Sleep-disordered breathing in cystic fibrosis

Shakkottai, Aarti; Nasr, Samya Z.; Hassan, Fauziya; O’Brien, Louise M.; Chervin, Ronald D.

doi:10.1016/j.sleep.2020.05.031

Cited by 10 publications

(15 citation statements)

References 49 publications

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“…In the general population, male gender, middle age, obesity, and signs of upper airway obstruction appear to be risk factors among adults, while obesity and tonsillar hypertrophy have been implicated in children 1,2 . The limited data on OSA in patients with CF suggest a higher disease frequency in children as compared to adults 24,25 . A single study from Brazil that included both children and adults with CF found associations between the apnea–hypopnea index (AHI) and nutritional status, excessive daytime sleepiness, and daytime oxygen saturation 25 .…”

Section: Introductionmentioning

confidence: 99%

“…The potential impact of OSA on sleep duration, sleep fragmentation, and nocturnal gas‐exchange was also explored. About half of the subjects in this report also were included in a previously published, different analysis 24 …”

Section: Introductionmentioning

confidence: 99%

“…21,22 Contrary to expectation, neither lung function nor findings on chest radiography have appeared linked to sleep apnea severity. 14,[24][25][26] The objective of the present study was to identify demographic and CF-specific risk factors for OSA in a cohort of sleep-laboratoryreferred patients with CF. Patients with and without a polysomnographically confirmed diagnosis of OSA were compared with respect to age, gender, nutritional status, lung function, findings of lung disease on chest radiography, and presence of upper airway pathology, including tonsillar hypertrophy, nasal polyposis, symptomatic chronic sinusitis, and oropharyngeal crowding.…”

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Risk factors for obstructive sleep apnea in cystic fibrosis

Shakkottai

Irani

O’Brien

et al. 2022

Pediatric Pulmonology

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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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confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Risk factors for obstructive sleep apnea in cystic fibrosis

Shakkottai

Irani

O’Brien

et al. 2022

Pediatric Pulmonology

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“…In addition to lung function, other factors are likely to impair sleep quality in CF adult patients such as night-time symptoms (cough [ 14 ], pain [ 15 ]), restless legs syndrome (RLS) [ 16 , 17 ], anxiety and depression [ 12 , 18 ], sleep-related breathing disorders [ 19 , 20 ], acute pulmonary exacerbation [ 21 ] or unhealthy lifestyle.…”

Section: Introductionmentioning

confidence: 99%

Insomnia in adults with cystic fibrosis: strong association with anxiety/depression and impaired quality of life

et al. 2021

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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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“…In addition to lung function, other factors are likely to impair sleep quality in CF adult patients such as night-time symptoms (cough (14), pain (15)), restless legs syndrome (RLS) (16) (17), anxiety and depression (12) (18), sleep-related breathing disorders (19) (20) or unhealthy lifestyle.…”

Section: Introductionmentioning

confidence: 99%

Insomnia in adults with cystic fibrosis: strong association with anxiety/depression and impaired quality of life

Mulette

Ravoninjatovo

Guguen

et al. 2020

Preprint

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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 mean age of 28.2 ± 8.5 (mean ± standard deviation) years and a mean forced expiratory volume in one second of 69 ± 31% 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-minute 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: mean anxiety score of 8.9 ± 2.4 vs 4.0 ± 2.4 (p <0.001), mean depression score of 7.3 ± 3.4 vs 2.1 ± 2.2 (p <0.01), with a positive correlation between ISI and HAD anxiety/depression scores (r=0.674/r=0.724, respectively, p <0.001). Insomnia was also associated with 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)

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Sleep-disordered breathing in cystic fibrosis

Cited by 10 publications

References 49 publications

Risk factors for obstructive sleep apnea in cystic fibrosis

Risk factors for obstructive sleep apnea in cystic fibrosis

Insomnia in adults with cystic fibrosis: strong association with anxiety/depression and impaired quality of life

Insomnia in adults with cystic fibrosis: strong association with anxiety/depression and impaired quality of life

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