The impact of home-based telerehabilitation pranayama on sleep quality and wellbeing in mild to moderate obstructive sleep apnea syndrome. A randomized controlled trial

Background Obstructive sleep apnea syndrome (OSAS) is a common disorder that causes repeated airway obstruction, disrupted breathing, and fragmented sleep. This study aimed to investigate the effects of Pranayama on sleep quality, daytime sleepiness, quality of life, fatigue, depression, and anxiety in patients with OSAS. Methods This study was designed as an open-label, prospective, randomized controlled trial. OSAS patients meeting the inclusion criteria were randomly assigned to either an Intervention group or a Control group. Pranayama training was applied to the Intervention group for 8 weeks, 7 days a week, and 3 times a day for 15 min. In addition, a single 15-minute session, 3 days a week, was conducted online under the supervision of a physiotherapist. The control group did not receive any intervention. Primary outcome was sleep quality (Pittsburgh Sleep Quality Index, PSQI). Secondary outcomes included daytime sleepiness (Epworth Sleepiness Scale, ESS), Fatigue Severity Scale (FSS), Functional Outcomes of Sleep Questionnaire (FOSQ), Nottingham Health Profile (NHP), and Hospital Anxiety and Depression Scale (HADS). All outcome measures were assessed at baseline and reassessed after the 8-week intervention period. Results Thirty-eight OSAS patients meeting the inclusion criteria were randomly assigned to either an Intervention group (n = 19) or a Control group (n = 19). Four participants (two in each group) were lost to follow-up, leaving the data of 34 participants (17 per group) available for inclusion in the final analysis. In the intervention group, PSQI scores decreased from 9.12 ± 4.71 to 6.88 ± 4.45 (p < 0.001), whereas no improvement was observed in the control group. Regarding the primary outcome, the reduction in PSQI scores was significantly greater in the intervention group than in the control group (p < 0.001). The ESS scores also decreased significantly in the intervention group, from 9.41 ± 6.15 to 7.41 ± 6.18 (p = 0.006, with a significant between-group difference (p < 0.001). Fatigue severity decreased in the intervention group (FSS change: 0.53 ± 0.70; p = 0.006), with a significant between-group difference (p = 0.037). The FOSQ score improved markedly, with significant gains in FOSQ total score (− 0.38 ± 0.25 vs. 0.14 ± 0.22 in controls; p < 0.001) and in activity level and vigilance subdomains (both p < 0.001). The HADS-anxiety scores decreased by 1.94 ± 3.94 (p = 0.059) and depression scores by 3.06 ± 2.05 (p < 0.001) in the intervention group, with significant between-group differences for both anxiety (p = 0.008) and depression (p < 0.001). Conclusion Pranayama was an effective adjunct therapy for these OSAS patients, and incorporating it into treatment strategies may enhance patient outcomes. Clinical trial registration number/date NCT04632147/22.10.2020.