Chronic Kidney DiseasesNCT07700693
4-7-8 Breathing for Fatigue and Sleep Management in Hemodialysis
A study testing Breathing technique in people with Chronic Kidney Diseases and Insomnia, run by Izmir Kavram Vocational School.
Trial summary
For many hemodialysis patients, fatigue and sleep disturbances are common and debilitating side effects that severely impact daily life and quality of life. In this study, patients will be taught a simple breathing exercise called the 4-7-8 technique to help manage these symptoms. Read more about this study
- Who is it for?
- Ages 18 to 85 years
- Conditions the study is for
- Chronic Kidney Diseases, Insomnia, 4-7-8 Breathing Technique
- What is being tested?
- Breathing technique
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 80 participants
- Where
- No sites listed yet
- Study dates
- 1 Aug 2026to 30 Jan 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 85 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age between 18 and 85 years
- Receiving hemodialysis treatment for at least 3 months
- No diagnosis of malignant respiratory disease (e.g., bronchial or lung cancer)
- No pathological condition affecting consciousness or focus (e.g., dialysis dementia or uremic encephalopathy)
- Native Turkish speaker
Who cannot join
- Advanced reading comprehension problems
- Advanced hearing impairment
- Presence of sleep apnea
- Known psychiatric illness.
About this study
Official title: The Effect of the 4-7-8 Breathing Exercise Program on the Management of Fatigue and Sleep Disorders in Hemodialysis Patients: A Randomized Controlled Trial
For many hemodialysis patients, fatigue and sleep disturbances are common and debilitating side effects that severely impact daily life and quality of life. In this study, patients will be taught a simple breathing exercise called the 4-7-8 technique to help manage these symptoms. A total of 80 adult patients undergoing regular hemodialysis at Izmir Atatürk Training and Research Hospital will be randomly assigned to two groups: an intervention group and a control group. Participants in the intervention group will receive a face-to-face training session from a research nurse and a short instructional video sent to their smartphones to encourage daily home practice, especially before bedtime. The program will be continued over the study period. Participants in the control group will continue with their current routine hemodialysis care without any structured breathing exercises. Fatigue levels, sleep quality, and daytime sleepiness will be measured in both groups before and after the program using validated questionnaires. The results of this study may provide nurses and patients with a safe, cost-effective, non-drug option to improve symptom management and overall well-being in hemodialysis patients.
Read the detailed description
This study was designed as a randomized controlled trial. The estimated sample size was calculated using the G*Power 3.1.9.7 software. The calculation was based on parameters from a preliminary study on the effects of breathing exercises in hemodialysis patients. For the independent two-group t-test, an analysis was conducted assuming 95% power (1-β), a significance level of α=0.05, and a large effect size (d=0.80). As a result, it was determined that 35 participants were needed in each group, for a total of 70 participants. Taking potential dropouts into account, the study will begin with a total of 80 participants, and analyses will be conducted using data from at least 70 participants who have completed the follow-up.
Inclusion Criteria: Age between 18 and 85 years; receiving hemodialysis treatment for at least 3 months; no diagnosis of malignant respiratory disease (e.g., bronchial or lung cancer); no pathological condition affecting consciousness or focus (e.g., dialysis dementia or uremic encephalopathy); native Turkish speaker.
Exclusion Criteria: Advanced reading comprehension problems; advanced hearing impairment; presence of sleep apnea; known psychiatric illness.
Intervention Group Protocol: Participants in the experimental group will be taught a standardized program consisting solely of the 4-7-8 breathing technique. The intervention will last four weeks. The technique will be demonstrated face-to-face by a research nurse, and patients will be provided with a short instructional video that explains the technique step by step. The video will be sent to patients' smartphones to encourage them to practice independently at home.
4-7-8 Breathing Technique Instructions:
Patients will be asked to sit or lie down in a comfortable position and follow the cycle below:
4 seconds: Take a slow, deep breath in through the nose.
7 seconds: Hold the breath.
8 seconds: Exhale slowly and completely through the mouth, with lips slightly pursed (making a slight hissing sound).
