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CC BY-NC-ND 4.0 · Sleep Sci 2019; 12(03): 165-170
DOI: 10.5935/1984-0063.20190079
ORIGINAL ARTICLE

Sleep-disordered breathing in cystic fibrosis pediatric subjects

Authors

  • Magali Santos Lumertz

    1   PUCRS, Pediatric Pulmonology - Porto Alegre - RS - Brazil.

  • Leonardo Araujo Pinto

    1   PUCRS, Pediatric Pulmonology - Porto Alegre - RS - Brazil.
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Objectives To describe the frequency of sleep-disordered breathing (SDB) in pediatric cystic fibrosis (CF) and to study associations between polysomnographic respiratory parameters and available clinical information.

Methods This was a retrospective, cross-sectional study. The sample data were obtained from information recorded on patient charts in 2015 and 2016. The study included all individuals with CF aged from 2 to 20 years for whom records were available for polysomnography performed within the previous two years.

Results Sixteen individuals with CF (mean age 11 ± 5.6 years old) were included. Polysomnographic respiratory parameter abnormalities were defined as an apnea-hypopnea index (AHI) exceeding one event per hour of sleep or an oxyhemoglobin saturation (SpO2) nadir below 90%; observed in 10 subjects (62.5%). Forced expiratory volume in first second (FEV1) was correlated (r=0.602, p=0.023) with mean sleep SpO2. FEV1 was also negatively correlated with sleep peak end-tidal carbon dioxide (EtpCO2) (r=-0.645, p=0.024). Additionally, chronic airway colonization by Pseudomonas aeruginosa was associated with mean EtpCO2 in non-REM sleep (p=0.024).

Discussion SDB was frequently observed in this sample of children with CF. There was an association between CF respiratory disease progression markers and sleep breathing parameters in children. Sleep studies appear to be an important tool for assessment of the respiratory status of these individuals with CF, although further studies are needed, especially with carbon dioxide sleep analysis.

Cystic Fibrosis - Pediatrics - Polysomnograph - Sleep Apnea Syndromes


Publication History

Received: 07 December 2018

Accepted: 05 July 2019

Article published online:
31 October 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • REFERENCES

