Nursing Practice Today 2015. 2(2):69-75.

Determining effect of controlled breathing on sleep quality in patient with chronic obstructive pulmonary disease
Shadan Pedramrazi, Yaghub Hame Khezri, Soraya Nejati, Anooshirvan Kazemnejad


Background & Aim: The aim of this clinical trial study was to evaluate sleep quality in patients with chronic lung disease and the role of controlled breathing to improve the quality of sleep.
Methods & Materials: Sixty-four patients with chronic lung disease in two group (experimental and control group) enrolled in a 7 weeks. Before interventions, the Pittsburgh Sleep Quality Index (PSQI) and the Demographic Information Questionnaire were completed by the samples in the control and intervention groups. Next, the pursed-lip breathing, diaphragmatic breathing and coughing techniques were taught to the experimental group, whereas the control group received the typical treatments. Seven weeks after the breathing exercises the PSQI was once again completed by the samples in the control and intervention groups. The resulting data were analyzed using SPSS.
Results: The results show that after controlling the differences of mean groups sleep quality scores in pre-exam, the intervention (breathing exercises) has affected on the means of the dependent variable scores (quality of sleep) in post-exam (P < 0.001). In other words, the sleep quality of intervention group has improved.
Conclusion: The researcher recommends the administrators, decision makers, and members of treatment groups to use non-pharmacologic methods and incorporate controlled breathing exercises into the sleep management and improvement programs designed for patients with chronic obstructive pulmonary disease.


chronic obstructive; pulmonary disease; sleep quality; controlled breathing; exercise

Full Text:



Bauer U, Briss P, Goodman RA. Prevention of chronic disease in the 21st century: elimi- nation of the leading preventable causes of premature death and disability in the USA. The Lancet 2014; 384(9937): 45-52.

Schmidt M, Duncan B, Silva G, Menezes A, Monteiro CA, Barreto S, et al. Chronic non- communicable diseases in Brazil: burden and current challenges. The Lancet 2011; 377(9781): 1949-61.

Idier L, Untas A, Koleck M, Chauveau P, Rascle N. Assessment and effects of Thera- peutic Patient Education for patients in he- modialysis: a systematic review. Int J Nurs Stud 2011; 48(12): 1570-86.

Avsar G, Kasikci M. Evaluation of patient education provided by clinical nurses in Turkey. Int J Nurs Pract 2011; 17(1): 67-71.

Pauwels RA, Buist AS, Calverley PM, Jen- kins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Work- shop summary. Am J Respir Crit Care Med 2001; 163(5): 1256-76.

Vestbo J. Definition and phenotypes. Clinics in Chest Medicine, 2014; 35(1): 1-6.

Ismail T, Mohamad WHW. Holistic man- agement of chronic obstructive pulmonary disease in primary care. Malaysian Family Physician 2010; 5(3): 119-25.

Ciapponi A, Alison L, Agustina M, Demian G, Silvana C, Edgardo S. The epidemiology and burden of COPD in Latin America and the Caribbean: systematic review and meta- analysis. COPD 2014; 11(3): 339-50.

Jo Y, Choi S, Lee J, Park YS, Lee SM, Yim J, et al. The relationship between chronic obstructive pulmonary disease and comor- bidities: A cross-sectional study using data from KNHANES 2010–2012. Respiratory Medicine 2015; 109(1): 96-104.

Mannino D, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. The Lancet 2007; 370(9586): 765-73.

Dharia SM, Brown LK, Unruh ML. Sleep and sleep disorders in chronic kidney dis- ease. In: Kimmel PL, Rosenberg ME, Edi- tors. Chronic renal disease. New York, NY: Elsevier; 2014. p. 332-49.

Soler X, Diaz-Piedra C, Ries AL. Pulmo- nary rehabilitation improves sleep quality in chronic lung disease. COPD 2013; 10(2): 156-63.

Hynninen MJ, Pallesen S, Hardie J, Eagan TM, Bjorvatn B, Bakke P, et al. Insomnia symptoms, objectively measured sleep, and disease severity in chronic obstructive pul- monary disease outpatients. Sleep Med 2013; 14(12): 1328-33.

McNicholas WT, Verbraecken J, Marin JM. Sleep disorders in COPD: the forgotten di- mension. Eur Respir Rev 2013; 22(129): 365-75.

Zohal M, Yazdi Z, Kazemifar AM, Mahjoob P. Sleep quality and quality of life in COPD patients with and without suspected obstruc- tive sleep apnea. Sleep Disorders 2014; 2014: 4.

Ali ZM, Yazdi Z, Kazemifar AM. Daytime sleepiness and quality of sleep in patients with COPD compared to control group. Glob J Health Sci 2013; 5(3): 150-5.

Singh S. Approaches to outcome assessment in pulmonary rehabilitation. Clin Chest Med 2014; 35(2): 353-61.

Güell Rous MR, Lobato SD, Trigo GR, Vélez FM, Miguel MS, Cejudo P, et al. Pulmonary rehabilitation. Arch Bron- coneumol 2014; 50: -332.

van Gestel AJ, Kohler M, Steier J, Teschler S, Russi EW, Teschler H. The effects of controlled breathing during pulmonary reha- bilitation in patients with COPD. Respira- tion 2012; 83(2): 115-24.

Fernandes M, Cukier A, Feltrim MI. Effica- cy of diaphragmatic breathing in patients with chronic obstructive pulmonary disease. Chron Respir Dis 2011; 8(4): 237-44.

Bhatt SP, Luqman-Arafath TK, Gupta AK, Mohan A, Stoltzfus JC, Dey T, et al. Voli- tional pursed lips breathing in patients with stable chronic obstructive pulmonary disease improves exercise capacity. Chron Respir Dis 2013; 10(1): 5-10.


  • There are currently no refbacks.

Nursing Practice Today (Quarterly), pISSN: 2383-1154, eISSN: 2383-1162

 Tehran University of Medical Sciences, Tehran, Iran.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.