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Li L, Zhang W, Liu S, Wang W, Ji X, Zhao Y, Shima M, Yoda Y, Yang D, Huang J, Guo X, Deng F. Cardiorespiratory effects of indoor ozone exposure during sleep and the influencing factors: A prospective study among adults in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 924:171561. [PMID: 38458472 DOI: 10.1016/j.scitotenv.2024.171561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/16/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
Ambient ozone (O3) is recognized as a significant air pollutant with implications for cardiorespiratory health, yet the effects of indoor O3 exposure have received less consideration. Furthermore, while sleep occupies one-third of life, research on the health consequences of O3 exposure during this crucial period is scarce. This study aimed to investigate associations of indoor O3 during sleep with cardiorespiratory function and potential predisposing factors. A prospective study among 81 adults was conducted in Beijing, China. Repeated measurements of cardiorespiratory indices reflecting lung function, airway inflammation, cardiac autonomic function, blood pressure, systemic inflammation, platelet and glucose were performed on each subject. Real-time concentrations of indoor O3 during sleep were monitored. Associations of O3 with cardiorespiratory indices were evaluated using linear mixed-effect model. Effect modification by baseline lifestyles (diet, physical activity, sleep-related factors) and psychological status (stress and depression) were investigated through interaction analysis. The average indoor O3 concentration during sleep was 20.3 μg/m3, which was well below current Chinese indoor air quality standard of 160 μg/m3. O3 was associated with most respiratory indicators of decreased airway function except airway inflammation; whereas the cardiovascular effects were only manifested in autonomic dysfunction and not in others. An interquartile range increases in O3 at 6-h average was associated with changes of -3.60 % (95 % CI: -6.19 %, -0.93 %) and -9.60 % (95 % CI: -14.53 %, -4.39 %) in FVC and FEF25-75, respectively. Further, stronger effects were noted among participants with specific dietary patterns, poorer sleep and higher level of depression. This study provides the first general population-based evidence that low-level exposure to indoor O3 during sleep has greater effects on the respiratory system than on the cardiovascular system. Our findings identify the respiratory system as an important target for indoor O3 exposure, and particularly highlight the need for greater awareness of indoor air quality, especially during sleep.
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Affiliation(s)
- Luyi Li
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
| | - Wenlou Zhang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
| | - Shan Liu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
| | - Wanzhou Wang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
| | - Xuezhao Ji
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
| | - Yetong Zhao
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
| | - Masayuki Shima
- Department of Public Health, School of Medicine, Hyogo Medical University, Nishinomiya, Hyogo 663-8501, Japan
| | - Yoshiko Yoda
- Department of Public Health, School of Medicine, Hyogo Medical University, Nishinomiya, Hyogo 663-8501, Japan
| | - Di Yang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
| | - Jing Huang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
| | - Xinbiao Guo
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
| | - Furong Deng
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China; Center for Environment and Health, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China.
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Giallongo A, Parisi GF, Papale M, Manti S, Mulé E, Aloisio D, Terlizzi V, Rotolo N, Leonardi S. Effects of Elexacaftor/Tezacaftor/Ivacaftor on Cardiorespiratory Polygraphy Parameters and Respiratory Muscle Strength in Cystic Fibrosis Patients with Severe Lung Disease. Genes (Basel) 2023; 14:449. [PMID: 36833376 PMCID: PMC9956139 DOI: 10.3390/genes14020449] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/17/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Cystic fibrosis transmembrane conductance regulator (CFTR) modulators represent targeted therapies directly acting on the CFTR channel. The triple therapy Elexacaftor/Tezacaftor/Ivacaftor (ELX/TEZ/IVA) has been demonstrated to improve lung function and quality of life in cystic fibrosis (CF) patients. However, the effects of ELX/TEZ/IVA on sleep-disordered breathing (SDB) and respiratory muscle strength are poorly studied. The aim of this study was to assess the effects of ELX/TEZ/IVA in patients with CF and severe lung disease on cardiorespiratory polygraphy parameters, maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) measures. METHODS patients with CF aged ≥ 12 who started treatment in a compassionate use program were retrospectively studied through the evaluation of nocturnal cardiorespiratory polygraphy parameters, MIP and MEP; and six-minute walk test (6MWT) at baseline and at months 3, 6, and 12 of treatment. RESULTS Nine patients (mean age 30.3 ± 6.5 years) with severe CF (mean baseline ppFEV1 34.6 ± 5.1%) were evaluated. A significant improvement in nocturnal oxygenation measured by mean SpO2 (92.4 vs. 96.4%, p < 0.05), time spent with SpO2 ≤ 90% (-12.6, -14.6, -15.2 min from baseline at months 3, 6, and 12, respectively, p < 0.05), and respiratory rate (RR) was shown, at month 12 and across the time points compared with baseline, as well as in respiratory muscle strength, although only the change in MEP was significant. CONCLUSIONS We provide further evidence on the efficacy of the CFTR modulators ELX/TEZ/IVA, adding information about their effect on the respiratory muscles' performance and cardiorespiratory polygraphy parameters in CF patients with severe lung disease.
