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Shakkottai A, Kim S, Mitchell RB. Obstructive sleep apnea in children with cystic fibrosis on highly effective modulator therapy. Pediatr Pulmonol 2024. [PMID: 38742253 DOI: 10.1002/ppul.27061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is common in children with cystic fibrosis (CF). Highly effective modulator therapies (HEMT) have led to improved sinopulmonary disease, but whether this translates to a lower frequency of OSA is unknown. METHODS We conducted a single center retrospective review of polysomnographic (PSG) data from 2012 to 2023 in patients aged 0-18 years with CF to assess frequency of OSA. Participants were classified based on HEMT status. Logistic regression was used to quantify the association between HEMT and OSA with p < .05 considered significant. RESULTS Forty-nine children underwent PSG during the study period. Ten percent were of non-White race and 24% were of Hispanic ethnicity. Twenty-one children (43%) were on HEMT. These children were older than those not on modulators (11.6 vs. 6.4 years; p = .0001) but no different with respect to gender, race, nutritional status, or lung function. Twenty-eight (57%) children had OSA. Odds of having OSA were higher in the HEMT group (odds ratio [OR] = 4.3; 95% confidence interval [CI]: 1.2-14.9; p = .02). Tonsillar hypertrophy was associated with an increased odds of having OSA independent of modulator status (OR: 6.6; 95% CI: 1.2-37.9; p = .03). CONCLUSIONS OSA is frequently diagnosed in the post-HEMT era in this large, racially diverse group of children with CF. Children on HEMT were older and more likely to have OSA as compared to those not on modulators but similar in nutritional status, lung function, and presence of upper airway pathology. Prospective studies are needed to further clarify the relationship between HEMT and OSA in children with CF.
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Affiliation(s)
- Aarti Shakkottai
- Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephany Kim
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ron B Mitchell
- Department of Otolaryngology, Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Galiniak S, Biesiadecki M, Rościszewska-Żukowska I, Rachel M. Calcitonin Gene-Related Peptide Level in Cystic Fibrosis Patients. Life (Basel) 2024; 14:565. [PMID: 38792587 PMCID: PMC11122201 DOI: 10.3390/life14050565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
Calcitonin gene-related peptide (CGRP) has long been implicated in both the physiology and pathophysiology of the respiratory tract. The objective of our study was to determine the serum concentration of alpha CGRP (αCGRP) in cystic fibrosis (CF) that arises from mutations in the gene responsible for encoding the cystic fibrosis transmembrane conductance regulator (CFTR) protein. Currently, there are not many data in the literature about the role of CGRP in CF. The serum level of αCGRP was estimated using the enzyme-linked immunosorbent assay among 64 patients with CF and 31 healthy controls. The αCGRP concentration in the CF group was 62.51 ± 15.45 pg/mL, while in the control group it was 47.43 ± 8.06 pg/mL (p < 0.001). We also compared the level of αCGRP in CF patients according to the type of CFTR mutation. Homozygotes for ΔF508 had higher αCGRP levels than heterozygotes (67.9 ± 10.2 vs. 54.5 ± 18.3 pg/mL, p < 0.01). The level of this neuropeptide was statistically higher in patients with severe disease than in those with mild CF (p = 0.003) when patients were divided into three groups by spirometry results. αCGRP concentration was not correlated with age, sex, clinical parameters, and pulmonary function test results in the study participants. The results of our study suggest a significant increase in the concentration of αCGRP in the serum of patients with CF compared to the control group. This observation opens interesting possibilities for understanding the role of αCGRP in the context of CF pathophysiology.
