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Volume 14 No. 10
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Accepted Papers

Scientific Investigations

Physical Activity Following Positive Airway Pressure Treatment in Adults With and Without Obesity and With Moderate-Severe Obstructive Sleep Apnea

Yuan Feng, MD, PhD1,2; David Maislin, BS2; Brendan T. Keenan, MS2; Thorarinn Gislason, MD3,4; Erna S. Arnardottir, PhD3,4; Bryndis Benediktsdottir, MD3,4; Julio A. Chirinos, MD, PhD2,5; Raymond R. Townsend, MD2,5; Bethany Staley, RPSGT2; Francis M. Pack, RN, CCRC2,5; Andrea Sifferman, MPH2; Allan I. Pack, MBChB, PhD2,5; Samuel T. Kuna, MD2,5,6
1Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China; 2Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania; 3Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; 4Faculty of Medicine, University of Iceland, Reykjavik, Iceland; 5Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; 6Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania

Study Objectives:

To examine the level of physical activity (PA) before and following positive airway pressure (PAP) treatment in adults who have obstructive sleep apnea (OSA) with obesity versus without obesity.


Simultaneous waist accelerometer and wrist actigraphy recordings were obtained in 129 adults with obesity and 69 adults without obesity and who had OSA prior to and following 4 months of PAP therapy and in 52 patients in a control group. Primary PA measurements were average steps per day on waist accelerometry and average counts per minute (CPM) per day on wrist actigraphy.


At baseline, participants with obesity and OSA exhibited fewer steps per day on waist accelerometer and fewer CPM per day on wrist actigraphy compared to participants without obesity and with OSA (despite similar apnea-hypopnea index between groups). Following PAP treatment, participants with OSA had modestly increased CPM per day on wrist actigraphy (17.69 [95% confidence interval (CI), 5.67–29.71], P = .005) and increased light PA time (0.26 [95% CI, 0.07–0.44] hours, P = .008) on waist accelerometer. Participants without obesity and with OSA had greater improvements in PA measures on average compared to participants with obesity and OSA, although the differences were not statistically significant. Weight increased following PAP treatment in the participants with obesity and OSA (1.71 [95% CI, 0.41–3.02] kg, P = .010) but was unchanged in the group without obesity (0.93 [95% CI, −0.89 to 2.76] kg, P = .311).


Compared to study participants without obesity and with OSA, participants with obesity and OSA had reduced PA at baseline. PA increased significantly in participants without obesity, with OSA, and who were adherent to PAP treatment. Results indicate that treatment of OSA is unlikely to be associated with a change in PA in adults with obesity and OSA and help explain the absence of weight loss following PAP treatment in adults with OSA.

Clinical Trial Registration:

Registry:, title: The Effects of Treating Obese and Lean Patients With Sleep Apnea (PISA), identifier: NCT01578031, URL:


Feng Y, Maislin D, Keenan BT, Gislason T, Arnardottir ES, Benediktsdottir B, Chirinos JA, Townsend RR, Staley B, Pack FM, Sifferman A, Pack AI, Kuna ST. Physical activity following positive airway pressure treatment in adults with and without obesity and with moderate-severe obstructive sleep apnea. J Clin Sleep Med. 2018;14(10):1705–1715.

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