This cycle will be repeated 10 times consecutively per session, with a total duration of approximately 10-15 minutes. Participants will be asked to perform the technique twice daily (once during the day and once before bedtime). To monitor adherence, patients will be given a simple practice log, and weekly reminders will be provided via phone calls or messages. On hemodialysis session days, the exercise will be performed during the HD session under the supervision of the research nurse.
Control Group Protocol: Participants in the control group will continue with their current routine hemodialysis care and will not be included in any structured breathing exercise program.
Assessment: Fatigue (Chalder Fatigue Scale), sleep quality (Jenkins Sleep Scale), and daytime sleepiness (Epworth Sleepiness Scale) will be assessed at three time points: at baseline (pre-test), at the end of the second week, and at the end of the fourth week of the intervention.
- Conditions
- Chronic Kidney Diseases, Insomnia, 4-7-8 Breathing Technique
- Being tested
- Breathing technique
- Keywords
- 4-7-8 Breathing Technique, Non-pharmacological Pain Management, Hemodialysis, insomnia
- Medical subject headings
- Renal Insufficiency, Chronic, Sleep Initiation and Maintenance Disorders
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Breathing techniqueBehavioural
A non-pharmacological behavioral intervention utilizing the 4-7-8 breathing technique. Prior to the first session, a research nurse provides brief face-to-face training and an instructional video sent to participants' smartphones for home practice. During daily practice sessions in a comfortable position, the cycle is performed: inhale for 4 seconds, hold for 7, exhale for 8 through pursed lips. This 10-cycle sequence lasts approximately 10-15 minutes per session. Applied twice daily (once during the day and once before bedtime) for four weeks, with fatigue, sleep quality, and daytime sleepiness assessed via validated questionnaires (Chalder Fatigue Scale, Jenkins Sleep Scale, Epworth Sleepiness Scale) at baseline, week 2, and week 4. The intervention aims to reduce fatigue and sleep disturbances by activating the parasympathetic system, promoting relaxation, decreasing anxiety, and modulating autonomic balance.
| Study group | Role | What they receive |
|---|---|---|
| Experimental | Experimental | Arm Description:During daily practice sessions, patients will be instructed to sit or lie down in a comfortable position and begin the breathing exercise. The patient will perform the following cycle:
* 4 seconds: Take a slow, deep breath through the nose.
* 7 seconds: Hold the breath.
* 8 seconds: Exhale slowly and completely through the mouth, with lips slightly pursed (making a slight hissing sound).
Number of Repetitions: This cycle will be repeated 10 times consecutively per session, with a total duration of approximately 10-15 minutes. Participants will be asked to perform this routine twice daily (once during the day and once before bedtime) throughout the four-week intervention period. On hemodialysis session days, the exercise will be performed under the supervision of the research nurse to ensure adherence. Receives: Behavioral: Breathing technique |
| Control | No intervention | Control Arm Description: Participants in the control group, on the other hand, will |
What is being measured
The primary outcome is the main question the study is designed to answer.
Fatigue Level
Fatigue severity experienced by the patient over the past month. This primary outcome is measured at baseline (pre-test), at the end of the second week, and at the end of the fourth week of the intervention. Fatigue is measured using the Chalder Fatigue Scale (CFS), an 11-item self-report scale. The first 7 items assess physical fatigue and the last 4 items assess cognitive fatigue. Each item is scored on a 4-point Likert scale (0-3), with total scores ranging from 0 to 33. Higher scores indicate greater fatigue severity. The patient completes the scale independently, and the total score is recorded.
Measured: Baseline, Week 2, Week 4
Secondary outcomes (1)
Sleep Quality
Sleep quality experienced by the patient over the past week. This secondary outcome is measured at baseline (pre-test), at the end of the second week, and at the end of the fourth week of the intervention. Sleep quality is measured using the Jenkins Sleep Scale (JSS), a 4-item self-report scale. Each item assesses the frequency of specific sleep problems on a 0-5 scale, with total scores ranging from 0 to 20. Higher scores indicate poorer sleep quality. The patient completes the scale independently, and the total score is recorded.
