Risk factors for obstructive sleep apnea in cystic fibrosis

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.

Pediatric pulmonary year in review 2021: Sleep medicine

“…A crowded oropharynx (defined as Mallampati score of 3+) was also a risk factor in adults (OR, 13.0 [95% CI: 1.4−121.4]; p = 0.02), while in children, tonsillar hypertrophy (OR = 5.2, [95% CI: 1.4−19.8]; p = 0.02) and symptomatic chronic sinusitis (OR = 5.8, [95% CI: 1.1−32.1]; p = 0.04) were risk factors for OSA. Interestingly, neither snoring, excessive daytime sleepiness, nor lung disease severity was associated with OSA in this cohort 13 . This suggests that OSA is prevalent in patients with CF and may be underappreciated, especially in those without obvious symptoms.…”

“…This era has brought new hope and new concerns, including the increasing problem of excess weight gain in some patients with CF 12 . In considering weight gain and other risk factors for obstructive sleep apnea among pediatric and adult CF patients, Shakkottai et al 13 retrospectively explored clinical and polysomnographic data from 2009 to 2020 in a single‐center analysis. Among 74 patients with CF referred for polysomnography (42 children and 32 adults), 39 (53%) had OSA.…”

Corneal Refractive Surgery Considerations in Patients with Cystic Fibrosis and Cystic Fibrosis Transmembrane Conductance Regulator-Related Disorders

“… Cutaneous Does your skin wrinkle easily after brief contact with water such as washing your hands? Notes : Data from these studies 3 , 15 , 19 , 21 , 43 , 59 , 60 . Abbreviations : ROS, review of systems; CF, cystic Fibrosis; CFTR-RD, cystic fibrosis transmembrane conductance regulator-related disorder; BMI, body mass index; CBC, complete blood count; LFT, liver function tests; ALP, alkaline phosphatase; ALT, alanine transaminase.…”

“…that obstructive sleep apnea (OSA), a condition for which patients with CF may be predisposed, is significantly correlated with peripapillary retinal nerve fiber layer thinning, increased risk of acute retinal vein occlusion, decreased endothelial cell density, and decreased central corneal thickness due to hypoxia. [19][20][21] Corneal damage may be prevented by ensuring that patients with moderate to severe CF/CFTR-RD are screened for OSA and receive adequate treatment. As CF patients are predisposed to developing OSA, screening them for floppy eyelid syndrome (FES) and keratoconus (KCN) may be indicated as these conditions have been significantly correlated with OSA.…”

A year in review: Real world evidence, functional monitoring and emerging therapeutics in 2021

“…Organ transplantation and CF related diabetes are independent risk factors for lower GI malignancy, suggesting that earlier screening may be beneficial in this population [50] . Furthermore, cardiovascular complications, obstructive sleep apnea, osteopenia and skeletal fragility are all emerging problems [51] , [52] , [53] , [54] , [55] . Addressing mental health issues and promoting emotional wellness warrant ongoing attention, particularly as those with depression are at increased risk of death [56] , [57] , [58] , [59] , [60] , [61] .…”