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Affiliation(s)
- Sabina Galiniak
- Institute of Medical Sciences, Medical College, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland; (M.B.); (I.R.-Ż.); (M.R.)
| | - Marek Biesiadecki
- Institute of Medical Sciences, Medical College, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland; (M.B.); (I.R.-Ż.); (M.R.)
| | - Iwona Rościszewska-Żukowska
- Institute of Medical Sciences, Medical College, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland; (M.B.); (I.R.-Ż.); (M.R.)
| | - Marta Rachel
- Institute of Medical Sciences, Medical College, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland; (M.B.); (I.R.-Ż.); (M.R.)
- Department of Allergology and Cystic Fibrosis, State Hospital 2 in Rzeszow, Lwowska 60, 35-301 Rzeszów, Poland
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3
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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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Shakkottai A, Irani S, Nasr SZ, O’Brien LM, Chervin RD. Risk factors for obstructive sleep apnea in cystic fibrosis. Pediatr Pulmonol 2022; 57:926-934. [PMID: 34967157 PMCID: PMC10425205 DOI: 10.1002/ppul.25811] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Despite emerging data that suggest a high frequency and severity of obstructive sleep apnea (OSA) among patients with cystic fibrosis (CF), few of them are referred for polysomnography. Little is known about which patients with CF are at increased risk for OSA and which sleep symptoms merit investigation. METHODS A single-center retrospective analysis of clinical and polysomnographic data from 2009, January 1 to October 31, 2020 in referred children and adults with CF. RESULTS Among 74 patients (42 children, 32 adults) with CF, 39 (53%) had OSA. No age or sex differences emerged in OSA frequency. Mean apnea-hypopnea index (AHI) was higher among overweight/obese adults (n = 16) as compared with adults of normal weight or underweight (11.4 vs. 6.2; p = 0.005). Adults with (n = 10) versus without a crowded oropharynx had 13.0 times greater odds of OSA (95% confidence interval (CI): 1.4, 121.4; p = 0.02). Children with (n = 24) versus without tonsillar hypertrophy had a higher risk for OSA (OR = 5.2; 95% CI: 1.4, 19.8; p = 0.02), as did children with (n = 10) versus without symptomatic chronic sinusitis (OR = 5.8; 95% CI: 1.1, 32.1; p = 0.04). Neither snoring, excessive daytime sleepiness, nor lung disease severity were associated with OSA. CONCLUSION Key risk factors for OSA may differ between children and adults with CF: upper airway pathology appears important in children and overweight/obesity or a crowded oropharynx in adults. Given the lack of sensitivity of snoring, daytime sleepiness, and lung disease severity, detection of OSA may require a low threshold for polysomnographic assessment in this vulnerable population.
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Affiliation(s)
- Aarti Shakkottai
- Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Sanaya Irani
- Pediatric Pulmonology, Department of Pediatrics, Michigan Medicine, Ann Arbor, MI
| | - Samya Z. Nasr
- Pediatric Pulmonology, Department of Pediatrics, Michigan Medicine, Ann Arbor, MI
| | - Louise M. O’Brien
- Sleep Disorders Center and Department of Neurology, Michigan Medicine, Ann Arbor, MI
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI
- Department of Oral and Maxillofacial Surgery, Michigan Medicine, Ann Arbor, MI
| | - Ronald D. Chervin
- Sleep Disorders Center and Department of Neurology, Michigan Medicine, Ann Arbor, MI
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Lugao RDS, Barbosa RRB, Coelho PDF, Liberato FMG, Vidal PR, Carvalho RBCOD, Melotti RDCNC, Donadio MVF. Association of sleep disorders with heart rate variability in children and adolescents with cystic fibrosis. ACTA ACUST UNITED AC 2021; 40:e2020295. [PMID: 34495277 PMCID: PMC8432146 DOI: 10.1590/1984-0462/2022/40/2020295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/17/2021] [Indexed: 11/25/2022]
Abstract