Measured: Baseline, Week 2, Week 4
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 Jul 2026
- Study start1 Aug 2026 (estimated)
- Primary completion30 Sep 2026 (estimated)
- Study completion30 Jan 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Chronic Kidney DiseasesStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Participants were randomly assigned in a 1:1 ratio to one of two parallel groups for the duration of the study.
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 80 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Izmir Kavram Vocational School
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Izmir Konak, Izmir Kavram Vocational School
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07700693
- Sponsor's protocol ID
- 21.01.2026/2761
- Status last verified
- Jul 2026
- First submitted
- 8 Jul 2026
- Last updated
- 15 Jul 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 15 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effect of the 4-7-8 Breathing Exercise Program on the Management of Fatigue and Sleep Disorders in Hemodialysis Patients: A Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT07700693
- Acronym / sponsor ID
- 21.01.2026/2761
- Conditions
- Chronic Kidney Diseases, Insomnia, 4-7-8 Breathing Technique
- Keywords
- 4-7-8 Breathing Technique, Non-pharmacological Pain Management, Hemodialysis, insomnia
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 80 participants (estimated)
- Lead sponsor
- Izmir Kavram Vocational SchoolUniversity, hospital or other
- Study start
- 1 Aug 2026 (estimated)
- Primary completion
- 30 Sep 2026 (estimated)
- Study completion
- 30 Jan 2027 (estimated)
- First posted
- 14 Jul 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
For many hemodialysis patients, fatigue and sleep disturbances are common and debilitating side effects that severely impact daily life and quality of life. In this study, patients will be taught a simple breathing exercise called the 4-7-8 technique to help manage these symptoms. A total of 80 adult patients undergoing regular hemodialysis at Izmir Atatürk Training and Research Hospital will be randomly assigned to two groups: an intervention group and a control group. Participants in the intervention group will receive a face-to-face training session from a research nurse and a short instructional video sent to their smartphones to encourage daily home practice, especially before bedtime. The program will be continued over the study period. Participants in the control group will continue with their current routine hemodialysis care without any structured breathing exercises. Fatigue levels, sleep quality, and daytime sleepiness will be measured in both groups before and after the program using validated questionnaires. The results of this study may provide nurses and patients with a safe, cost-effective, non-drug option to improve symptom management and overall well-being in hemodialysis patients.
Detailed description
This study was designed as a randomized controlled trial. The estimated sample size was calculated using the G*Power 3.1.9.7 software. The calculation was based on parameters from a preliminary study on the effects of breathing exercises in hemodialysis patients. For the independent two-group t-test, an analysis was conducted assuming 95% power (1-β), a significance level of α=0.05, and a large effect size (d=0.80). As a result, it was determined that 35 participants were needed in each group, for a total of 70 participants. Taking potential dropouts into account, the study will begin with a total of 80 participants, and analyses will be conducted using data from at least 70 participants who have completed the follow-up.
Inclusion Criteria: Age between 18 and 85 years; receiving hemodialysis treatment for at least 3 months; no diagnosis of malignant respiratory disease (e.g., bronchial or lung cancer); no pathological condition affecting consciousness or focus (e.g., dialysis dementia or uremic encephalopathy); native Turkish speaker.
Exclusion Criteria: Advanced reading comprehension problems; advanced hearing impairment; presence of sleep apnea; known psychiatric illness.
Intervention Group Protocol: Participants in the experimental group will be taught a standardized program consisting solely of the 4-7-8 breathing technique. The intervention will last four weeks. The technique will be demonstrated face-to-face by a research nurse, and patients will be provided with a short instructional video that explains the technique step by step. The video will be sent to patients' smartphones to encourage them to practice independently at home.
4-7-8 Breathing Technique Instructions:
Patients will be asked to sit or lie down in a comfortable position and follow the cycle below:
4 seconds: Take a slow, deep breath in through the nose.
7 seconds: Hold the breath.
8 seconds: Exhale slowly and completely through the mouth, with lips slightly pursed (making a slight hissing sound).
