Obstructive sleep apnea and nocturnal hypoxemia in adult patients with cystic fibrosis

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.

Sleep-Disordered Breathing and Chronic Respiratory Infections: A Narrative Review in Adult and Pediatric Population

“…In this study, the estimated prevalence of OSA in adults with CF was 3.9%, which is less than the general population [ 64 , 72 ]. Similar results were reported by Milross et al, while Welsner et al, reported a higher prevalence (40%) [ 73 , 74 ]. These conflicting results suggest that the prevalence of OSA is still unknown and may be greatly underestimated [ 75 , 76 ].…”

Nutritional status in the era of highly effective CFTR modulators

“…A study of youth and adults with CF found that adults with overweight and obesity had a higher apnea‐hypopnea index than normal and underweight subjects 107 . Conversely, in a German cohort of 52 adults with CF (15% with overweight/obesity) who underwent polysomnography, BMI was not different between subjects with and without diagnoses of OSA 104 . HEMT may also alter the landscape of sleep‐disordered breathing in CF.…”

“…OSA, nocturnal hypoxemia, and excessive daytime sleepiness are common comorbidities in both children and CF, traditionally attributed to lower and upper airway disease 102–104 . In the general population, obesity is a well‐recognized risk factor for OSA 105 .…”

Overnutrition in persons with cystic fibrosis on modulator therapy and the relationship to obstructive sleep apnea

“…34 Persons with CF are at increased risk for sleeprelated hypoxemia and nocturnal hypoventilation. 36,37 In addition, there is also high prevalence of insomnia, restless leg syndrome (RLS), and opioid use, which can lead to non-OSA SDB. [38][39][40][41][42] Therefore, the best diagnostic test for OSA in pwCF would be PSG.…”

“…Although a HSAT can be utilized for the diagnosis of OSA in an uncomplicated adult patients, it is not recommended for those with increased risk of non‐OSA SDB 34 . Persons with CF are at increased risk for sleep‐related hypoxemia and nocturnal hypoventilation 36,37 . In addition, there is also high prevalence of insomnia, restless leg syndrome (RLS), and opioid use, which can lead to non‐OSA SDB 38–42 .…”