Objective: To assess the association of sleep disorders with the findings of heart rate variability (HRV) in children and adolescents with cystic fibrosis (CF). Methods: Cross-sectional study including children and adolescents aged six to 18 years with a clinical diagnosis of CF. Sociodemographic and clinical data were collected. Sleep disorders were evaluated using baseline nocturnal polysomnography. The autonomic nervous system (ANS) was evaluated through resting HRV. Results: A total of 30 individuals (11.2 years) with a mean forced expiratory volume in the first second (FEV1) of 62.7% were included. The respiratory disturbance index presented a median of 2.6 and obstructive sleep apnea syndrome (OSAS) was identified in 30%. In the HRV analysis, a mean standard deviation of all inter-beat (RR) intervals (SDNN) of 60.8±45.9ms was found. There was a significant correlation between the HRV low-frequency/high-frequency (LF/HF) global modulation index and the minimum SpO2 during sleep in patients with FEV1<60% (r=0.71; p=0.02). The prevalence of sleep disorders and HRV abnormalities was higher in individuals with lesser pulmonary function (FEV1<60%). Conclusions: The results indicate a weak correlation of sleep disorders (minimum SpO2) with HRV parameters (LH/HF) in children and adolescents with CF. When pulmonary function was reduced, a stronger correlation was found, highlighting the influence of disease severity. A high prevalence of ANS disorders, nocturnal hypoxemia, and presence of OSAS was also found.
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Affiliation(s)
| | | | | | | | - Pâmela Reis Vidal
- School of Sciences, Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil
| | | | | | - Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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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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8
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Barbosa RRB, Liberato FMG, de Freitas Coelho P, Vidal PDR, de Carvalho RBCO, Donadio MVF. Sleep-disordered breathing and markers of morbidity in children and adolescents with cystic fibrosis. Pediatr Pulmonol 2020; 55:1974-1983. [PMID: 32364318 DOI: 10.1002/ppul.24780] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/01/2020] [Accepted: 04/05/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Studies have shown that sleep disorders occur in cystic fibrosis (CF) patients and may be present before daytime clinical manifestations. OBJECTIVES To evaluate the presence of sleep disorders among children and adolescents with CF, attempting to identify associations with pulmonary function, nutritional status, days in hospital, and days taking antibiotics. METHODS Individuals with a diagnosis of CF aged between 6 and 18 years were included. Information on sociodemographic, clinical profile, history of hospitalizations, and use of antibiotics in the last year were collected. Spirometry, bioimpedance, and polysomnography were performed. The presence of nocturnal hypoxemia and obstructive sleep apnea syndrome (OSAS) were evaluated and participants divided according to their presence. RESULTS Thirty-one patients were included. The prevalence of OSAS was 32.3% and nocturnal hypoxemia was 29.0%. Average nocturnal peripheral oxyhemoglobin saturation (SpO2 ) correlated (P < .001) with forced vital capacity (r = .55) and forced expiratory volume in the first second (r = .62). The higher the percentage of total sleep time (TST) with SpO2 less than 90%, the lower the pulmonary function. Individuals with OSAS and nocturnal hypoxemia had lower spirometric values compared to patients without these disorders, but the nocturnal hypoxemia group also had lower Shwachman-Kulczycki score, longer hospitalization time and antibiotic use. TST with SpO2 less than 90% was associated with length of hospitalization (r2 = .53). CONCLUSION Children and adolescents with CF have sleep disorders, including OSAS (32.3%) and nocturnal hypoxemia (29%). Individuals with nocturnal hypoxemia presented lower lung function, worse clinical score, and higher morbidity. TST with SpO2 less than 90% was associated with length of hospitalization.
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Affiliation(s)
- Roberta Ribeiro Batista Barbosa
- Department of Physiotherapy, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Vitória, Espírito Santo, Brazil
| | | | - Pitiguara de Freitas Coelho
- Department of Physiotherapy, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Vitória, Espírito Santo, Brazil
| | - Pâmela Dos Reis Vidal
- Department of Physiotherapy, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Vitória, Espírito Santo, Brazil
| | | | - Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
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9
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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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10
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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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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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