Effect of night symptoms and disease severity on subjective sleep quality in children with non-cystic-fibrosis bronchiectasis

Comparison of sleep quality between outpatient and hospitalized children with respiratory tract dysfunction

OBJECTIVES

The main objective of the study to compare the effect of hospitalized and outpatient settings on quality of sleep in children with respiratory tract dysfunction.

METHODOLOGY

A descriptive correlational study was carried out at Dhi-Qar Health Directorate pediatric hospitals. The period of the study was from the November 19, 2023 to March 10, 2024. Purposive sample (non-probability) of 250 children (male and female). A total of (125) children were chosen from the children whose admitted to the hospitals, and a total of (125) children were chosen from the outpatient settings. The study instrument consisted of three parts: the sociodemographic sheet, clinical diagnosis sheet, and sleep quality scale. The questionnaire was modified according to experts' recommendation to use it for children with respiratory tract dysfunction. The questionnaire was evaluated by a panel of 15 experts from diverse medical and nursing professions. Both descriptive and inferential statistics were used to analyze the data.

RESULTS

The study findings that effect outpatient settings have more effect from hospitalized settings on quality of sleep in children with respiratory tract dysfunction (M ± SD = 1.322 ± 0.1522).

CONCLUSION

A study showed that the quality of sleep in children with respiratory tract dysfunction was generally average, whether in hospitalized or outpatient settings, outpatient settings had greater difficulties falling asleep and waking than children in hospitalized.

The Impact of Lung Function Parameters on Sleep Among Aboriginal Australians - A Polysomnography and Spirometry Relationship Study

Background

Sleep disorders such as obstructive sleep apnoea (OSA) are known to overlap significantly with airway diseases in various populations. This study assessed the relationship between lung function parameters against polysomnography (PSG) and continuous positive airway pressure (CPAP) adherence data amongst an Aboriginal Australian population.

Methods

Patients who undertook both a diagnostic PSG and spirometry were included. Restrictive, obstructive, and mixed impairments were assessed via global lung function initiative (GLI-2012, ATS/ERS) criteria/guidelines. PSG and CPAP data were evaluated between patients with or without spirometry impairments.

Results

Of the total 771 patients, 248 had PSG and spirometry data available (52% female, 44% remote residents, 78% obese). The majority (89%) had OSA (51% severe), 95 (38%) were observed to have a restrictive impairment, and 31 (13%) had an obstructive or mixed impairment on spirometry. Compared to patients with no spirometric impairment, those with restrictive or obstructive/mixed impairments demonstrated significantly lower sleep efficiency (median 84% vs 79% and 78%), higher apnoea-hypopnea index (AHI) during rapid eye movement (REM) sleep (median 32 vs 52 and 55 events/hour), reduced REM oxygen saturation (SpO₂) (median 94.0% vs 92.0% and 92.5%) and reduced adherence to CPAP therapy (median 39% vs 22% and 17%). Differences in sleep efficiency, REM AHI, and NREM SpO₂ held for patients with obstructive/mixed impairments in multivariate modelling.

Conclusion

Aboriginal Australian patients with OSA have a higher concurrent lung function' impairment. Spirometric impairment appears to negatively influence sleep efficiency, nocturnal SpO₂ and CPAP adherence. This may have substantial implications for OSA management among Aboriginal Australians.

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

Sleep-disordered breathing (SDB) comprises different diseases characterized by abnormal respiratory patterns during sleep including obstructive sleep apnea. SDB prevalence and impact in patients with chronic respiratory infections have been only marginally studied. The purpose of this narrative review is to report the prevalence and impact of SDB in chronic respiratory infections, including cystic fibrosis (CF), bronchiectasis and mycobacterial infections, and explore the possible pathophysiological mechanisms. Common pathophysiological mechanisms, underlying SDB onset in all chronic respiratory infections, include inflammation, which plays a central role, chronic nocturnal cough and pain, excessive production of mucous plugs, presence of obstructive and/or restrictive ventilatory impairment, upper airways involvement, and comorbidities, such as alteration of nutritional status. SDB may affect about 50% of patients with bronchiectasis. The severity of the disease, e.g., patients colonized with P. aeruginosa and frequent exacerbators, as well as comorbidities, such as chronic obstructive pulmonary disease and primary ciliary dyskinesia, may impact SDB onset. SDB may also frequently complicate the clinical course of both children and adults with CF, impacting the quality of life and disease prognosis, suggesting that their routine assessment should be incorporated into the clinical evaluation of patients from the first stages of the disease regardless of suggestive symptoms, in order to avoid late diagnosis. Finally, although the prevalence of SDB in patients with mycobacterial infections is uncertain, extrapulmonary manifestations, particularly nasopharyngeal locations, and concomitant symptoms, such as body pain and depression, may act as atypical predisposing factors for their development.

