Keywords: Diaphragmatic Breathing, adolescents, sleep quality, continuity of care, female athletes

Background:

Sleep disturbances are common among adolescent athletes and negatively affect physical performance, recovery, mental well-being, and injury risk. However, sustainable, non-pharmacological interventions that can be consistently reinforced and monitored over time remain limited.

Research questions:

What is the effect of a four-week, digitally supported 4-7-8 diaphragmatic breathing program on sleep quality in adolescent female volleyball players compared with usual care?

Method:

This quasi-experimental study with a pre- and post-intervention control group design was conducted in Istanbul, in 2025. A total of 80 licensed female volleyball players aged 12–18 years were allocated to an intervention group (n=40) or a control group (n=40). The intervention group practiced the 4-7-8 diaphragmatic breathing technique for 10 minutes nightly before bedtime over four weeks. To support continuity of care and adherence, participants received daily digital reminders via mobile messaging, complemented by brief weekly follow-ups. The control group continued routine training without intervention. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) at baseline and post-intervention. Data were analyzed using intention-to-treat principles. Between-group comparisons were conducted using chi-square tests for categorical variables, while within- and between-group differences in PSQI scores were analyzed using Wilcoxon test.

Results:

At baseline, poor sleep quality (PSQI≥5) was prevalent in both groups (intervention: 75.0%; control: 83.3%). After four weeks, the intervention group demonstrated a statistically significant improvement in overall sleep quality compared with the control group (p<0.001). The proportion of participants achieving good sleep quality increased to 75.0% in the intervention group, while remaining at 26.2% in the control group. Significant improvements were observed in sleep latency, habitual sleep duration, and sleep efficiency.

Conclusions:

4-7-8 diaphragmatic breathing exercises significantly improved sleep quality in adolescent athletes. Supported by digital reminders and regular follow-up, this self-managed intervention aligns well with primary care continuity of care by enabling longitudinal monitoring, consistent management strategies, and sustainable behavior change.

Points for discussion:

How can non-pharmacological sleep interventions, such as diaphragmatic breathing, be sustainably integrated into routine primary care follow-up for adolescents?

What role can digital reminders (e.g., messaging apps or mobile health tools) play in strengthening continuity of care without increasing clinician workload?

Could this intervention be adapted for everyday primary care practice within a continuity of care framework?