  • 1 Farrell PM, Rosenstein BJ, White TB, Accurso FJ, Castellani C, Cutting GR, et al; Cystic Fibrosis Foundation. Guidelines for diagnosis of cystic fibrosis in newborns through older adults: Cystic Fibrosis Foundation consensus report. J Pediatr. 2008;153(2):S4-S14.
  • 2 Ballard RD, Sutarik JM, Clover CW, Suh BY. Effects of non-REM sleep on ventilation and respiratory mechanics in adults with cystic fibrosis. Am J Respir Crit Care Med. 1996;153(1):266-71.
  • 3 Milross MA, Piper AJ, Dobbin CJ, Bye PT, Grunstein RR. Sleep disordered breathing in cystic fibrosis. Sleep Med Rev. 2004;8(4):295-308.
  • 4 Wise MS, Nichols CD, Grigg-Damberger MM, Marcus CL, Witmans MB, Kirk VG, et al. Executive summary of respiratory indications for polysomnography in children: an evidence-based review. Sleep. 2011;34(3):389-98AW.
  • 5 Paranjape SM, McGinley BM, Braun AT, Schneider H. Polysomnographic Markers in Children With Cystic Fibrosis Lung Disease. Pediatrics. 2015;136(5):920-6.
  • 6 Ramos RT, Santana MA, Almeida PC, Machado AS Jr, Araújo-Filho JB, Salles C. Nocturnal hypoxemia in children and adolescents with cystic fibrosis. J Bras Pneumol. 2013;39(6):667-74.
  • 7 de Castro-Silva C, de Bruin VM, Cavalcante AG, Bittencourt LR, de Bruin PF. Nocturnal hypoxia and sleep disturbances in cystic fibrosis. Pediatr Pulmonol. 2009;44(11):1143-50.
  • 8 Bradley S, Solin P, Wilson J, Johns D, Walters EH, Naughton MT. Hypoxemia and hypercapnia during exercise and sleep in patients with cystic fibrosis. Chest. 1999;116(3):647-54.
  • 9 Spicuzza L, Sciuto C, Leonardi S, La Rosa M. Early occurrence of obstructive sleep apnea in infants and children with cystic fibrosis. Arch Pediatr Adolesc Med. 2012;166(12):1165-9.
  • 10 Suratwala D, Chan JS, Kelly A, Meltzer LJ, Gallagher PR, Traylor J, et al. Nocturnal saturation and glucose tolerance in children with cystic fibrosis. Thorax. 2011;66(7):574-8.
  • 11 Naqvi SK, Sotelo C, Murry L, Simakajornboon N. Sleep architecture in children and adolescents with cystic fibrosis and the association with severity of lung disease. Sleep Breath. 2008;12(1):77-83.
  • 12 Villa MP, Pagani J, Lucidi V, Palamides S, Ronchetti R. Nocturnal oximetry in infants with cystic fibrosis. Arch Dis Child. 2001;84(1):50-4.
  • 13 Versteegh FG, Bogaard JM, Raatgever JW, Stam H, Neijens HJ, Kerrebijn KF. Relationship between airway obstruction, desaturation during exercise and nocturnal hypoxaemia in cystic fibrosis patients. Eur Respir J. 1990;3(1):68-73.
  • 14 Uyan ZS, Ozdemir N, Ersu R, Akpinar I, Keskin S, Cakir E, et al. Factors that correlate with sleep oxygenation in children with cystic fibrosis. Pediatr Pulmonol. 2007;42(8):716-22.
  • 15 Waters KA, Lowe A, Cooper P, Vella S, Selvadurai H. A cross-sectional analysis of daytime versus nocturnal polysomnographic respiratory parameters in cystic fibrosis during early adolescence. J Cyst Fibros. 2017;16(2):250-7.
  • 16 Katz ES. Cystic fibrosis and sleep. Clin Chest Med. 2014;35(3):495-504.
  • 17 Hayes D Jr. Obstructive sleep apnea syndrome: a potential cause of lower airway obstruction in cystic fibrosis. Sleep Med. 2006;7(1):73-5.
  • 18 Macdonald KD, McGinley BM, Brown DJ, Sterni LM, Rosenstein BJ, Mogayzel PJ Jr. Primary snoring and growth failure in a patient with cystic fibrosis. Respir Care. 2009;54(12):1727-31.
  • 19 Fauroux B, Pepin JL, Boelle PY, Cracowski C, Murris-Espin M, Nove-Josserand R, et al. Sleep quality and nocturnal hypoxaemia and hypercapnia in children and young adults with cystic fibrosis. Arch Dis Child. 2012;97(11):960-6.
  • 20 Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, et al. CDC growth charts: United States. Adv Data. 2000;(314):1-27.
  • 21 Shwachman H, Kulczycki LL. Long term study of one hundred five patients with cystic fibrosis. Am J Dis Child. 1958;96(1):6-15.
  • 22 Kozlowska WJ, Bush A, Wade A, Aurora P, Carr SB, Castle RA, et al; London Cystic Fibrosis Collaboration. Lung function from infancy to the preschool years after clinical diagnosis of cystic fibrosis. Am J Respir Crit Care Med. 2008;178(1):42-9.
  • 23 Lee TW, Brownlee KG, Conway SP, Denton M, Littlewood JM. Evaluation of a new definition for chronic Pseudomonas aeruginosa infection in cystic fibrosis patients. J Cyst Fibros. 2003;2(1):29-34.
  • 24 Stanojevic S, Wade A, Cole TJ, Lum S, Custovic A, Silverman M, et al; Asthma UK Spirometry Collaborative Group. Spirometry centile charts for young Caucasian children: the Asthma UK Collaborative Initiative. Am J Respir Crit Care Med. 2009;180(6):547-52.
  • 25 Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al; ATS/ERS Task Force. Standardisation of Spirometry. Eur Resp J. 2005;26(2):319-38.
  • 26 Steinkamp G, Wiedemann B. Relationship between nutritional status and lung function in cystic fibrosis: cross sectional and longitudinal analyses from the German CF quality assurance (CFQA) project. Thorax. 2002;57(7):596-601.
  • 27 Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL, et al.; American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.3. Darien: American Academy of Sleep Medicine; 2016.
  • 28 Ramos RT, Salles C, Daltro CH, Santana MA, Gregório PB, Acosta AX. Sleep architecture and polysomnographic respiratory profile of children and adolescents with cystic fibrosis. J Pediatr (Rio J). 2011;87(1):63-9.
  • 29 Liou TG, Elkin EP, Pasta DJ, Jacobs JR, Konstan MW, Morgan WJ, et al. Year-to-year changes in lung function in individuals with cystic fibrosis. J Cyst Fibros. 2010;9(4):250-6.
  • 30 Urquhart DS, Montgomery H, Jaffé A. Assessment of hypoxia in children with cystic fibrosis. Arch Dis Child. 2005;90(11):1138-43.
  • 31 Knudson RJ, Lebowitz MD, Holberg GJ, Burrows B. Changes in the normal maximal expiratory flow-volume curve with growth and aging. Am Rev Respir Dis. 1983;127(6):725-4.
  • 32 Polgar G. Pulmonary function tests in children. J Pediatr. 1979;95(1):168-70.
  • 33 Aurora RN, Zak RS, Karippot A, Lamm CI, Morgenthaler TI, Auerbach SH, et al; American Academy of Sleep Medicine. Practice parameters for the respiratory indications for polysomnography in children. Sleep. 2011;34(3):379-88.
  • 34 Moreira G, Haddad F, Bittencourt L. Recomendações para o diagnóstico e tratamento da síndrome da apneia obstrutiva do sono na criança e adolescente. São Paulo: Estação Brasil; 2013.
  • 35 Ramos RT, Salles C, Gregório PB, Barros AT, Santana A, Araújo-Filho JB, et al. Evaluation of the upper airway in children and adolescents with cystic fibrosis and obstructive sleep apnea syndrome. Int J Pediatr Otorhinolaryngol. 2009;73(12):1780-5.