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Objective and Subjective Sleep Efficiency in Adult Patients with Cystic Fibrosis and Impact on Quality of Life

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Abstract

Introduction

Poor sleep quality and excessive daytime sleepiness are common in patients with cystic fibrosis (CF), and both are negatively correlated with health-related quality of life (HRQoL). The objective of our study was to evaluate subjective and objective sleep quality in adult CF patients and its effect on HRQoL.

Materials and methods

This was a descriptive, prospective, cross-sectional study of CF patients > 18 years of age. Patients underwent nocturnal polysomnography (PSG) and were administered the Pittsburgh Sleep Quality Index questionnaire (PSQI) and the Cystic Fibrosis Quality of Life Questionnaire (CFQR 14 + Spain).

Results

The study included 23 patients, 14 women (61%). The mean age of the participants was 32 + 18 years. The mean PSQI score was 5.57 + 3.55; 13 (56.5%) of the patients were poor sleepers, and 13% reported poor sleep quality; seven (30%) had sleep latency > 30 min, 10 (43.5%) had sleep efficiency < 85%. Nineteen underwent polysomnography. According to PSG measurements, sleep efficiency was less than 90% in 61% of the patients. Pathological values were found for the following parameters: intra-sleep wakefulness in 12 patients (63%); microarousal index in 12 patients (63%); and apnea–hypopnea index (AHI) in 2 patients. The desaturation time with SpO2 < 90% (T90) was > 30% in 3 patients. We observed a significant correlation between PSQI and all dimensions of CFQR 14.

Conclusions

Subjective and objective sleep efficiency decreases in adult CF patients. Sleep quality has an impact on HRQoL. The PSQI questionnaire was able to discriminate sleep quality.

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References

  1. Andersen DH (1938) Cystic fibrosis in the pancreas and its relationship to celiac disease. Am J Dis Child 56:344–399

    Article  Google Scholar 

  2. Kerem B, Rommens JM, Buchanan JA, Markiewicz D, Cax TK, Chakravarti A et al (1989) Identification of the cystic fibrosis gene: genetic analysis. Science 245:1073–1080

    Article  CAS  Google Scholar 

  3. Verhaeghe C, Delbecque K, de Leval L, Oury C, Bours V (2007) Early inflammation in the airways of a cystic fibrosis foetus. J Cystic Fibros 6(4):304–308

    Article  CAS  Google Scholar 

  4. Nir M, Lanng S, Johansen HK, Koch C (1996) Long term survival and nutritional data in patients with cystic fibrosis treated in Danish Centre. Thorax 51:1023–1027

    Article  CAS  Google Scholar 

  5. Chetta A, Pisi G, Zanini A, Foresi A, Grzincich GL, Aiello M et al (2001) Six minute walking test in cystic fibrosis adults with mild to moderate lung disease: comparison to healthy subjects. Respir Med 95:986–991

    Article  CAS  Google Scholar 

  6. Katz ES (2014) Cystic fibrosis and sleep. Clin Chest Med 35:495–504

    Article  Google Scholar 

  7. Flume PA, Ciolino J, Gray S, Lester MK (2009) Patient-reported pain and impaired sleep quality in adult patients with cystic fibrosis. J Cystic Fibros 8:321–325

    Article  Google Scholar 

  8. Jankelowitz L, Reid KJ, Wolfe L, Cullina J, Zee PC, Jain M (2005) Cystic fibrosis patients have poor sleep quality despite normal sleep latency and efficiency. Chest 127:1593–1599

    Article  Google Scholar 

  9. Naqvi SK, Sotelo C, Murry L, Simakajornboon N (2008) Sleep architecture in children and adolescents with cystic fibrosis and the association with severity of lung disease. Sleep Breath 12(1):77–83

    Article  Google Scholar 

  10. Dancey DR, Tullis ED, Heslegrave R, Thornley K, Hanly PJ (2002) Sleep quality and daytime function in adults with cystic fibrosis and severe lung disease. Eur Respir J 19:504–510

    Article  CAS  Google Scholar 

  11. Fauroux B, Pepin JL, Boelle PY, Cracowski C, Murris-Espin M, Nove-Josserand R et al (2012) Sleep quality and nocturnal hypoxemia and hypercapnia in children and young adults with cystic fibrosis. Arch Dis Child 97:960–966

    Article  Google Scholar 

  12. Sawicki GS, Sellers DE, Robinson WM (2008) Self-reported physical and psychological symptom burden in adults with cystic fibrosis. J Pain Symptom Manage 35:372–380

    Article  Google Scholar 

  13. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi Rcoates A, et al (2005) Standardisation of spirometry. Eur Respir J 26:319–338

    Article  CAS  Google Scholar 

  14. Report ERS Task Force (2012) Multiethnic reference values for spirometry for the age range of 3 to 95 years: global lung function 2012 equations. Eur Respir J 40:1324–1343

    Article  Google Scholar 

  15. Pellegrino R, Viegi G, Enright P, Brusasco V, Crapo RO, Burgos F et al (2005) Interpretative strategies for lung function tests. Eur Respir J 26:948–968

    Article  CAS  Google Scholar 

  16. American Thoracic Society (2003) ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 167:211–277

    Article  Google Scholar 

  17. Oliveira G, Gaspar I, Cruz I, Dorado A, Pérez- Ruiz E et al (2010) Validation of the Spanish version of the revised cystic fibrosis quality of life questionnaire in adolescents and adults (CFQR 14 + Spain). Arch Bronconeumol 46:165–175

