Effect of relaxation exercises on dyspnea and sleep quality in chronic obstructive pulmonary disease

Abstract

Aim: Sleep disorders is one of the most common problems after respiratory symptoms in patients with COPD. The probability of sleep disorders increases at the same rate with the severity of COPD symptoms. The aim of our study is to evaluate the effect of relaxation exercises on dyspnea and sleep quality in COPD patients receiving optimal bronchodilator therapy.
Material and Method: This is a randomized controlled clinical study. The study was conducted with 67 voluntary patients with COPD who admitted to the Muğla Traininng and Research Hospital Chest Dieseases Outpatient Clinic. The study was planned as pretest and posttest clinical trial which included COPD patients with severe dyspnea and patients were randomly distributed to the intervention and control groups. Patients in the intervention group (n=34) were given relaxation exercises to be practiced at home for six weeks. Patients in the control group (n=33) were given breathing exercises. During this period, all patients continued to receive routine medical treatments. At baseline and after the intervention dypsnea and sleep quality was assessed.
Results: There was a significant decrease in the posttest Modified Borg Scale-MBS, Modified Medical Research Council Scale-mMRC medians (p<0.001) in intervention group. Additionally a significant improvement in Global Pittsburgh Sleep Quality Index (PSQI) (p<0.001) and also some sleep quality subscales including subjective sleep quality (p<0.001), sleep latency (p=0.029), sleep duration (p<0.001), sleep efficiency (p=0.047) and daytime dysfunction (p<0.001) were found in the intervention group.
Conclusion: We think that relaxation exercise, which is simple and an easy-to-apply method would provide a decrease in the dyspnea severity and an improvement in sleep quality of the patients with COPD when added to the optimal medical treatment.

Keywords

• COPD
• relaxation exercises
• dyspnea
• sleep quality

Kronik obstrüktif akciğer hastalığında gevşeme egzersizlerinin dispne ve uyku kalitesine etkisi

Abstract

Amaç: KOAH'lı hastalarda solunum semptomlarından sonra en sık görülen sorunlardan biri uyku bozukluklarıdır. Uyku bozuklukları olasılığı, KOAH semptomlarının şiddeti ile aynı oranda artar. Çalışmamızın amacı, optimal bronkodilatör tedavi alan KOAH hastalarında gevşeme egzersizlerinin dispne ve uyku kalitesi üzerine etkisini değerlendirmektir. Gereç ve Yöntem: Bu randomize kontrollü klinik çalışma, Muğla Eğitim ve Araştırma Hastanesi Göğüs Hastalıkları polikliniğine başvuran KOAH'lı 67 hasta ile gerçekleştirildi. Çalışma, dispne şiddeti yüksek olan hastalarının yer aldığı ön test ve son test klinik araştırma olarak planlandı. Hastalar müdahale ve kontrol gruplarına rastgele dağıtıldı. Müdahale grubundaki hastalara (n=34) altı hafta süreyle evde uygulanmak üzere gevşeme egzersizleri verildi. Kontrol grubundaki hastalara (n=33) solunum egzersizleri verildi. Bu dönemde tüm hastalar rutin tıbbi tedavilerini almaya devam etti. Başlangıçta ve müdahale sonrasında hastaların nefes darlığı ve uyku kalitesi değerlendirildi. Bulgular: Müdahale grubundaki hastalarının son test Modifiye Borg Skalası-MBS, Modifiye Medikal Araştırma Kurulu Ölçeği-mMRC ve KOAH Değerlendirme Testi-CAT medyan değerlerinde anlamlı (p<0.001) bir azalma saptandı. Global Pittsburgh Uyku Kalitesi İndeksinde (PSQI) (p<0.001), subjektif uyku kalitesinde (p<0.001), uyku latansında (p=0.029), uyku süresinde (p<0.001), uyku etkinliğinde (p=0.047) ve gündüz disfonksiyonlarında (p<0.001) anlamlı bir iyileşme gözlendi. Sonuç: Basit ve uygulaması kolay bir yöntem olan gevşeme egzersizinin, optimal medikal tedaviye eklendiğinde KOAH'lı hastalarda dispne şiddetinde azalma ve uyku kalitesinde iyileşme sağlayacağını düşünüyoruz.