Depression, anxiety, and sleep quality of caregivers of children with spinal muscular atrophy

BACKGROUND

The aim of this study was to evaluate the prevalence of anxiety, depression, sleep, and associated factors in caregivers of children with spinal muscular atrophy (SMA).

MATERIALS AND METHODS

Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory-State (STAI-S), the State-Trait Anxiety Inventory-Trait (STAI-T), and Pittsburgh Sleep Quality Index (PSQI) were used to assess the anxiety, depression, and sleep quality of the caregivers of children with SMA. Higher scores indicated worse outcome for all three questionnaires.

RESULTS

Fifty-six caregivers of children with SMA were included in the study. Median age of children was 6 (3.2-10) years and mean age of the caregivers was 37.0 ± 6.5 years. Median scores of the BDI, STAI-S, STAI-T, and PSQI were 12 (7.2-17), 35.5 (31-44), 40.5 (35-48), and 7.0 (5.0-10.0), respectively. There was a positive correlation between BDI and PSQI scores (p < 0.05). There was a negative correlation between the age of the caregivers and PSQI, BDI, STAI-T scores (p = 0.01, r = -0.341; p = 0.006, r = -0.364; p = 0.003, r = -0.395, respectively). There was a negative correlation between the age of the patients and the PSQI scores of the caregivers (p = 0.01, r = -0.33). There was a negative correlation between BDI scores and household income (p = 0.01, r = -0.34).

CONCLUSION

Caregivers of children with SMA had elevated depression and anxiety levels and they also had decreased sleep quality. Economic and social support resources are needed to help caregivers of those children.

Diagnosis and quantification of bronchiectasis using computed tomography or magnetic resonance imaging: A systematic review

BACKGROUND

Bronchiectasis is an irreversible dilatation of the airways caused by inflammation and infection. To diagnose bronchiectasis in clinical care and to use bronchiectasis as outcome parameter in clinical trials, a radiological definition with exact cut-off values along with image analysis methods to assess its severity are needed. The aim of this study was to review diagnostic criteria and quantification methods for bronchiectasis.

METHODS

A systematic literature search was performed using Embase, Medline Ovid, Web of Science, Cochrane and Google Scholar. English written, clinical studies that included bronchiectasis as outcome measure and used image quantification methods were selected. Criteria for bronchiectasis, quantification methods, patient demographics, and data on image acquisition were extracted.

RESULTS

We screened 4182 abstracts, selected 972 full texts, and included 122 studies. The most often used criterion for bronchiectasis was an inner airway-artery ratio ≥1.0 (42%), however no validation studies for this cut-off value were found. Importantly, studies showed that airway-artery ratios are influenced by age. To quantify bronchiectasis, 42 different scoring methods were described.

CONCLUSION

Different diagnostic criteria for bronchiectasis are being used, but no validation studies were found to support these criteria. To use bronchiectasis as outcome in future studies, validated and age-specific cut-off values are needed.

The Bronchiectasis in COPD-OSA Overlap Syndrome Patients

Purpose

COPD-OSA (chronic obstructive pulmonary disease–obstructive sleep apnea) overlap syndrome is associated with more frequent COPD acute exacerbations than COPD without OSA. With the application of high-resolution computed tomography (HRCT) in COPD, bronchiectasis is commonly detected and is associated with disease severity. Sleep respiratory disease is also associated with bronchiectasis; however, the correlation between OSA and coexisted bronchiectasis in COPD (COPD-Bx) has not been reported yet.

Patients and Methods

A total of 124 consecutive patients with stable COPD were enrolled. All subjects completed the chest HRCT and nocturnal polysomnography (PSG). The scores of extent and severity in bronchiectasis were assessed based on the Smith method and the Bhalla scoring system. Clinical data, questionnaire, routine blood test data, blood levels of C-reactive protein (CRP) and Immunoglobulin E, and the lymphocyte subtype were collected.

Results

Among all enrolled patients, 56.45% (70/124) were diagnosed as COPD-OSA based on the results of PSG screening. Bronchiectasis was detected in 42.86% (30/70) of the patients with COPD-OSA, but in 18.52% (10/54) of the patients without OSA (χ2=8.264, p=0.004). PSG screening revealed that COPD with OSA had a significantly higher apnea-hypopnea index and percent of time spent with oxygen saturation below 90% (T90). Higher values of CRP, T90, and lower CD4/CD8 in the COPD-Bx with OSA were detected compared to COPD-Bx without OSA. Correlation analysis showed that the Bhalla severity score was related to CD8 cell count (r=0.446, p<0.05) and CD4/CD8 (r=−0.357, p<0.05) in all the COPD-Bx patients. The Smith extent score was also associated with the values of CD8 count (r=0.388, p<0.05) and CD4/CD8 (r=−0.381, p<0.05).

