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Short-term efficacy of home-based heart rate variability biofeedback on sleep disturbance in patients with incurable cancer: a randomised open-label study
  1. Hideaki Hasuo,
  2. Kenji Kanbara,
  3. Hisaharu Shizuma,
  4. Yukihiro Morita and
  5. Mikihiko Fukunaga
  1. Psychosomatic Medicine, Kansai Medical University, Hirakata, Osaka, Japan
  1. Correspondence to Dr Hideaki Hasuo, Psychosomatic medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan; hasuohid{at}


Objectives Early palliative care reportedly contributes to the quality of life by improving coping skills in patients with cancer. The aims of the study are to (1) Build a self-coping system that makes it possible to perform a session of home-based heart rate variability biofeedback (HRV-BF) with resonant breathing in patients with sleep disturbance and to acquire its techniques early on, and (2) Examine its short-term efficacy and feasibility.

Methods A randomised, open-label, comparative study was conducted in the presence or absence of home-based HRV-BF with resonant breathing using a portable HRV-BF device prior to bedtime. The participants were 50 patients with incurable cancer with sleep disturbance who underwent a hospital practice of HRV-BF with resonant breathing. The primary end point was the rate of change in sleep efficiency for 10–14 days. The Japanese version of the Pittsburgh Sleep Quality Index (subjective indicator) and actigraphy sleep parameters (objective indicators) were used for sleep assessments.

Results The completion rate and implementation rate in the home-based HRV-BF group (n=25) were 96.0% and 91.4%, respectively. This group showed a significant improvement in sleep efficiency, sleep duration and the low-frequency component of HRV. Sleep latency worsened in this group, but a significant difference was not observed.

Conclusions A home practice of HRV-BF with resonant breathing made it possible to acquire its techniques early on and improve sleep and autonomic function; therefore, our study showed high short-term efficacy and feasibility required for a self-coping system.

  • complementary therapy
  • education and training
  • home care
  • psychological care
  • symptoms and symptom management

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  • Contributors HH was responsible for the conception and design of this study and wrote the article, which was critically revised by all the other authors. HH, HS and MF were responsible for data analysis. HH, KK and YM were responsible for data analysis. All authors have approved the final version of this manuscript.

  • Funding This work was supported by JSPS Grants-in-Aid for Scientific Research Number JP18K07431.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. The data that support the findings of this study are openly available in figshare at, reference number 7, 29, 30 and 34.