    Google Scholar 

  18. Henry B, Staab D, Prados C, Aussge P, de Ponth-Brune S, Grosskotf C et al (1998) How to measure quality of life in cystic fibrosis (CF) patients across countries and cultures: the Cystic Fibrosis Questionnaire (CFQ) abtrac. Pediatr Pulmonol 17(suppl):392–393

    Google Scholar 

  19. Quittner AL, Buu A, Messer MA, Modi AC, Watrous M (2005) Development and validation of the cystic Fibrosis Questionnaire in The United States: a health-related quality of life measure for cystic fibrosis. Chest 128:2347–2354

    Article  Google Scholar 

  20. Rayuela A, Macías JA (1997) Propiedades clinimétricas de la versión castellana del cuestionario Pittsburg. Vigilia-Sueno 9:81–94

    Google Scholar 

  21. Lloberes P, Duran Cantolla J, Martínez–García MA, Marín JM, Ferrer A, Corral J et al (2011) Diagnóstico y tratamiento del síndrome de apneas-hipopneas del sueño. [Diagnosis and treatment of sleep apnea-hypopnea syndrome.]. Arch Bronconeumol 47:143–156

    PubMed  Google Scholar 

  22. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the scoring of sleep associated events. Deliberations of the sleep apnea definitions task force of the American academy of sleep medicine. J Clin Sleep Med 8:597–619

    PubMed  PubMed Central  Google Scholar 

  23. Perin C, Fagondes SC, Casarotto FC et al (2012) Sleep findings and predictors of sleep desaturation in adult cystic fibrosis patients. Sleep Breath 16:1041–1048

    Article  Google Scholar 

  24. Villa MP, Pagani J, Lucidi V, Palamides S, Ronchetti R (2001) Nocturnal oximetry in infants with cystic fibrosis. Arch Dis Child 84:50–54

    Article  CAS  Google Scholar 

  25. Morrell MJ, Dempsey JA (2002) Impact of Sleep on ventilation. In: McNicholas WT, Phillipson EA (eds) Breathing disorders in sleep. WB Saunders, London, pp 3–17

    Google Scholar 

  26. Muller NL, Francias PW, Gurwitz D, Levison H, Bryan AL (1980) Mechanism of hemoglobin desaturation during rapid eye movement sleep in normal subjects and in patients with cystic fibrosis. Am Rev Respir Dis 121:463–469

    Article  CAS  Google Scholar 

  27. Spier S, Rivlin J, Hughes D, Levison H (1984) The effect of oxygen on sleep, blood gases and ventilation in cystic fibrosis. Am Rev Respir Dis 129:712–718

    Article  CAS  Google Scholar 

  28. Zinmam R, Cory M, Coates AL et al (1989) Nocturnal Home oxygen in the treatment of hypoxemic cystic fibrosis patients. J Pediatr 114:368–377

    Article  Google Scholar 

  29. Stokes DC, McBride JT, Wall MA, Erba G, Strieder DJ (1980) Sleep Hypoxemia in young adults with cystic fibrosis. Am J Dis Child 134:741–743

    CAS  PubMed  Google Scholar 

  30. Milross MA, Piper AJ, Norman M, Willson GN, Grunstein RR, Sullivan CE, Bye PT (2001) Predicting sleep-disordered breathing with cystic fibrosis. Chest 120:1239–1245

    Article  CAS  Google Scholar 

  31. Ramos RT, Salles C, Gregorio PB, Barros AT, Santana A, Araujo Filho-JB, Acosta AX (2009) Evaluation of the upper airway in children and adolescents with cystic fibrosis and obstructive sleep apnea syndrome. Int J Pediatr Otorhinolaryngol 73:1780–1785

    Article  Google Scholar 

  32. Coffey MJ, Fitzgerald MX, Mc Nicholas WT (1991) Comparison of oxygen desaturation during sleep and exercise in patients with cystic fibrosis. Chest 100:659–662

    Article  CAS  Google Scholar 

  33. Bradley S, Salin P, Wilson J, Johns D, Walters EH, Naughton MT (1999) Hypoxemia and hypercapnia during exercise and sleep in patients with cystic fibrosis. Chest 116:647

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We would like to thank SEPAR for providing a Publibeca grant that allowed us to obtain the assistance of Medical Science Consulting, who advised us in the writing of this manuscript.

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Authors and Affiliations

  1. Lung Clinical Management Area, Central University Hospital of Asturias, Avenida de Roma, Oviedo, 33011, Asturias, Spain

    Marta Íscar-Urrutia, Claudia Janeth Madrid-Carbajal, Gemma Rubinos-Cuadrado, Ramón Fernández-Álvarez, María José Vázquez-López, Cristina Hernández-González, Ana Isabel Enríquez-Rodríguez & Marta García-Clemente

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  1. Marta Íscar-Urrutia
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  2. Claudia Janeth Madrid-Carbajal
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Correspondence to Marta Íscar-Urrutia.

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Íscar-Urrutia, M., Madrid-Carbajal, C.J., Rubinos-Cuadrado, G. et al. Objective and Subjective Sleep Efficiency in Adult Patients with Cystic Fibrosis and Impact on Quality of Life. Lung 196, 761–767 (2018). https://doi.org/10.1007/s00408-018-0167-x

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  • DOI: https://doi.org/10.1007/s00408-018-0167-x

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