Effects of diaphragmatic breathing exercise on sleeping quality, cortisol, cardiovascular autonomic functions, depression, and fatigue: a randomized-controlled trial in women with systemic sclerosis

Abstract

Introduction: The available pharmacotherapies (immunosuppressant therapies) for systemic sclerosis (SSc) are not curative, especially in cases with non-lethal but challenging manifestations or complications of the disease. Fatigue, anxiety, depression, an over-activated hypothalamic–pituitary– adrenal axis (stress axis), and low sleeping quality are the common SSc-induced non-lethal manifestations that need close management. Diaphragmatic breathing tele-exercise (DBTE), as a standalone deep breathing retraining and tele-interventional technique, has not been utilized in the rehabilitation context of non-lethal complications in women with SSc. This online interventional study aimed to explore the efficacy of DBTE in controlling depression, cardiovascular autonomic functions, stress, sleep, and anxiety in women with SSc. Material and methods: This randomized controlled tele-interventional trial recruited 40 non-obese women with SSc (aged > 18 years old) from an Egyptian teaching hospital. Women were randomly assigned to the DBTE group (n = 20) or non-DBTE group (n = 20). The DBTE group underwent 12-week 20-minute morning and evening DBTE sessions (sessions were supervised daily through the Zoom video conference program). The non-DBTE group served as a waitlist control group. The outcomes of this study were diastolic blood pressure (BPD), serum cortisol, the total score of the Hamilton Anxiety Rating Scale (HARS-TS), systolic blood pressure (BPS), the general score of the Pittsburgh Sleep Quality Index (PSQI-GS), pulse rate (PR), the eight-item Patient Health Questionnaire (EI-PHQ8 ), respiratory rate (RR), and the Visual Analogue Scale of fatigue (VAS-F). Results: In the DBTE group, there were significantly lowered values of PSQI-GS, HARS-TS, EI-PHQ8, serum cortisol, VAS-F, and cardiovascular/respiratory autonomic functions (BPS, BPD, RR, and PR). In the non-DBTE group, no significant changes were observed for any variables. Conclusions: It can be concluded from this tele-interventional trial that the 12-week application of DBTE may reduce cortisol, EI-PHQ8 , PSQI-GS, HARS-TS, BPS, BPD, RR, PR, and VAS-F in women with SSc.