Impact of manual diaphragm release on respiratory performance and sleep quality in pregnant women with sleep apnea: a randomized controlled trial
DOI:
https://doi.org/10.47197/retos.v80.119012Keywords:
Obstructive sleep apnea, pregnancy, sleep quality, diaphragmatic excursion, non-invasive treatmentAbstract
Introduction: Obstructive sleep apnea (OSA) in pregnancy presents significant health hazards to both mothers and their babies. Current OSA treatments are often uncomfortable or not well accepted by pregnant women.
Objectives: This study evaluates the effectiveness of the Manual Diaphragm Release Technique (MDRT) in improving sleep quality, diaphragmatic excursion, and sleep duration among pregnant women with OSA.
Methodology:
This randomized, controlled trial included 39 pregnant women in their third trimester diagnosed with OSA. Participants were randomly allocated into the experimental group (12 sessions of MDRT over four weeks plus positioning education) or the control group (positioning education). Outcomes measured were the Pittsburgh Sleep Quality Index (PSQI), diaphragmatic excursion, and sleep duration.
Results
The experimental group indicated significant improvements in all measured outcomes: PSQI (p=0.008), diaphragmatic excursion (p=0.001), and sleep duration (p=0.001).
Conclusion
These findings suggest that MDRT is a promising, non-invasive intervention for improving diaphragmatic excursion, sleep quality, and duration in pregnant women with OSA. However, additional research with larger sample sizes and longer follow-up is necessary.
References
Amare, Y. E., & Haile, D. (2020). Evaluation of pulmonary function tests among pregnant women of different trimesters in Debre Berhan Referral Hospital, Ethiopia. International Journal of Wom-en’s Health, 12, 1135–1143. https://doi.org/10.2147/IJWH.S275742
Atef, H., Helmy, Z., & Farghaly, A. (2020). Effect of different types of exercise on sleep deprivation and functional capacity in middle-aged patients after coronary artery bypass grafting. Sleep Science, 13(2), 113–118. https://doi.org/10.5935/1984-0063.20190136
Carnelio, S., Morton, A., & McIntyre, H. D. (2017). Sleep disordered breathing in pregnancy: The mater-nal and fetal implications. Journal of Obstetrics and Gynaecology, 37(2), 170–178.
Chaput, J.-P., Dutil, C., Featherstone, R., Ross, R., Giangregorio, L., Saunders, T. J., Janssen, I., Poitras, V. J., Kho, M. E., & Ross-White, A. (2020). Sleep duration and health in adults: An overview of system-atic reviews. Applied Physiology, Nutrition, and Metabolism, 45(10), S218–S231.
Dominguez, J. E., & Habib, A. S. (2022). Obstructive sleep apnea in pregnant women. International anesthesiology clinics, 60(2), 59-65.
Facco, F. L., Grobman, W. A., Reid, K. J., Parker, C. B., Hunter, S. M., Silver, R. M., Basner, R. C., Saade, G. R., Pien, G. W., & Manchanda, S. (2017). Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes. American Jour-nal of Obstetrics and Gynecology, 217(4), 447.e1–447.e13.
Ghallab, M. A., Salman, A. F., Nawar, N. M., Saafan, K. I., Mostafa, A. I., Kelini, K. I. S., Bondok, S. M. M., & Abdelwahab, M. A. (2024). Influence of manual diaphragm release combined with conventional breathing exercises and prone positioning on pulmonary functions in women with COVID-19. Revista Iberoamericana de Psicología del Ejercicio y el Deporte, 19(1), 83–88.
Jensen, D., Webb, K. A., & O’Donnell, D. E. (2007). Chemical and mechanical adaptations of the respira-tory system at rest and during exercise in human pregnancy. Applied Physiology, Nutrition, and Metabolism, 32, 1239–1250.
Leonés-Macías, E., Torres-Sánchez, I., Cabrera-Martos, I., Ortiz-Rubio, A., López-López, L., & Valenza, M. C. (2018). Effects of manual therapy on the diaphragm in asthmatic patients: A randomized pi-lot study. International Journal of Osteopathic Medicine, 29, 26–31. https://doi.org/10.1016/j.ijosm.2018.07.006
Lessa, T. B., de Abreu, D. K., Bertassoli, B. M., & Ambrósio, C. E. (2016). Diaphragm: A vital respiratory muscle in mammals. Annals of Anatomy, 205, 122–127.