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Affiliation(s)
- Alessandro Giallongo
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, 95121 Catania, Italy
| | - Giuseppe Fabio Parisi
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, 95121 Catania, Italy
| | - Maria Papale
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, 95121 Catania, Italy
| | - Sara Manti
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, 95121 Catania, Italy
- Pediatric Unit, Department of Human and Pediatric Pathology “Gaetano Barresi”, AOUP G. Martino, University of Messina, Via Consolare Valeria, 1, 98124 Messina, Italy
| | - Enza Mulé
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, 95121 Catania, Italy
| | - Donatella Aloisio
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, 95121 Catania, Italy
| | - Vito Terlizzi
- Cystic Fibrosis Regional Reference Center, Department of Pediatric Medicine, Meyer Children’s Hospital IRCCS, 50139 Firenze, Italy
| | - Novella Rotolo
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, 95121 Catania, Italy
| | - Salvatore Leonardi
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, 95121 Catania, Italy
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Canter KS, Strang A, Wilks S, Okonak K, Chidekel A. Acceptability and feasibility of a brief behavioral sleep intervention for youth with CF. J Cyst Fibros 2023; 22:179-182. [PMID: 35871972 DOI: 10.1016/j.jcf.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 11/19/2022]
Abstract
Youth with CF are at increased risk for physiological and behavioral sleep difficulties due to disease-specific symptoms and more general pediatric sleep challenges. Despite evidence suggesting that behavioral sleep interventions are effective for improving common sleep difficulties, no interventions exist for youth with CF. SLEEP-CF was designed to fill this gap by providing tailored, flexible behavioral sleep support to youth with CF. Results suggest that SLEEP-CF is an acceptable and feasible behavioral sleep intervention, even in a population with normative sleep habits. There may be benefit in terms of improving sleep knowledge and sleep hygiene. Technology use during and after bedtime is prevalent. CF care team members are encouraged to assess sleep as part of routine CF care, and to provide support as indicated.
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Affiliation(s)
- Kimberly S Canter
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE 19803, United States; Division of Behavioral Health, Nemours Children's Health, Delaware, 1600 Rockland Road, Wilmington, DE 19803, United States; Department of Pediatrics, Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA 19107, United States.
| | - Abigail Strang
- Department of Pediatrics, Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA 19107, United States; Division of Pulmonology, Nemours Children's Health, Delaware, 1600 Rockland Road, Wilmington, DE 19803, United States
| | - Sophie Wilks
- Division of Pulmonology, Nemours Children's Health, Delaware, 1600 Rockland Road, Wilmington, DE 19803, United States
| | - Katherine Okonak
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE 19803, United States
| | - Aaron Chidekel
- Department of Pediatrics, Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA 19107, United States; Division of Pulmonology, Nemours Children's Health, Delaware, 1600 Rockland Road, Wilmington, DE 19803, United States
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Welsner M, Dietz-Terjung S, Stehling F, Schulte T, Niehammer U, Gahbiche FE, Taube C, Strassburg S, Schoebel C, Weinreich G, Sutharsan S. Obstructive sleep apnea and nocturnal hypoxemia in adult patients with cystic fibrosis. BMC Pulm Med 2022; 22:446. [DOI: 10.1186/s12890-022-02243-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Obstructive sleep apnea (OSA), nocturnal hypoxemia and excessive daytime sleepiness (EDS) are common comorbidities in people with cystic fibrosis (pwCF). Most of the data showing this originates from children and adolescents. The aim of this study was to collect data on sleep parameters, EDS and pulmonary function from a large cohort of adult pwCF.
Methods
Full overnight polysomnography (PSG) was performed. EDS was determined using the Epworth Sleepiness Scale (ESS). Demographic and clinical data (body mass index [BMI], pulmonary function, capillary blood gases) were collected.
Results
A total of 52 adult pwCF were included (mean age 30.7 ± 8.0 years, mean percent predicted forced expiratory volume in 1 s [ppFEV1] of 52.1 ± 14.8). Overall AHI was in the normal range (4.5 ± 4.0/h); 21/52 pwCF (40%) had an apnea-hypopnea index > 5/h. Nocturnal hypoxemia was found in 25% of participants and this was associated with ppFEV1 (p = 0.014), awake oxygen saturation (SpO2; p = 0.021) and awake partial pressure of oxygen (pO2; p = 0.003); there were no significant differences in age, lung function and BMI were found for pwCF with versus without OSA (all p > 0.05). Eight pwCF (15%) had an ESS score > 10 (indicating EDS). OSA was best predicted by awake pO2 (area under the curve [AUC] 0.66, p = 0.048), while nocturnal hypoxemia was best predicted by ppFEV1 (AUC 0.74, p = 0.009), awake pO2 (AUC 0.76, p = 0.006) and awake SpO2 (AUC 0.71; p = 0.025).
Conclusion
OSA, nocturnal hypoxemia and EDS were common in adult pwCF, but no strong predictors were identified. Therefore, we suggest regular PSG and ESS scoring in adult pwCF, regardless of disease severity.
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Taheri L, Mirlashari J, Modaresi M, Pederson A. Cough in adolescent with cystic fibrosis, from nightmare to COVID-19 stigma: A qualitative thematic analysis. J Pediatr Nurs 2022; 64:119-125. [PMID: 35279332 PMCID: PMC8906655 DOI: 10.1016/j.pedn.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 02/12/2022] [Accepted: 02/17/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Cough is part of the daily life of patients with Cystic fibrosis (CF) and its most common symptom. This study explored the experiences of adolescents with CF in Iran during the COVID-19 pandemic in relation to their cough. DESIGN AND METHODS In this qualitative study, we conducted 32 semi-structured interviews with 21 adolescents with CF. We analyzed the data thematically. RESULTS We identified three main themes among adolescents with CF in relation to coughing: 1. Cough is a permanent companion; 2. Coughing raises fear of double stigma; 3. Patients' individualized coping strategies to deal with coughing. Participants complained that cough interrupted daily tasks and sleep, drew unwanted attention in public places, and elicited questions about whether they were COVID-19 patients or substance users-both highly stigmatized identities. CONCLUSION Although coughing is a protective mechanism for CF patients, frequent coughing often causes major challenges, particularly during the COVID pandemic, when people were acutely sensitive and aware about coughing. During the COVID-19 pandemic, in addition to taking care of themselves and managing the disease, CF patients therefore had to also overcome issues related to social stigma and isolation. PRACTICE IMPLICATIONS Healthcare workers play an important role in increasing public awareness about CF and its symptoms, including cough. During the pandemic, healthcare workers can help reduce the stigma of coughing through public education. Healthcare workers can actively communicate with patients to identify severe and ineffective cases of cough due to exacerbation of the disease and refer them to a specialist.
