Development and investigation of the efficacy of an interactive, web-based game exercise system (ApnoeaTheraPlay) for individuals with obstructive sleep apnoea syndrome: study protocol for a randomised, single-blind, controlled trial

INTRODUCTION: Obstructive sleep apnoea syndrome (OSAS) is a prevalent sleep disorder caused by recurrent upper airway collapse during sleep. Continuous positive airway pressure (CPAP) therapy is the most commonly prescribed treatment; however, adherence remains suboptimal, with non-compliance rates reported between 46% and 83%. Exercise-based interventions have demonstrated beneficial effects on respiratory muscle strength, upper airway function and sleep quality. This study aims to develop an interactive, web-based, game exercise platform (ApneaTheraPlay (ATP)) integrating respiratory, aerobic, strengthening and oropharyngeal exercises as an adjunct to CPAP therapy for individuals with OSAS, and to evaluate its effectiveness compared with a structured presleep exercise programme and a control condition. METHODS AND ANALYSIS: This study is designed as a single-blinded, three-arm, parallel-group randomised controlled trial. Individuals diagnosed with OSAS who use CPAP will be randomly allocated to the ATP group, the structured presleep exercise group (SPEG) or the control group (CG). Participants in the ATP and SPEG groups will perform exercise sessions three times per week for 12 weeks (36 sessions in total). The ATP group will use a web-based, interactive, game-based exercise system, whereas the SPEG group will follow a conventional video-based exercise programme delivered in a non-interactive format. Participants in the CG will continue their usual activities and record daily physical activity using an activity diary. The primary outcome measures will be the Apnoea-Hypopnoea Index and nocturnal oxygen saturation parameters. Secondary outcomes will include sleep quality, daytime functioning, fatigue, muscle strength and function, CPAP adherence, psychological status and technology usability. ETHICS AND DISSEMINATION: ) for clinical trial registration and reporting. The results of this trial will be disseminated through publication in peer-reviewed scientific journals and presentation at national and international scientific meetings. No individual participant data will be shared publicly. This study is supported by The Scientific and Technological Research Council of Turkey (TÜBİTAK) under project number 225S257. TRIAL REGISTRATION NUMBER: NCT07214636.