This cycle will be repeated 10 times consecutively per session, with a total duration of approximately 10-15 minutes. Participants will be asked to perform the technique twice daily (once during the day and once before bedtime). To monitor adherence, patients will be given a simple practice log, and weekly reminders will be provided via phone calls or messages. On hemodialysis session days, the exercise will be performed during the HD session under the supervision of the research nurse.
Control Group Protocol: Participants in the control group will continue with their current routine hemodialysis care and will not be included in any structured breathing exercise program.
Assessment: Fatigue (Chalder Fatigue Scale), sleep quality (Jenkins Sleep Scale), and daytime sleepiness (Epworth Sleepiness Scale) will be assessed at three time points: at baseline (pre-test), at the end of the second week, and at the end of the fourth week of the intervention.
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
- Model description
- Participants were randomly assigned in a 1:1 ratio to one of two parallel groups for the duration of the study.
| Arm | Type | Receives |
|---|---|---|
| Experimental | Experimental | Behavioral: Breathing techniqueArm Description:During daily practice sessions, patients will be instructed to sit or lie down in a comfortable position and begin the breathing exercise. The patient will perform the following cycle: * 4 seconds: Take a slow, deep breath through the nose. * 7 seconds: Hold the breath. * 8 seconds: Exhale slowly and completely through the mouth, with lips slightly pursed (making a slight hissing sound). Number of Repetitions: This cycle will be repeated 10 times consecutively per session, with a total duration of approximately 10-15 minutes. Participants will be asked to perform this routine twice daily (once during the day and once before bedtime) throughout the four-week intervention period. On hemodialysis session days, the exercise will be performed under the supervision of the research nurse to ensure adherence. |
| Control | No intervention | –Control Arm Description: Participants in the control group, on the other hand, will |
Who may qualify
- Ages
- 18 to 85 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Age between 18 and 85 years
- Receiving hemodialysis treatment for at least 3 months
- No diagnosis of malignant respiratory disease (e.g., bronchial or lung cancer)
- No pathological condition affecting consciousness or focus (e.g., dialysis dementia or uremic encephalopathy)
- Native Turkish speaker
Key exclusion criteria (4 listed)
- Advanced reading comprehension problems
- Advanced hearing impairment
- Presence of sleep apnea
- Known psychiatric illness.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Breathing techniqueA non-pharmacological behavioral intervention utilizing the 4-7-8 breathing technique. Prior to the first session, a research nurse provides brief face-to-face training and an instructional video sent to participants' smartphones for home practice. During daily practice sessions in a comfortable position, the cycle is performed: inhale for 4 seconds, hold for 7, exhale for 8 through pursed lips. This 10-cycle sequence lasts approximately 10-15 minutes per session. Applied twice daily (once during the day and once before bedtime) for four weeks, with fatigue, sleep quality, and daytime sleepiness assessed via validated questionnaires (Chalder Fatigue Scale, Jenkins Sleep Scale, Epworth Sleepiness Scale) at baseline, week 2, and week 4. The intervention aims to reduce fatigue and sleep disturbances by activating the parasympathetic system, promoting relaxation, decreasing anxiety, and modulating autonomic balance. | Behavioural | Experimental |
Primary outcome
Fatigue Level
Time frame: Baseline, Week 2, Week 4
Fatigue severity experienced by the patient over the past month. This primary outcome is measured at baseline (pre-test), at the end of the second week, and at the end of the fourth week of the intervention. Fatigue is measured using the Chalder Fatigue Scale (CFS), an 11-item self-report scale. The first 7 items assess physical fatigue and the last 4 items assess cognitive fatigue. Each item is scored on a 4-point Likert scale (0-3), with total scores ranging from 0 to 33. Higher scores indicate greater fatigue severity. The patient completes the scale independently, and the total score is recorded.
1 secondary outcome
Sleep Quality
Time frame: Baseline, Week 2, Week 4
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 Jul 2026.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
The record lists no contact. Use the official record to reach the sponsor.
Questions about this trial
What is this clinical trial studying?
A study testing Breathing technique in people with Chronic Kidney Diseases and Insomnia, run by Izmir Kavram Vocational School.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 15 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Fatigue Level (time frame: Baseline, Week 2, Week 4). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Jul 2026.