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Affiliation(s)
- Leila Taheri
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Jila Mirlashari
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran; Department of OBGYN, Women's Health Research Institute, University of British Columbia, Vancouver, Canada.
| | - Mohammadreza Modaresi
- Pediatric Pulmonary Disease and Sleep Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran; Cystic Fibrosis research center, Iran CF Foundation (ICFF), Tehran, Iran.
| | - Ann Pederson
- Population Health School of Population and Public health, University of British Columbia, British Columbia, Canada.
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Recent Advances in Chronotherapy Targeting Respiratory Diseases. Pharmaceutics 2021; 13:pharmaceutics13122008. [PMID: 34959290 PMCID: PMC8704788 DOI: 10.3390/pharmaceutics13122008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/17/2022] Open
Abstract
Respiratory diseases contribute to a significant percentage of mortality and morbidity worldwide. The circadian rhythm is a natural biological process where our bodily functions align with the 24 h oscillation (sleep-wake cycle) process and are controlled by the circadian clock protein/gene. Disruption of the circadian rhythm could alter normal lung function. Chronotherapy is a type of therapy provided at specific time intervals based on an individual's circadian rhythm. This would allow the drug to show optimum action, and thereby modulate its pharmacokinetics to lessen unwanted or unintended effects. In this review, we deliberated on the recent advances employed in chrono-targeted therapeutics for chronic respiratory diseases.
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Sismanlar Eyuboglu T, Aslan AT, Ramaslı Gursoy T, Asfuroglu P, Soysal AS, Yapar D, İlhan MN. Sleep disturbances in children with cystic fibrosis, primary ciliary dyskinesia and typically developing children during COVID-19 pandemic. J Paediatr Child Health 2021; 57:1605-1611. [PMID: 34004018 PMCID: PMC8242396 DOI: 10.1111/jpc.15553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 11/28/2022]
Abstract
AIM We aimed to investigate sleep disturbances in children with cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) and typically developing (TD) children during the COVID-19 pandemic. METHODS Primary care givers of children with CF and PCD aged 3-16 years were asked to enrol in the study. Primary care givers of TD children were included as control group. The Sleep Disturbance Scale for Children (SDSC) was used, and questions related to sleep habits during the pandemic were asked. Results of the three groups were compared. RESULTS Primary care givers of 33 children with CF, 16 children with PCD and 66 TD children were included in the study. There were no differences in terms of age and gender between the three groups. Changes in sleep patterns during the pandemic were more common among TD children and their families, with 75% of the children and 80% of their families sleeping later than before. The sleep initiation and maintenance disorder scores were higher in TD children (P = 0.001), whereas the sleep breathing disorder scores were higher in children with PCD (P = 0.001), and the sleep hyperhidrosis scores were higher in children with CF and PCD (P = 0.011). No relationships were found between sleep parameters and clinical findings of children with lung disease. CONCLUSIONS Children's sleep habits have changed during the pandemic. Children with chronic lung diseases and even TD children may experience sleep disturbances during this period.
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Affiliation(s)
| | - Ayse Tana Aslan
- Department of Pediatric PulmonologyGazi University Faculty of MedicineAnkaraTurkey
| | - Tugba Ramaslı Gursoy
- Department of Pediatric PulmonologyGazi University Faculty of MedicineAnkaraTurkey
| | - Pelin Asfuroglu
- Department of Pediatric PulmonologyGazi University Faculty of MedicineAnkaraTurkey
| | | | - Dilek Yapar
- Department of Public HealthGazi University Faculty of MedicineAnkaraTurkey
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Fauroux B, Waters K, MacLean JE. Sleep in children and young adults with cystic fibrosis. Paediatr Respir Rev 2021:S1526-0542(21)00094-4. [PMID: 34686437 DOI: 10.1016/j.prrv.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
Large gains have been made in the management of respiratory diseases associated with cystic fibrosis (CF). Initial studies evaluating sleep issues in CF focused on respiratory problems of nocturnal hypoxia, alveolar hypoventilation and risk of airway obstruction from nasal polyps with treatment evaluations including long term oxygen therapy or noninvasive ventilation in case of nocturnal hypercapnia. More recent studies include patients whose lung function is better preserved, and have permitted more focus on sleep patterns and sleep quality. This literature identified that reduced sleep duration and poor sleep quality are common and may be explained by chronic pain and cough, frequent stools, gastro-oesophageal reflux, nasal obstruction or sinusitis, and drugs such as corticosteroids or beta-agonists. In the teenage years, poor sleep hygiene, sleep debt and poor sleep quality are associated with depression, poor academic performance, less physical activity, and a decrease in quality of life. Restless leg syndrome also seems to be common in adult patients with CF. These sleep problems seem more important in patients with a low lung function but may also be observed in patients with preserved lung function. The consequences of poor sleep may potentially exaggerate the multi-organ morbidity of CF, such as pain, inflammation, susceptibility to infection, and glucose intolerance, but these aspects are largely under-evaluated. Sleep should be evaluated on a routine basis in CF and prospective studies assessing the benefits of interventions aiming at improving sleep duration and sleep quality urgently needed.
