BW, PL and FS.

  • Funding This work was funded by the endowment fund ‘Agir pour les maladies chroniques’, France, an unrestricted grant from Philips and was also supported by the French National Research Agency (ANR) in the framework of the ‘Investissements d’avenir’ program (ANR-15-IDEX-02).

  • Competing interests IV reports personal fees and other from Invacare and salaries from Agiradom, all outside the submitted work. RT reports grants from Resmed, Philips and other from Agiradom, all outside the submitted work. J-CB reports grants and personal fees from Resmed and Philips, salaries from Agiradom and other from Nomics, all outside the submitted work. FM reports grants from GlaxoSmithKline, Boehringer Ingelheim, Novartis and AstraZeneca; personal fees from Novartis, Griffols, Boehringer Ingelheim and Novartis, all outside the submitted work. J-LP reports grants and personal fees from Resmed, Philips, Sefam, Agiradom, Vitalaire; personal fees from Elevie grants from Fisher & Paykel, Astra Zenecaand Bohringer, all outside the submitted work. MC, AG, BW CM, FS and PL have nothing to disclose.

  • Patient consent Obtained.

  • Ethics approval CPP Sud Est V (09-PROR-1), France and CER Laval Hospital (#20649), IUCPQ, Quebec, Canada.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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