Impact of relaxation training and sedative medication use on respiratory recovery in hospitalized patients with respiratory diseases: a retrospective observational study

Background Psychological distress and sedative medication exposure are common among hospitalized patients with respiratory diseases and may influence clinical recovery. However, evidence regarding the combined impact of relaxation training and medication use on respiratory outcomes remains limited. This study aimed to examine the association between relaxation training, sedative or psychotropic medication use, and respiratory recovery in patients hospitalized with respiratory diseases. Methods A retrospective observational study was conducted using electronic medical records from Hejiang County People’s Hospital, Sichuan Province, China. Consecutive adults ( ≥ 18 years) admitted with a primary diagnosis of chronic obstructive pulmonary disease, pneumonia, asthma, bronchiectasis, or interstitial lung disease between January 2020 and January 2025 were included. Patients were categorized according to documented exposure to relaxation training during hospitalization. The primary outcome was respiratory recovery at discharge, defined a priori using objective criteria based on routinely documented records: successful discontinuation of invasive or non-invasive ventilatory support (if applicable), oxygen saturation ≥ 95% on room air for ≥ 4 h, respiratory rate 12–24 breaths/min at rest, and no evidence of ongoing respiratory failure (pH ≥ 7.35 and no worsening hypercapnia PaCO 2 not increasing compared with the most recent prior measurement and/or PaO 2 ≥ 60 mmHg on room air when an arterial blood gas test was available within 24 h before discharge). Variables associated with recovery were identified using univariate and multivariable logistic regression analyses. Model discrimination, calibration, and clinical utility were assessed by the concordance index (C-index), Hosmer–Lemeshow test, calibration plot, and decision curve analysis. Results A total of 389 patients were included (mean age 63.3 ± 12.2 years; 58.1% male), of whom 158 (40.6%) received relaxation training. In multivariable analysis, younger age (OR = 0.96, 95% CI 0.94–0.98, P = 0.002), lower anxiety scores (OR = 0.87, 95% CI 0.81–0.93, P 0.001), lower PaCO 2 levels (OR = 0.94, 95% CI 0.91–0.97, P 0.001), higher PaO 2 /FiO 2 ratio (OR = 1.07 per 10-unit increase, 95% CI 1.03–1.12, P = 0.001), and lower CRP levels (OR = 0.98, 95% CI 0.97–0.99, P = 0.007) were independently associated with respiratory recovery. Participation in relaxation training significantly increased the odds of recovery (OR = 2.38, 95% CI 1.45–3.90, P 0.001), whereas early benzodiazepine exposure within 72 h of admission reduced the likelihood of recovery (OR = 0.37, 95% CI 0.22–0.63, P 0.001). The predictive model demonstrated good discrimination (C-index = 0.872, 95% CI 0.799–0.944) and satisfactory calibration (Hosmer–Lemeshow χ 2 = 6.585, P = 0.582). Decision curve analysis indicated a higher net clinical benefit of the model across relevant probability thresholds. Conclusion In this retrospective cohort of hospitalized patients with respiratory diseases, engagement in relaxation training was independently associated with improved respiratory recovery, whereas early sedative medication exposure predicted poorer outcomes. Psychological and physiological parameters jointly influenced recovery probability. These findings underscore the importance of integrating psychological relaxation interventions and cautious sedative management in the clinical care of respiratory patients.