BACKGROUND: Exercise and CPAP improve OSA. This study examined the effects of exercise in patients with heart failure (HF) and OSA. METHODS: Patients with HF and OSA were randomized to the following study groups: control, exercise, CPAP, and exercise plus CPAP. RESULTS: Sixty-five participants completed the protocol. Comparing baseline versus 3 months, the mean Apnea-Hypopnea Index (AHI) did not change significantly (in events per hour) in the control group, decreased moderately in the exercise group (28 +/- 17 to 18 +/- 12; p < 0.03), and decreased significantly more in the CPAP group (32 +/- 25 to 8 +/- 11; p < 0.007) and in the exercise plus CPAP group (25 +/- 15 to 10 +/- 16; p < 0.007). Peak oxygen consumption, muscle strength, and endurance improved only with exercise. Both exercise and CPAP improved subjective excessive daytime sleepiness, quality of life, and the New York Heart Association functional class. However, compared with the control group, changes in scores on the 36-item Medical Outcomes Study Short Form Survey and Minnesota Living with Heart Failure Questionnaire were only significant in the exercise groups. CONCLUSIONS: In patients with HF and OSA, our preliminary results showed that exercise alone attenuated OSA and improved quality of life more than CPAP. In the landscape treatment of OSA in patients with HF, this analysis is the only randomized trial showing any treatment (in this case, exercise) that improved all the studied parameters. The results highlight the important therapeutic benefits of exercise, particularly because adherence to CPAP is low.

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