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Predicting Sleep-Disordered Breathing in Patients With Cystic Fibrosis^*

^* From the Royal Prince Alfred Hospital (Ms. Milross; Drs. Piper, Grunstein, and Bye; Mr. Norman, and Mr. Willson), Camperdown,Sydney; and Faculty of Medicine (Dr. Sullivan), University of Sydney, Sydney, Australia.

Correspondence to: Peter T. P. Bye, MD, FCCP, Department of Respiratory Medicine, Royal Prince Alfred Hospital, Missenden Rd, Camperdown NSW 2050, Australia; e-mail: peterb{at}mail.med.usyd.edu.au

Study objectives: To examine predictors of sleep-disordered breathing in patients with cystic fibrosis (CF) and moderate-to-severe lung disease using a comprehensive evaluation of both sleep and daytime function.

Design: Cross-sectional analysis of sleep studies, lung function, respiratory muscle strength, and evening and morning arterial blood gas measurements in patients with stable CF. A questionnaire addressing sleep quality was administered. Forward stepwise regression analysis was used to identify the parameters that best predict sleep-related desaturation, hypercapnia, and respiratory disturbance.

Setting: Sleep investigation unit and lung function laboratory.

Patients: Thirty-two patients with CF and FEV₁ < 65% predicted, in stable clinical condition. Patients were aged 27 ± 8 years (mean ± 1 SD) with FEV₁ of 36 ± 10% predicted, evening PaO₂ of 68 ± 8 mm Hg, and PaCO₂ of 43 ± 5 mm Hg.

Results: Evening PaO₂ (p < 0.0001) and morning PaCO₂ (p < 0.01) were predictive of the average minimum oxyhemoglobin saturation per 30-s epoch of sleep (r² = 0.74; p < 0.0001). Evening PaO₂ (p < 0.001) was predictive of the rise in transcutaneous carbon dioxide (TcCO₂) seen from non-rapid eye movement (NREM) to rapid eye movement (REM) sleep (r² = 0.37; p < 0.001). In addition, there was some relationship between expiratory respiratory muscle strength and the REM respiratory disturbance index (r² = 0.22; p < 0.01).

Conclusion: Evening PaO₂ was found to contribute significantly to the ability to predict both sleep-related desaturation and the rise in TcCO₂ from NREM sleep to REM sleep in this subgroup of patients with CF.

Key Words: cystic fibrosis • hypoxemia • sleep-disordered breathing

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