Effects of Biofeedback Therapy on Cardiovascular and Respiratory Indices in NREM Sleep Parasomnias with Obstructive Sleep Apnea: A Case Study

Non-REM parasomnias are a relatively common condition in the general population. Current treatment plans are usually based on small case series and reports. Considering the effects of sleep disorders on different aspects of human life and the failure of pharmacological therapies, the present study was designed to investigate the effect of biofeedback therapy on cardiovascular and respiratory parameters in a case of Non-REM parasomnias with obstructive sleep apnea. 

The present case study was conducted in 2020 on a 60-years-old man with a family history of sleepwalking disorders. The treatment plan in the present study was as follows: execution of the principles of sleep hygiene by the patient, use of continuous positive airway pressure machine (CPAP), and eight weekly biofeedback therapy sessions (including the use of mental exercises for the patient with the use of heart rate sensors, respiration rate per minute, and coordination of respiratory and cardiovascular events). Before the start and after the treatment period, cardiovascular parameters such as blood pressure, arterial blood oxygen saturation, heart rate, and respiratory parameters (apnea, hypopnea, etc.) were measured. Statistical analyses were performed using the delta calculation of changes in indicators and scores obtained from the patient at different stages of the study. 

Prior to the interventions, the number of obstructive sleep apneas was 34 times, the number of obstructive hypopneas was 106 times, and the incidence of oxygen desaturation events was 389 times, which accounted for 24% of the total sleep time. After the therapeutic interventions, the obstructive sleep apnea completely disappeared, the number of obstructive hypopneas was reported only 12 times, and the rate of oxygen desaturation events was reduced to 102 times. 

The treatment plan in the present study resulted in complete improvement in some parameters such as obstructive sleep apnea and relative improvement in others such as arterial blood oxygen pressure and heart rate. The present study was able to explore and clarify new aspects, both in terms of identifying the mechanisms of the disorder and in terms of treatment.