Effect of “365 Breathing Technique” on Intraocular Pressure and Autonomic Functions in Patients With Glaucoma: A Randomized Controlled Trial

Abstract

Precis: Primary open angle glaucoma patients were advised to follow ‘365 breathing technique’ for 6 weeks in addition to their pharmacological glaucoma treatment. It helped to reduce IOP, stress biomarker- cortisol and improve autonomic dysfunction. Purpose: To study the effect of ‘365 breathing technique’ on intraocular pressure(IOP), autonomic functions and stress biomarkers in patients with primary open angle glaucoma(POAG). Methods: In this randomised, controlled, interventional trial: after randomisation, forty subjects in intervention group followed “365 breathing” ( 3times a day, breathing rate: 6cycles/min for 5 min) in addition to their pharmacological glaucoma treatment and forty subjects in control group continued only with their pharmacological glaucoma treatment. IOP, serum cortisol, heart rate variability(HRV) and heart rate response to deep breathing test(DBT) were recorded at pre-intervention and 6weeks post-intervention. Results: The mean IOP, serum cortisol, parameters of HRV test and DBT were comparable between two groups at baseline. At 6weeks follow-up, in the intervention group: mean IOP was significantly lower(16.09±2.24 mmHg vs. 18.38±1.58 mmHg, P-value=0.03) and serum cortisol was significantly lower(13.20±3.11 mcg/dl vs. 14.95±2.60 mcg/dl, P=0.038) compared to control group. In the HRV test Time domain analysis showed a significant difference in root mean square of successive difference between RR interval value between both groups at 6weeks(P=0.015) pointing towards higher post-intervention parasympathetic activation in intervention group. In frequency domain analysis(HRV-test), ratio of low-frequency component to high-frequency component was significantly lower in intervention group at 6weeks(1.65 vs. 1.79, P-value=0.019) indicating a shift in sympatho-vagal balance towards greater vagal modulation. There was a significant increase in delta heart rate(P-value=0.019) and Expiratory:Inspiratory ratio(P-value=0.011) in intervention group at 6weeks when compared to baseline values, indicating improved parasympathetic reactivity to DBT. Conclusion: 365 breathing technique can reduce IOP, serum cortisol and improve autonomic dysfunction in glaucoma patients.

The Clinical Efficacy of Different Relaxation Exercises on Intraocular Pressure Reduction: A Meta-Analysis

“…One study was excluded as its research participants were identical to those of another study [21]. Ultimately, twelve studies (consisting of 764 eyes) were incorporated into our research [21][22][23][24][25][26][27][28][29][30][31][32][33] (refer to Supplementary Figure S3 and Table 1). The included studies were from Asia (n = 9), the Middle East (n = 2), and Europe (n = 2).…”

“…The main result did not c significantly after removing any one of the included studies. All analyses showed statistical nificant effects of relaxation exercise on IOP reduction[21][22][23][24][25][26][27][28][29][30]32,33].…”