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Affiliation(s)
- Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, Necker University Hospital, AP-HP, Paris, France; Université de Paris, EA 7330 VIFASOM, F-75004 Paris, France.
| | - Karen Waters
- The Children's Hospital at Westmead, Sydney, Australia; Faculty of Medicine, University of Sydney, Australia
| | - Joanna E MacLean
- Division of Respiratory Medicine, Department of Pediatrics, University of Alberta, Edmonton, Canada
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Dietz-Terjung S, Gruber W, Sutharsan S, Taube C, Olivier M, Mellies U, Koerner-Rettberg C, Dillenhöfer S, Stehling F, Welsner M. Association between habitual physical activity (HPA) and sleep quality in patients with cystic fibrosis. Sleep Breath 2021; 25:609-615. [PMID: 32661789 PMCID: PMC8195922 DOI: 10.1007/s11325-020-02130-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/03/2020] [Accepted: 06/13/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Sleep disturbances and poor sleep quality are known to be present in patients with CF. Regular physical activity plays an important role in the treatment of CF patients due to its positive influence on progression of disease and quality of life. The aim of this work is to create a home-based sleep and activity profile and to investigate the influence of habitual physical activity (HPA) on sleep quality in children, adolescents, and adults with CF. METHODS A total of 109 CF patients (64 male, mean age 22.7 ± 12.0 years; mean ppFEV1 63.0 ± 26.7) were equipped with an actigraph for a home-based collection of data on sleep and activity over 4 weeks. RESULTS Age, FEV1, and BMI affect sleep and activity in CF patients. Especially younger age and higher FEV1 show a great influence on certain aspects of sleep (SE, TST, TIB, WASO, # of awakenings) and activity and its different intensities. General HPA does not affect sleep, but there is a strong correlation between times spent in vigorous to very vigorous intensities and better sleep quality. CONCLUSION Besides younger age and higher FEV1, daily activity in higher intensities influences sleeping behavior of CF patients in a positive way. Patients with poor sleep quality and sleep disturbances possibly benefit from an intensification of physical activity in the home environment. TRAIL REGISTRATION: number: 14-6117-BO (University Duisburg-Essen) and NCT03518697 (clinical trials).
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Affiliation(s)
- Sarah Dietz-Terjung
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Tueschener Weg 40, 45239, Essen, Germany
| | - Wolfgang Gruber
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Tueschener Weg 40, 45239, Essen, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Tueschener Weg 40, 45239, Essen, Germany
| | - Margarete Olivier
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Uwe Mellies
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Cordula Koerner-Rettberg
- Department of Pediatric Pneumology, University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Stefanie Dillenhöfer
- Department of Pediatric Pneumology, University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Florian Stehling
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Matthias Welsner
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Tueschener Weg 40, 45239, Essen, Germany.
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10
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McMurray J, Widger K, Stephenson AL, Stremler R. Actigraphic and patient and family reported sleep outcomes in children and youth with cystic fibrosis: A systematic review. J Cyst Fibros 2021; 21:e49-e82. [PMID: 34039530 DOI: 10.1016/j.jcf.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/26/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sleep concerns are commonly reported by children and youth with cystic fibrosis (CF). Understanding normative sleep in the home environment and as reported from the perspective of patients and parents is a first step in responding to an important clinical concern and developing a sleep intervention strategy. This systematic review aimed to describe actigraphic and self/parent reported measures of sleep quantity; quality; and determine factors associated with poor sleep quantity and/or quality in children and youth (0-25yrs.) with CF. METHODS Five online databases; Medline, Embase, CINAHL, PsycInfo, and CENTRAL were searched for relevant articles from inception-February 2020. Studies reporting primary data, using either qualitative/quantitative methods or both were eligible for inclusion. Eligible full text articles were independently screened by two reviewers. Data from included studies were independently extracted and synthesized by one reviewer and accuracy verified independently by a second reviewer. RESULTS This review found 31 articles that met inclusion criteria. Analysis found evidence demonstrating that actigraphic SE was lower, actigraphic nighttime awakenings were greater, and self/parent-reported measures of sleep quality were poorer in children and youth with CF. Study findings related to actigraphic TST, WASO, and self/parent-reported sleep duration were mixed. Thirteen factors demonstrated an association with poor quality sleep. CONCLUSIONS In children and youth with CF, evidence exists of objectively measured sleep disturbance and poor self/parent reported sleep quality. Further longitudinal and comparative research studies are warranted to better understand sleep disturbance in this population. Clinically, sleep assessment should be an integral part of routine CF care.
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Affiliation(s)
- Jordana McMurray
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada.
| | - Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada; The Hospital for Sick Children (SickKids), 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Anne L Stephenson
- St. Michaels Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada; The Hospital for Sick Children (SickKids), 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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11
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A Qualitative Exploration of Sleep Habits and Intervention Needs Among Youth with Cystic Fibrosis. J Clin Psychol Med Settings 2021; 29:44-53. [PMID: 33837923 DOI: 10.1007/s10880-021-09774-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Evidence suggests that individuals with Cystic Fibrosis (CF) experience difficulties with sleep architecture and hygiene, although research is limited. There are currently no behavioral sleep interventions for youth with CF. The current study used qualitative methods to understand sleep needs and concerns among youth with CF, as well as to obtain feedback about potentially useful behavioral sleep intervention strategies. Semi-structured interviews were conducted with youth with CF between the ages of 11-17 and their parents. Themes were extracted from the data and will be used to inform the development of a brief behavioral sleep intervention for youth with CF. Youth and their parents described several CF-specific sleep concerns, often related to respiratory symptoms, and a number of strategies used to manage these concerns. They also described concerns that apply to the general population, including pervasive use of technology around bedtime. Many evidence-based behavioral sleep intervention strategies are acceptable to youth with CF, although modifications are appropriate to reduce time burden and address CF-specific needs. Youth with CF experience a number of disease-specific and more generalized sleep concerns which are likely amenable to behavioral intervention. Results from this study will be used to inform the development of a brief behavioral sleep intervention for youth with CF.