Keywords

• KOAH
• gevşeme egzersizleri
• dispne
• uyku kalitesi

References

1. Global Strategy For the Diagnosis, Managemant and Preventing of Chronic Obstructive Pulmonary Disease 2019 Report. http://goldcopd.org/gold-reports/.
2. Rennard S, Decramer M, Calverley PM, et al. Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey. Eur Respir J 2002; 20: 799-805.
3. Breslin E, van der Schans C, Breukink S, et al. Perception of fatigue and quality of life in patients with COPD. Chest 1998; 114: 958-64.
4. Burge PS, Calverley PM, Jones PW, Spencer S, Anderson JA, Maslen TK. Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ 2000; 320: 1297-303.
5. Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. JAMA 1994; 272: 1497-505.
6. Pauwels RA, Löfdahl CG, Laitinen LA, et al. Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease. N Engl J Med 1999; 340: 1948-53.
7. Vestbo J, Sorensen T, Lange P, Brix A, Torre P, Viskum K. Long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: a randomised controlled trial. Lancet 1999; 353: 1819-23.
8. Garvey C, Bayles MP, Hamm LF, et al. Pulmonary rehabilitation exercise prescription in chronic obstructive pulmonary disease: Review of selected guidelines: An official statement from the American Association of Cardiovascular and Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev 2016; 36: 75-83.

9. Sharma S, Sharma P. Prevalence of dyspnea and its associated factors in patients with chronic obstructive pulmonary disease. Indian J Respiratory Care 2019; 8: 36-41.
10. Liu Y, Pleasants RA, Croft JB, et al. Smoking duration, respiratory symptoms, and COPD in adults aged ≥45 years with a smoking history. International journal of chronic obstructive pulmonary disease 2015; 10: 1409-16.
11. Rosi E, Scano G. Cigarette Smoking and Dyspnea Perception. Tob Induc Dis 2004; 2: 3-5.
12. Sanchez FF, Faganello MM, Tanni SE, Lucheta PA, Padovani CR, Godoy I. Relationship between disease severity and quality of life in patients with chronicobstructive pulmonary disease. Braz J Med Biol Res 2008; 41: 860-5.
13. Lin FJ, Pickard AS, Krishnan JA. et al. Measuring health-related quality of life in chronic obstructive pulmonary disease: properties of the EQ-5D-5L and PROMIS-43 short form. BMC Med Res Methodol 2014; 14: 78.
14. Yılmaz CK, Kapucu S. The effect of progressive relaxation exercises on fatigue and sleep quality in ındividuals with COPD. Holist Nurs Pract 2017; 31: 369-77.
15. Grant S, Aitchison T, Henderson EA. A comparison of the reproducibility and the sensitivity to change of visual analogue scales, Borg scales, and Likert scales in normal subjects during submaximal exercise. Chest 1999; 116: 1208-17.
16. Collop N. Sleep and sleep disorders in chronic obstructive pulmonary disease. Respiration 2010; 80: 78-86.
17. Mohsenin H. Sleep in chronic obstructive pulmonary disease. Semin Respir Crit Care Med 2005; 26: 109-16.
18. Stege G, Vos PJ, van den Elshout FJ, Richard Dekhuijzen PN, van de Ven MJ, Heijdra YF. Sleep, hypnotics and chronic obstructive pulmonary disease. Respir Med 2008; 102: 801-14.
19. Douglas NJ, Flenley DC. Breathing during sleep in patients with obstructive lung disease. Am Rev Respir Dis 1990; 141: 1055-70.
20. Klink ME, Dodge R, Quan SF. The relation of sleep complaints to respiratory symptoms in a general population. Chest 1994; 105: 151-4.
21. Seyedi Chegeni P, Gholami M, Azargoon A, Hossein Pour AH, Birjandi M, Norollahi H. The effect of progressive muscle relaxation on the management of fatigue and quality of sleep in patients with chronic obstructive pulmonary disease: A randomized controlled clinical trial. Complement Ther Clin Pract 2018; 31: 64-70.
22. Akgün Şahin Z, Dayapoğlu N. Effect of progressive relaxation exercises on fatigue and sleep quality in patients with chronic obstructive lung disease (COPD). Complement Ther Clin Pract 2015; 21: 277-81.