{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T11:51:06Z","timestamp":1775649066343,"version":"3.50.1"},"reference-count":39,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004410","name":"Scientific and Technological Research Council of Turkey","doi-asserted-by":"crossref","award":["1001"],"award-info":[{"award-number":["1001"]}],"id":[{"id":"10.13039\/501100004410","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004410","name":"Scientific and Technological Research Council of Turkey","doi-asserted-by":"crossref","award":["225S257"],"award-info":[{"award-number":["225S257"]}],"id":[{"id":"10.13039\/501100004410","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,6]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>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\u2013Hypopnoea 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>\n                      This study was approved by the Istanbul Medipol University Non-Interventional Clinical Research Ethics Committee (E-10840098-202.3.02-6266; 17 September 2025). The study will comply with the guidelines established by the\n                      <jats:italic>International Committee of Medical Journal Editors<\/jats:italic>\n                      (\n                      <jats:italic>ICMJE<\/jats:italic>\n                      ) 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 (T\u00dcB\u0130TAK) under project number 225S257.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT07214636\">NCT07214636<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-117541","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:55:29Z","timestamp":1775645729000},"page":"e117541","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct07214636","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5592-7546","authenticated-orcid":false,"given":"Gulay","family":"Aras Bayram","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul Medipol Universitesi, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Devrim","family":"Tarakci","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul Medipol Universitesi, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gizem","family":"Ergezen Sahin","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul Medipol Universitesi, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gokce","family":"Savas Cevlan","sequence":"additional","affiliation":[{"name":"Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, \u0130stanbul Medipol \u00dcniversitesi, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alper","family":"Ceylan","sequence":"additional","affiliation":[{"name":"Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, \u0130stanbul Medipol \u00dcniversitesi, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esra","family":"Atilgan","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul Medipol Universitesi, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kemal","family":"Ozkan","sequence":"additional","affiliation":[{"name":"Department of Computer Engineering, Eskisehir Osmangazi University, Eskisehir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erdogan","family":"Kunter","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Chest Disease, Istanbul Medipol University, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"2026040803551755000_16.4.e117541.1","doi-asserted-by":"crossref","first-page":"10845","DOI":"10.3390\/ijerph191710845","article-title":"Effects of Exercise on Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis","volume":"19","author":"Peng","year":"2022","journal-title":"IJERPH"},{"key":"2026040803551755000_16.4.e117541.2","first-page":"171","article-title":"Are physical inactivity, sitting time and screen time associated with obstructive sleep apnea in adults? A cross-sectional study","volume":"140","author":"Pitta","year":"2022","journal-title":"Sao Paulo Med J"},{"key":"2026040803551755000_16.4.e117541.3","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000988"},{"key":"2026040803551755000_16.4.e117541.4","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/34.1.111"},{"key":"2026040803551755000_16.4.e117541.5","doi-asserted-by":"publisher","DOI":"10.1513\/pats.200708-119MG"},{"key":"2026040803551755000_16.4.e117541.6","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/kjm2.12130","article-title":"Obstructive sleep apnea treatment in adults","volume":"36","author":"Chang","year":"2020","journal-title":"The Kaohsiung J Med Sci"},{"key":"2026040803551755000_16.4.e117541.7","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.8456"},{"key":"2026040803551755000_16.4.e117541.8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/sms.12581","article-title":"Exercise as medicine \u2013 evidence for prescribing exercise as therapy in 26 different chronic diseases","volume":"25","author":"Pedersen","year":"2015","journal-title":"Scandinavian Med Sci Sports"},{"key":"2026040803551755000_16.4.e117541.9","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.1422"},{"key":"2026040803551755000_16.4.e117541.10","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-009-0311-1"},{"key":"2026040803551755000_16.4.e117541.11","doi-asserted-by":"crossref","first-page":"bmjsem","DOI":"10.1136\/bmjsem-2016-000155","article-title":"High-intensity interval training improves obstructive sleep apnoea","volume":"2","author":"Karlsen","year":"2017","journal-title":"BMJ Open Sport Exerc Med"},{"key":"2026040803551755000_16.4.e117541.12","doi-asserted-by":"crossref","DOI":"10.3390\/jcm13226814","article-title":"Relationship Between Obstructive Sleep Apnea and Sports-Systematic Review and Meta-Analysis","volume":"13","author":"Mart\u00ednez Revuelta","year":"2024","journal-title":"J Clin Med"},{"key":"2026040803551755000_16.4.e117541.13","doi-asserted-by":"crossref","first-page":"A39","DOI":"10.1093\/sleepadvances\/zpad035.101","article-title":"P016 Effects of Aerobic Exercise versus Inspiratory Muscle training on Apnea-Hypopnea Index in patients with Obstructive Sleep Apnea","volume":"4","author":"Ittinirundorn","year":"2023","journal-title":"Sleep Advances"},{"key":"2026040803551755000_16.4.e117541.14","doi-asserted-by":"crossref","unstructured":"Kim KA , Kim SJ . Oropharyngeal exercise for OSA patients. In: Kim SJ , Kim KB , eds. Orthodontics in obstructive sleep apnea patients. Springer International Publishing, 2020: 131\u201341.","DOI":"10.1007\/978-3-030-24413-2_10"},{"key":"2026040803551755000_16.4.e117541.15","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1016\/j.sleep.2024.10.026","article-title":"Efficacy comparison of aerobic exercise, combined exercise, oropharyngeal exercise and respiratory muscle training for obstructive sleep apnea: A systematic review and network meta-analysis","volume":"124","author":"Tang","year":"2024","journal-title":"Sleep Med"},{"key":"2026040803551755000_16.4.e117541.16","unstructured":"Sabat\u00e9 E . Adherence to long-term therapies: evidence for action. World Health Organization; 2003. Available: https:\/\/books.google.com\/books?hl=tr&lr=&id=kcYUTH8rPiwC&oi=fnd&pg=PR5&dq=Sabat%C3%A9,+E.