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Mulette P, Ravoninjatovo B, Guguen C, Barbe C, Ancel J, Dury S, Dumazet A, Perdu D, Perotin JM, Guillard T, Lebargy F, Deslee G, Launois C. Insomnia in adults with cystic fibrosis: strong association with anxiety/depression and impaired quality of life. BMC Pulm Med 2021; 21:108. [PMID: 33794842 PMCID: PMC8017792 DOI: 10.1186/s12890-021-01473-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND While sleep disruption is a common complaint among children with cystic fibrosis (CF), only a few studies have investigated insomnia in adults. The aim of this study was to identify factors associated with insomnia in clinically stable adult CF patients. METHODS Twenty-eight CF patients (18M/10F), with a median age of 27 (22-34) (median (interquartile range) years and a median of forced expiratory volume in one second of 72 (39-93) % predicted completed questionnaires on insomnia (Insomnia Severity Index, ISI), sleep quality (PSQI), daytime sleepiness (Epworth), restless legs syndrome (IRLS), pain (NRS), anxiety/depression (HAD) and quality of life (CFQ-R 14+). Respiratory assessment data, including symptoms, sputum analysis, arterial blood gases, 6-min walking test, pulmonary function tests and polysomnographic variables, were also analyzed. RESULTS Forty-three percent of patients were insomniac (ISI > 7). Compared with non-insomniac patients (ISI ≤ 7), insomniac patients had more severely impaired quality of life and a higher HAD score: median anxiety score of 9 (8-11) vs 4 (3-6) (p < 0.0001), median depression score of 7 (5-10) vs 1 (1-4) (p < 0.001), with a positive correlation between ISI and HAD anxiety/depression scores (r = 0.702/r = 0.701, respectively, p < 0.0001). Insomnia was also associated with mMRC dyspnea scale ≥ 2, restless legs syndrome, pain and lower SpO2 during sleep. CONCLUSIONS The strong association between insomnia, impaired quality of life and increased HAD score should prompt physicians to be particularly attentive to the management of anxiety and depression in adult CF patients with insomnia. TRIAL REGISTRATION On clinicaltrials.gov (NCT02924818, date of registration: October 5, 2016).
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Affiliation(s)
- Pauline Mulette
- Service Des Maladies Respiratoires, CHU Reims, 45, Rue Cognacq Jay Reims Cedex, 51092, Reims, France.,Inserm UMR-S 1250 "Pathologies Pulmonaires et Plasticité Cellulaire", Reims, France
| | - Bruno Ravoninjatovo
- Service Des Maladies Respiratoires, CHU Reims, 45, Rue Cognacq Jay Reims Cedex, 51092, Reims, France
| | - Camille Guguen
- Service Des Maladies Respiratoires, CHU Reims, 45, Rue Cognacq Jay Reims Cedex, 51092, Reims, France
| | - Coralie Barbe
- Département de Méthodologie, CHU Reims, Reims, France
| | - Julien Ancel
- Service Des Maladies Respiratoires, CHU Reims, 45, Rue Cognacq Jay Reims Cedex, 51092, Reims, France.,Inserm UMR-S 1250 "Pathologies Pulmonaires et Plasticité Cellulaire", Reims, France
| | - Sandra Dury
- Service Des Maladies Respiratoires, CHU Reims, 45, Rue Cognacq Jay Reims Cedex, 51092, Reims, France.,EA 4683 Université de Médecine et de Pharmacie, Reims, France
| | - Antoine Dumazet
- Service Des Maladies Respiratoires, CHU Reims, 45, Rue Cognacq Jay Reims Cedex, 51092, Reims, France
| | - Dominique Perdu
- Service Des Maladies Respiratoires, CHU Reims, 45, Rue Cognacq Jay Reims Cedex, 51092, Reims, France
| | - Jeanne-Marie Perotin
- Service Des Maladies Respiratoires, CHU Reims, 45, Rue Cognacq Jay Reims Cedex, 51092, Reims, France.,Inserm UMR-S 1250 "Pathologies Pulmonaires et Plasticité Cellulaire", Reims, France
| | - Thomas Guillard
- Inserm UMR-S 1250 "Pathologies Pulmonaires et Plasticité Cellulaire", Reims, France.,Laboratoire de Bactériologie-Virologie-Hygiène-Parasitologie-Mycologie, CHU Reims, Reims, France
| | - François Lebargy
- Service Des Maladies Respiratoires, CHU Reims, 45, Rue Cognacq Jay Reims Cedex, 51092, Reims, France.,EA 4683 Université de Médecine et de Pharmacie, Reims, France
| | - Gaëtan Deslee
- Service Des Maladies Respiratoires, CHU Reims, 45, Rue Cognacq Jay Reims Cedex, 51092, Reims, France.,Inserm UMR-S 1250 "Pathologies Pulmonaires et Plasticité Cellulaire", Reims, France
| | - Claire Launois
- Service Des Maladies Respiratoires, CHU Reims, 45, Rue Cognacq Jay Reims Cedex, 51092, Reims, France.
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Jagpal SK, Jobanputra AM, Ahmed OH, Santiago TV, Ramagopal M. Sleep-disordered breathing in cystic fibrosis. Pediatr Pulmonol 2021; 56 Suppl 1:S23-S31. [PMID: 33263201 DOI: 10.1002/ppul.25028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/06/2020] [Accepted: 08/08/2020] [Indexed: 11/10/2022]
Abstract
Sleep-disordered breathing (SBD) is an under recognized comorbidity in the cystic fibrosis (CF) population across the lifespan. Nocturnal hypoxemia, obstructive sleep apnea, and nocturnal hypoventilation are respiratory abnormalities that occur commonly during sleep in patients with lung disease, and have deleterious consequences to the quality of life in people with CF. Effective screening for these abnormalities is needed to allow for timely initiation of treatment, which has been reported to be efficacious. Lack of treatment leads to worsened pulmonary, cardiovascular, and metabolic outcomes in patients. In this review, we give an overview of SBD for the CF clinician, including prevalence, treatment, and suggestions for future research. We strongly encourage the CF community to incorporate evaluation for SBD in CF clinical care so that outcomes for the subset of the CF patients with comorbid SBD improve.
