Sleep is an issue for many patients with cystic fibrosis, but noninvasive measures can ease at least some of the problem, according to Dr. Eliot Katz of Harvard Medical School, Boston.
A host of factors can disrupt sleep for patients with CF, including chronic cough, hypoventilation, musculoskeletal pain, gastrointestinal reflux, abdominal discomfort, depression, and the need for frequent defecation, Dr. Katz noted. Children with CF may also have obstructive sleep apnea caused by factors such as adenotonsillar hypertrophy and chronic rhinosinusitis. Some patients also take medications that disrupt sleep or struggle to sleep because they receive overnight enteral feeding, he added (Clin. Chest. Med. 2014 [doi:10.1016/j.ccm.2014.06.005]).
Patients also may develop nocturnal hypercapnia and hypoxemia during sleep. Although nocturnal hypoxemia is most common in patients with advanced lung disease (FEV1 less than 65%), it can also affect patients with milder lung disease, Dr. Katz said. "Hypoxemia is not usually associated with arousal from sleep and, therefore, may be unrecognized," he noted.
As their lung disease progresses, patients with CF develop hypercapnia and subsequent dyspnea, which can be relieved, at least in the short term, by noninvasive ventilation to increase tidal volume and minute ventilation during sleep, Dr. Katz said. He noted that in a study of patients with advanced lung disease, minute ventilation was 22% lower during REM sleep than when patients were awake breathing room air, but was only 14% lower when sleeping patients received noninvasive ventilation (Am. J. Respir. Crit. Care. Med. 2001;163;129-34).
Dr. Katz reported no funding sources and had no disclosures.