+Ed.+2003.+%E2%80%9CAdherence+to+long-term+therapies:+evidence+for+action%E2%80%9D,+World+Health+Organization&ots=tD5Qlt5bnZ&sig=DU-lVe8tHUeDoAIUYQi5IYjQ0O4 [Accessed 18 Jan 2026]."},{"key":"2026040803551755000_16.4.e117541.17","doi-asserted-by":"crossref","first-page":"1320112","DOI":"10.3389\/fpubh.2024.1320112","article-title":"Effects of active video games on physical activity among overweight and obese college students: a systematic review","volume":"12","author":"Zhao","year":"2024","journal-title":"Front Public Health"},{"key":"2026040803551755000_16.4.e117541.18","doi-asserted-by":"crossref","DOI":"10.3390\/nu13113689","article-title":"Telehealth: A Useful Tool for the Management of Nutrition and Exercise Programs in Pediatric Obesity in the COVID-19 Era","volume":"13","author":"Calcaterra","year":"2021","journal-title":"Nutrients"},{"key":"2026040803551755000_16.4.e117541.19","doi-asserted-by":"crossref","DOI":"10.2196\/11819","article-title":"Consumer-Based Wearable Activity Trackers Increase Physical Activity Participation: Systematic Review and Meta-Analysis","volume":"7","author":"Brickwood","year":"2019","journal-title":"JMIR Mhealth Uhealth"},{"key":"2026040803551755000_16.4.e117541.20","doi-asserted-by":"crossref","unstructured":"Deterding S , Dixon D , Khaled R , et al . From game design elements to gamefulness: defining gamification. Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments, ACM; 2011:9\u201315. doi:10.1145\/2181037.2181040","DOI":"10.1145\/2181037.2181040"},{"key":"2026040803551755000_16.4.e117541.21","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.jbi.2017.05.011","article-title":"A systematic review of gamification in e-Health","volume":"71","author":"Sardi","year":"2017","journal-title":"J Biomed Inform"},{"key":"2026040803551755000_16.4.e117541.22","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1007\/s12178-022-09797-w","article-title":"Gamification in Musculoskeletal Rehabilitation","volume":"15","author":"Alfieri","year":"2022","journal-title":"Curr Rev Musculoskelet Med"},{"key":"2026040803551755000_16.4.e117541.23","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.entcom.2015.10.002","article-title":"Exergaming and rehabilitation: A methodology for the design of effective and safe therapeutic exergames","volume":"14","author":"Pirovano","year":"2016","journal-title":"Entertain Comput"},{"key":"2026040803551755000_16.4.e117541.24","doi-asserted-by":"crossref","first-page":"332","DOI":"10.3390\/fi17080332","article-title":"Augmented Reality and Virtual Reality in Exergaming","volume":"17","author":"Lampropoulos","year":"2025","journal-title":"Future Internet"},{"key":"2026040803551755000_16.4.e117541.25","first-page":"2341","article-title":"Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea","volume":"32","author":"Iftikhar","year":"2014","journal-title":"J Hypertens (Los Angel)"},{"key":"2026040803551755000_16.4.e117541.26","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.8212","article-title":"Effect of an Interdisciplinary Weight Loss and Lifestyle Intervention on Obstructive Sleep Apnea Severity: The INTERAPNEA Randomized Clinical Trial","volume":"5","author":"Carneiro-Barrera","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026040803551755000_16.4.e117541.27","doi-asserted-by":"crossref","DOI":"10.3389\/fphys.2022.995575","article-title":"Validity of three smartwatches in estimating energy expenditure during outdoor walking and running","volume":"13","author":"Le","year":"2022","journal-title":"Front Physiol"},{"key":"2026040803551755000_16.4.e117541.28","doi-asserted-by":"publisher","DOI":"10.1016\/0165-1781(89)90047-4"},{"key":"2026040803551755000_16.4.e117541.29","doi-asserted-by":"publisher","DOI":"10.1016\/S1389-9457(00)00065-4"},{"key":"2026040803551755000_16.4.e117541.30","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/14.6.540"},{"key":"2026040803551755000_16.4.e117541.31","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/32.7.915"},{"key":"2026040803551755000_16.4.e117541.32","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3999(93)90081-P"},{"key":"2026040803551755000_16.4.e117541.33","first-page":"65","article-title":"Expiratory and inspiratory muscle functions in obstructive sleep apnea syndrome","volume":"3","author":"Parmaks\u0131z","year":"2016","journal-title":"J Turkish Sleep Med"},{"key":"2026040803551755000_16.4.e117541.34","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/30.6.711"},{"key":"2026040803551755000_16.4.e117541.35","unstructured":"Brooke J . SUS: a retrospective. J Usability Stud 2013;8."},{"key":"2026040803551755000_16.4.e117541.36","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.pubmed.a024606"},{"key":"2026040803551755000_16.4.e117541.37","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afr051"},{"key":"2026040803551755000_16.4.e117541.38","doi-asserted-by":"crossref","first-page":"685","DOI":"10.2519\/jospt.2018.7851","article-title":"Hand-Grip Strength: Normative Reference Values and Equations for Individuals 18 to 85 Years of Age Residing in the United States","volume":"48","author":"Wang","year":"2018","journal-title":"J Orthop Sports Phy Ther"},{"key":"2026040803551755000_16.4.e117541.39","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1983.tb09716.x"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-117541","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:55:36Z","timestamp":1775645736000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-117541"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":39,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,8]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bmjopen-2026-117541"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-117541","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}