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Affiliation(s)
- Sugeet K Jagpal
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Aesha M Jobanputra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Omar H Ahmed
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Teodoro V Santiago
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Maya Ramagopal
- Division of Pediatric Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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14
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Henderson D, Moore V, MacMorran K, Castellini J, Hay K, Keegan V, Reid D, Curtin D, Tay G. A Cohort Study of Sleep Quality in Adult Patients with Acute Pulmonary Exacerbations of Cystic Fibrosis. Intern Med J 2020; 52:63-68. [PMID: 33025684 DOI: 10.1111/imj.15082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The impact of an acute pulmonary exacerbation of CF on sleep quality has not been established. Patients have greater burden of symptoms, higher intensity of therapy, and are often admitted to hospital outside of their usual sleeping environment. METHODS This prospective, observational study determined the prevalence of impaired sleep quality and associated factors in adult patients admitted to a single CF unit with an acute pulmonary exacerbation of CF. Sleep quality was defined by the Pittsburgh Sleep Quality Index (PSQI), with >5 indicating poor sleep quality. Data was obtained through patient questionnaires, chart review, and examination. RESULTS Sixty-six percent of patients had impaired sleep quality. Patients with poor sleep had more sleep disruption due to pain (median response "mild sleep disruption" vs "no sleep disruption" p=0.003) and insomnia (mean insomnia severity index (ISI) 13 vs 5, p<0.001). In patients with symptoms of restless legs, poor sleepers had worse symptoms (mean IRLSS 15 vs 5, p=0.029). Univariate modelling showed relationships between PSQI and symptoms of depression and anxiety as well as with sleep disruption due to pain, general noise, and nursing observations. In a multivariable model, ISI was the only variable that remained significantly associated with PSQI. Mean PSQI score increased 0.58 units for each 1 unit increase in ISI (95% CI 0.42-0.73, p<0.001). CONCLUSIONS Poor sleep quality is common among patients admitted with an acute exacerbation of CF and is strongly associated with insomnia symptoms in this cohort. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Vanessa Moore
- Clinical Nurse Consultant, The Prince Charles Hospital
| | | | | | - Karen Hay
- Statistics Unit QIMR Berghofer Medical Research Institute
| | | | - David Reid
- Director of Adult Cystic Fibrosis Centre, The Prince Charles Hospital
| | - Deanne Curtin
- Director of Sleep Disorders Centre, The Prince Charles Hospital
| | - George Tay
- Sleep and Thoracic Physician, The Prince Charles Hospital
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15
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Byars KC, Chini B, Hente E, Amin R, Boat T. Sleep disturbance and sleep insufficiency in primary caregivers and their children with cystic fibrosis. J Cyst Fibros 2020; 19:777-782. [DOI: 10.1016/j.jcf.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/26/2020] [Accepted: 04/13/2020] [Indexed: 12/27/2022]
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16
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Shakkottai A, Nasr SZ, Hassan F, Irani S, O'Brien LM, Chervin RD. Sleep-disordered breathing in cystic fibrosis. Sleep Med 2020; 74:57-65. [PMID: 32841845 DOI: 10.1016/j.sleep.2020.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Cystic fibrosis (CF) is a life-shortening, genetic disease that affects approximately 30,000 Americans. Although patients frequently report snoring, mouth breathing, and insomnia, the extent to which sleep-disordered breathing (SDB) may underlie these complaints remains unknown. METHODS Single-center retrospective review of polysomnography results from referred patients with and without CF individually-matched (1:2) for age, gender, race, and body mass index (BMI). RESULTS Mean ages were 8.0 ± 5.2 (sd) and 35.9 ± 12.9 years, among 29 children and 23 adults with CF respectively. The CF and non-CF groups were well-matched in age and BMI. Subjects with vs. without CF had three times greater odds of moderate-severe SDB (apnea-hypopnea index (AHI) ≥ 5 in children, ≥ 15 in adults) (p = 0.01). Nocturnal oxygen saturation nadir (Minimum SpO2) was lower among CF vs. non-CF groups (p = 0.002). For every 1-unit increase in AHI, the decline in Minimum SpO2 was larger for subjects with vs. without CF (p = 0.05). In subjects with CF, forced expiratory volume in 1 s percent predicted (FEV1 PPD) was associated with Minimum SpO2 (Pearson r = 0.68, p < 0.0001) but not AHI (r = -0.19, p = 0.27). For every 1-unit increase in AHI, magnitude of decline in Minimum SpO2 was larger for those with low vs. normal FEV1 PPD (p = 0.01). CONCLUSION Severity of SDB may be worse among referred patients with vs. without CF. The SDB may modify the relationship between CF lung disease and nocturnal hypoxemia. Markers of lung disease severity including lung function do not predict SDB severity, suggesting the need for routine polysomnography to screen for this sleep disorder.
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Affiliation(s)
- Aarti Shakkottai
- Sleep Disorders Center and Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA; Pediatric Pulmonology, Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, MI, USA.
| | - Samya Z Nasr
- Pediatric Pulmonology, Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, MI, USA
| | - Fauziya Hassan
- Sleep Disorders Center and Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA; Pediatric Pulmonology, Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, MI, USA
| | - Sanaya Irani
- Pediatric Pulmonology, Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, MI, USA
| | - Louise M O'Brien
- Sleep Disorders Center and Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA; Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI, USA; Department of Oral and Maxillofacial Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Ronald D Chervin
- Sleep Disorders Center and Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA
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17
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Reiter J, Gileles-Hillel A, Cohen-Cymberknoh M, Rosen D, Kerem E, Gozal D, Forno E. Sleep disorders in cystic fibrosis: A systematic review and meta-analysis. Sleep Med Rev 2020; 51:101279. [PMID: 32145647 DOI: 10.1016/j.smrv.2020.101279] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/09/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022]
Abstract
Cystic fibrosis (CF) is a genetic disorder that leads to airway mucus accumulation, chronic inflammation, and recurrent respiratory infections - all likely impacting sleep. However, controlled studies of sleep in CF patients are limited, and have shown mixed results. We reviewed all publications on CF and sleep indexed in PubMed, CINAHL, and Scopus through April 2019. In the meta-analysis, we calculated pooled weighted mean differences for sleep quality, sleepiness, oximetry, and polysomnographic (PSG) parameters, using fixed or random-effects models as appropriate. A total of 87 manuscripts were reviewed. Compared to controls, children with CF had lower nighttime oxygen saturation nadirs, decreased sleep efficiency and a higher respiratory event index, with no differences in the percentage of REM sleep. Adults with CF had lower oxygen saturation nadirs, with a trend towards reduced sleep efficiency and no differences in REM sleep. In addition, patients with CF cough more during sleep and experience painful events that interfere with sleep. Actigraphy and questionnaires suggest disturbed sleep and daytime sleepiness. Noninvasive ventilation appears to improve gas exchange and symptoms. We conclude that when sleep is evaluated objectively or subjectively in patients with CF, perturbations are common, emphasizing the importance of their identification and treatment and inclusion as part of routine care. Additional research, with larger sample sizes and standardized outcomes, are necessary.
