INTRODUCTION: Besides dyslipidemia, insulin resistance and glucose intolerance, one of the most common metabolic complications associated with obstructive sleep apnoea (OSA) is non-alcoholic fatty liver disease (NAFLD), ie, the excessive accumulation of fats or lipoproteins in the hepatic tissues. However, while continuous positive airway pressure (CPAP) is frequently used as first-line treatment for OSA and NAFLD, it has demonstrated conflicting results. The aim of the present study is to determine the efficacy of free walking as a treatment for OSA patients with NAFLD. MATERIALS AND METHODS: Forty moderate-to-severe OSA patients with NAFLD were randomly assigned to a group receiving CPAP (n = 20) or one with CPAP plus a daily free walking programme (aerobic exercise group, n = 20). The CPAP was performed for four hours each night. The Pittsburgh Sleep Quality Index, serum alanine and aspartate transaminase levels, body mass index (BMI), fatigue severity scale, serum triglyceride, and Epworth sleepiness scale were read at baseline and after 12 weeks. RESULTS: Almost all patient outcomes, apart from serum triglyceride level in the CPAP-only group (p = 0.025), demonstrated significant improvements over time (p < 0.001). No significant change in BMI was observed in the CPAP-only group. All improvements were greater in the CPAP plus walking group. The CPAP plus walking group also achieved significantly better outcomes (p < 0.05) at the end of the programme. CONCLUSIONS: Adding free walking maximizes the therapeutic benefit of CPAP in OSA patients with NAFLD.

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