Maniaci, A., La Via, L., Pecorino, B., Chiofalo, B., Scibilia, G., Lavalle, S., & Scollo, P. (2024). Obstructive sleep apnea in pregnancy: A comprehensive review of maternal and fetal implications. Neurol-ogy International, 16, 522–532. https://doi.org/10.3390/neurolint16030039
McKenzie, D. K., Butler, J. E., & Gandevia, S. C. (2009). Respiratory muscle function and activation in chronic obstructive pulmonary disease. Journal of Applied Physiology, 107(2), 621–629.
Molnár, V., Molnár, A., Lakner, Z., Tárnoki, D. L., Tárnoki, Á. D., Jokkel, Z., Szabó, H., Dienes, A., Angyal, E., & Németh, F. (2022). Examination of the diaphragm in obstructive sleep apnea using ultrasound imaging. Sleep and Breathing, 1–7.
Mone, P., Kansakar, U., Varzideh, F., Boccalone, E., Lombardi, A., Pansini, A., & Santulli, G. (2022). Epi-demiology of obstructive sleep apnea: What is the contribution of hypertension and arterial stiffness? Journal of Clinical Hypertension, 24(4), 395–397. https://doi.org/10.1111/jch.14426
Nair, A., Alaparthi, G. K., Krishnan, S., Rai, S., Anand, R., Acharya, V., & Acharya, P. (2019). Comparison of diaphragmatic stretch technique and manual diaphragm release technique on diaphragmatic excursion in chronic obstructive pulmonary disease: A randomized crossover trial. Pulmonary Medicine, 2019, Article 6364376.
Naughton, M. T., & Phillips, B. (2004). Fast facts: Obstructive sleep apnea. Karger Medical and Scientific Publishers.
Nishiyama, T., Mizuno, T., Kojima, M., Suzuki, S., Kitajima, T., Ando, K. B., Kuriyama, S., & Nakayama, M. (2014). Criterion validity of the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale for the diagnosis of sleep disorders. Sleep Medicine, 15(4), 422–429.
Omobomi, O., & Quan, S. F. (2018). Positional therapy in the management of positional obstructive sleep apnea: A review of the current literature. Sleep and Breathing, 22, 297–304.
Pamidi, S., & Ayappa, I. (2024). Automating detection of inspiratory flow limitation: the next frontier in assessing sleep disordered breathing in pregnancy and risk for adverse pregnancy outco-mes?. European Respiratory Journal, 64(1).
Polo-Kantola, P., Aukia, L., Karlsson, H., Karlsson, L., & Paavonen, E. J. (2017). Sleep quality during preg-nancy: Associations with depressive and anxiety symptoms. Acta Obstetricia et Gynecologica Scandinavica, 96(2), 198–206.
Rocha, T., Souza, H., Brandão, D. C., Rattes, C., Ribeiro, L., Campos, S. L., Aliverti, A., & De Andrade, A. D. (2015). The manual diaphragm release technique improves diaphragmatic mobility, inspirato-ry capacity and exercise capacity in people with chronic obstructive pulmonary disease: A ran-domized trial. Journal of Physiotherapy, 61(4), 182–189.
Sedov, I. D., Cameron, E. E., Madigan, S., & Tomfohr-Madsen, L. M. (2018). Sleep quality during pregnan-cy: A meta-analysis. Sleep Medicine Reviews, 38, 168–176.
Sherif, S. G., Elnahass, N., Rizk, M., Mohamed, A. E., & Ali, S. M. (2024). Effect of manual diaphragmatic activation on diaphragm function in patients with gastroesophageal reflux disease. Benha Inter-national Journal of Physical Therapy, 2(1), 66–72.
Silvestri, R., & Aricò, I. (2019). Sleep disorders in pregnancy. Sleep Science, 12(3), 232–239. https://doi.org/10.5935/1984-0063.20190098
Srijithesh, P. R., Aghoram, R., Goel, A., & Dhanya, J. (2019). Positional therapy for obstructive sleep ap-noea. Cochrane Database of Systematic Reviews, (5).
Thali, S. M., & Ganesh, B. R. (2023). Comparison of diaphragmatic stretch and manual diaphragmatic release technique along with chest proprioceptive neuromuscular facilitation in mild-to-moderate chronic obstructive pulmonary disease: A randomized clinical trial. Indian Journal of Physical Therapy and Research, 5(2), 169–175. https://doi.org/10.4103/ijptr.ijptr_127_22.
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Copyright (c) 2026 Shaimaa Mohamed Hamed, Rana Nabil Hussien, Zeinab S. Ahmed, Maha Gamal Ibrahim, Eman J. Hassan, Doha H. Labi, Reham E. Hamoda
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