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Affiliation(s)
- Joel Reiter
- Pediatric Pulmonary & Sleep Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Alex Gileles-Hillel
- Pediatric Pulmonary & Sleep Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonary & Sleep Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dennis Rosen
- Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eitan Kerem
- Pediatric Pulmonary & Sleep Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Gozal
- Department of Child Health and Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh and University of Pittsburgh, PA, USA
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18
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Advanced Stage Lung Disease. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Katsouli G, Polytarchou A, Tsaoussoglou M, Loukou I, Chrousos G, Kaditis AG. Nocturnal oximetry in children with obstructive lung disease or sleep-disordered breathing. Pediatr Pulmonol 2019; 54:551-556. [PMID: 30672145 DOI: 10.1002/ppul.24259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 12/28/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Although progress has been made in the standardized interpretation of nocturnal oximetry in children with obstructive sleep-disordered breathing (SDB), no evidence exists on oximetry abnormalities in other respiratory disorders. We aimed to compare obstructive lung disease (OLD) and SDB regarding nocturnal oximetry parameters. METHODS We analyzed oximetry recordings from children with (i) OLD (obliterative bronchiolitis; cystic fibrosis); (ii) snoring and adenotonsillar hypertrophy (SDB); and (iii) no respiratory disorder (controls). The three groups were compared regarding: (i) oxygen desaturation of hemoglobin index (SpO2 drops ≥3%/h-ODI3) and (ii) basal SpO2 (average SpO2 between SpO2 drops). The associations of oximetry parameters (natural logarithm) with study group were tested using linear regression including age as covariate. RESULTS Data of 16 subjects with OLD (median age: 7.3 years; Q25, Q75: 5.4, 12), 22 children with SDB (6.3 years; 4, 9) and 22 controls (6.8 years; 5.6, 10.3) were analyzed. Children with OLD or SDB had significantly lower basal SpO2 than controls (91.9% [90.8, 93.4] vs 96.3% [96, 97.4] vs 97.6% [97.1, 97.9]; P < 0.01). No subjects in the SDB or control groups had basal SpO2 < 95%. Children with SDB had significantly higher ODI3 than children with OLD or controls [8.4 episodes/h (6.2, 16.6) vs 4.4 episodes/h (3.6, 6.6) vs 2 episodes/h (1.3, 2.7); P < 0.01]. OLD had the greatest negative effect on basal SpO2 (R2 = 0.62; P < 0.001) and SDB the greatest positive effect on ODI3 (R2 = 0.34; P < 0.001). CONCLUSION OLD is associated mostly with reduced basal SpO2 , whereas SDB is characterized by elevated ODI3.
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Affiliation(s)
- Georgia Katsouli
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Anastasia Polytarchou
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Marina Tsaoussoglou
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Ioanna Loukou
- Cystic Fibrosis Center, Aghia Sophia Children's Hospital, Athens, Greece
| | - George Chrousos
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Athanasios G Kaditis
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
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20
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McCormick J, Cho DY, Lampkin B, Richman J, Hathorne H, Rowe SM, Woodworth BA. Ivacaftor improves rhinologic, psychologic, and sleep-related quality of life in G551D cystic fibrosis patients. Int Forum Allergy Rhinol 2018; 9:292-297. [PMID: 30472785 DOI: 10.1002/alr.22251] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/01/2018] [Accepted: 11/04/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ivacaftor is a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator that improves pulmonary function in cystic fibrosis (CF) patients with at least 1 copy of the G551D CFTR mutation. The purpose of this study is to evaluate the impact of ivacaftor on chronic rhinosinusitis (CRS) symptoms in this population. METHODS The G551D Observational (GOAL) study was a multicenter prospective cohort study enrolling CF patients ≥6 years with at least 1 G551D mutation. Subjects were provided 20-item Sino-Nasal Outcome Test (SNOT-20) questionnaires prior to ivacaftor therapy and at 1, 3, and 6 months afterward. The impact on rhinologic (R), psychological (P), sleep (S), and ear/facial (E) quality of life (QOL) domains was evaluated separately. RESULTS Of 153 subjects, 129 (84%) completed all questionnaires. Typical baseline symptom burden was low (75% with scores <1) and degree of improvement (ie, reduced scores) was greater with higher baseline scores. SNOT-20 decreased, reflecting improvement, at all follow-up intervals (1 month: [mean change ± standard deviation] -0.25 ± 0.53, p < 0.01; 3 months; -0.29 ± 0.58, p < 0.01; 6 months: -0.21 ± 0.58, p = 0.02), but less than the prespecified minimal clinically important difference (0.8). Significant improvement was observed at 1, 3, and 6 months in the R domain (1 month: -0.24, p < 0.01; 3 months: -0.34, p < 0.01; 6 months: -0.25, p < 0.01) and P domain (1 month: -0.25, p < 0.01; 3 months: -0.32, p < 0.01; 6 months: -0.26, p < 0.01), and 1 and 3 months in the S domain (1 months: -0.35, p < 0.01; 3 months: -0.32, p < 0.01; 6 months: -0.18, p = 0.07). There was no improvement in the E domain at any time point. CONCLUSION Ivacaftor improves QOL in the R, P, and S domains in G551D CF patients, although QOL instruments validated for CRS may not translate well to CF CRS patients because symptom burden was surprisingly low.
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Affiliation(s)
- Justin McCormick
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Do-Yeon Cho
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Brooks Lampkin
- College of Medicine, University of South Alabama, Mobile, AL
| | - Joshua Richman
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Heather Hathorne
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Steven M Rowe
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.,Gregory Fleming James Cystic Fibrosis Research Center, Birmingham, AL
| | - Bradford A Woodworth
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
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21
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Tomaszek L, Cepuch G, Pawlik L. Evaluation of selected insomnia predictors in adolescents and young adults with cystic fibrosis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162:212-218. [DOI: 10.5507/bp.2018.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/14/2018] [Indexed: 12/27/2022] Open
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22
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Shakkottai A, O'Brien LM, Nasr SZ, Chervin RD. Sleep disturbances and their impact in pediatric cystic fibrosis. Sleep Med Rev 2018; 42:100-110. [PMID: 30093360 DOI: 10.1016/j.smrv.2018.07.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 06/15/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022]
Abstract
Cystic fibrosis is a chronic, life-shortening illness that affects multiple systems and results in frequent respiratory infections, chronic cough, fat malabsorption and malnutrition. Poor sleep is often reported by patients with cystic fibrosis. Although objective data to explain these complaints have been limited, they do show poor sleep efficiency and frequent arousals. Abnormalities in gas exchange are also observed during sleep in patients with cystic fibrosis. The potential impact of these abnormalities in sleep on health and quality of life remains largely unstudied. This review summarizes what is known about sleep in children with cystic fibrosis, and implications for clinical practice. This report also highlights new evidence on the impact of sleep problems on disease-specific outcomes such as lung function, and identifies areas that need further exploration.
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Affiliation(s)
- Aarti Shakkottai
- Sleep Disorders Center and Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA; Pediatric Pulmonology, Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, MI, USA.
| | - Louise M O'Brien
- Sleep Disorders Center and Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA; Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI, USA; Department of Oral and Maxillofacial Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Samya Z Nasr
- Pediatric Pulmonology, Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, MI, USA
| | - Ronald D Chervin
- Sleep Disorders Center and Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA
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23
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Dreier LA, Wager J, Blankenburg M, Zernikow B. The Unfavorable Alliance of Pain and Poor Sleep in Children with Life-Limiting Conditions and Severe Psychomotor Impairment. CHILDREN 2018; 5:children5070082. [PMID: 29933542 PMCID: PMC6068563 DOI: 10.3390/children5070082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 01/16/2023]
Abstract
A high prevalence of sleep problems exists in children and adolescents with life-limiting conditions (LLC) and severe psychomotor impairment (SPMI). This study aimed to compare the impacts of various child-related (pain, epilepsy, repositioning, medical care) and environment-related (light, noise, TV/radio, open door) factors on sleep in this vulnerable population. Data were obtained through the “Sleep Questionnaire for Children with Severe Psychomotor Impairment” (SNAKE) by proxy assessment. n = 212 children (mean age: 10.4 years) were included in the analyses. Logistic and linear regression models were used to compare child- and environment-related factors against the global rating of children’s sleep quality, five SNAKE scales, children’s sleep duration, and sleep efficacy. Pain increased the risk of sleeping poorly four-fold (OR (odds ratio) = 4.13; 95% CI (confidence interval): 1.87–9.13) and predicted four sleep problems as assessed by the SNAKE. Children who needed to reposition during the night were at three times greater risk of sleeping poorly (OR = 3.08; 95% CI: 1.42–6.69). Three of the five SNAKE scales were predicted through nocturnal repositioning. Repositioning and epilepsy predicted a reduced sleep duration and low sleep efficacy. None of the environment-related factors exhibited statistically significant results. This study emphasizes the urgent need for reliable pain detection in the context of sleep disturbances in severely ill children.
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Affiliation(s)
- Larissa Alice Dreier
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, 45711 Datteln, Germany.
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany.
| | - Julia Wager
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, 45711 Datteln, Germany.
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany.
| | - Markus Blankenburg
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany.
- Paediatric Neurology, Psychosomatics and Pain Therapy, Center for Child, Youth and Women's Health, Klinikum Stuttgart, Olgahospital/Frauenklinik, 70174 Stuttgart, Germany.
| | - Boris Zernikow
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, 45711 Datteln, Germany.
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany.
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Quality of life and mood in children with cystic fibrosis: Associations with sleep quality. J Cyst Fibros 2017; 17:811-820. [PMID: 29277313 DOI: 10.1016/j.jcf.2017.11.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/08/2017] [Accepted: 11/30/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND We aimed to investigate the relationship between sleep quality, mood and health-related quality of life (HRQOL) in children with CF and controls. METHODS Children (7-12years) and adolescents (13-18years) with CF and controls completed sleep evaluation: overnight oximetry and 14days of actigraphy. Age-appropriate questionnaires assessed mood (Children's Depression Inventory; CDI or Beck's Depression Inventory), HRQOL (CF Questionnaire-Revised; CFQ-R or PedsQL), and sleepiness (Pediatric Daytime Sleepiness Scale). RESULTS 87 CF and 55 controls recruited. Children with CF had poorer sleep quality, more sleepiness and lower mood than controls, with a negative correlation between mood score and sleep efficiency. Sleepiness score was predictive of mood score and multiple CFQ-R domains. Adolescents with CF also demonstrated poorer sleep and more sleepiness than controls, but no difference in mood. Reduced sleep quality predicted lower CFQ-R scores. No correlation between sleep, mood or HRQOL in controls. CONCLUSIONS In children and adolescents with CF, impaired sleep quality is associated with lower mood and HRQOL in an age-specific manner. Future research will aid understanding of effective strategies for prevention and treatment of mood disorders and sleep disturbance in children with CF.
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