Conclusion

The comorbid bronchiectasis was more common in COPD-OSA overlap syndrome patient and may be related to more severe hypoxia and increased systemic inflammation.

Neurological and Sleep Disturbances in Bronchiectasis

Bronchiectasis unrelated to cystic fibrosis is a chronic lung disease that is increasingly recognised worldwide. While other common chronic lung conditions such as chronic obstructive lung disease have been associated with cardiovascular disease, there is a paucity of data on the relationship between bronchiectasis and cardiovascular risks such as stroke and sleep disturbance. Furthermore, it is unclear whether other neuropsychological aspects are affected, such as cognition, cerebral infection, anxiety and depression. In this review, we aim to highlight neurological and sleep issues in relation to bronchiectasis and their importance to patient care.

Evaluation of obstructive sleep apnea in non-cystic fibrosis bronchiectasis: A cross-sectional study

The relationship between sleep disorders and bronchiectasis has not been well described. We hypothesize that, due to the irreversible dilatation of the bronchi, the presence of secretions, and airflow obstruction, patients with non-cystic fibrosis bronchiectasis may be predisposed to hypoxemia during sleep, or to symptoms that may lead to arousal. A cross-sectional observational study was performed involving 49 patients with a clinical diagnosis of non-cystic fibrosis bronchiectasis (NCFB). All patients underwent clinical evaluation, spirometry, and polysomnography, and were evaluated for the presence of excessive daytime sleepiness (EDS) and risk of obstructive sleep apnea (OSA). The mean age of the participants was 50.3 ± 13.6 years; 51.1% of patients were male and had a mean body mass index of 23.8 ± 3.4 kg/m². The mean total sleep time (TST) was 325.15 ± 64.22 min with a slight reduction in sleep efficiency (84.01 ± 29.2%). Regarding sleep stages, stage 1 sleep and REM sleep were abnormal. OSA was present in 40.82% of the patients. The mean arousal index was 5.6 ± 2.9/h and snoring was observed in 71.43% of the patients. The oxygen desaturation index (ODI) was 14.35 ± 15.36/h, mean minimum oxygen saturation (SpO₂ nadir) was 83.29 ± 7.99%, and mean TST with an SpO₂ less than 90% was 30.21 ± 60.48 min. EDS was exhibited by 53.06% of the patients and 55.1% were at high risk of developing OSA. The patients infected by Pseudomonas aeruginosa had higher apnea-hypopnea indices, ODI, and TST with SpO₂ < 90%, and lower values of SpO₂ nadir. Adult patients with clinically stable NCFB, especially those infected by Pseudomonas aeruginosa, display EDS and a high prevalence of OSA, associated with considerable oxygen desaturation during sleep.

An update on pediatric bronchiectasis

INTRODUCTION

The prevalence and awareness of bronchiectasis not related to cystic fibrosis (CF) is increasing and it is now recognized as a major cause of respiratory morbidity, mortality and healthcare utilization worldwide. The need to elucidate the early origins of bronchiectasis is increasingly appreciated and has been identified as an important research priority. Current treatments for pediatric bronchiectasis are limited to antimicrobials, airway clearance techniques and vaccination. Several new drugs targeting airway inflammation are currently in development. Areas covered: Current management of pediatric bronchiectasis, including discussion on therapeutics, non-pharmacological interventions and preventative and surveillance strategies are covered in this review. We describe selected adult and pediatric data on bronchiectasis treatments and briefly discuss emerging therapeutics in the field. Expert commentary: Despite the burden of disease, the number of studies evaluating potential treatments for bronchiectasis in children is extremely low and substantially disproportionate to that for CF. Research into the interactions between early life respiratory tract infections and the developing immune system in children is likely to reveal risk factors for bronchiectasis development and inform future preventative and therapeutic strategies. Tailoring interventions to childhood bronchiectasis is imperative to halt the disease in its origins and improve adult outcomes.

Sleep disordered breathing and sleep quality in children with bronchiolitis obliterans

The incidence of sleep-disordered breathing (SDB) increases in chronic lung diseases. Our aim was to evaluate SDB and sleep quality in children with postinfectious bronchiolitis obliterans (BO) and assess associated risk factors. We hypothesized that children with BO are at increased risk for SDB and have impaired sleep quality. We also hypothesized that severity of SDB and impairment of sleep quality is related to the severity of lung disease. Sleep Related Breathing Disorder (SRBD) subscale of the Pediatric Sleep Questionnaire (PSQ) and Pittsburgh Sleep Quality Index (PSQI) questionnaires; spirometry, impulse oscillometry (IOS), and overnight polysomnography (PSG) were performed. Twenty-one patients (14 male, median age: 8.3 years) were enrolled. Five patients (25%) had a PSQ score of >0.33, predictive of a SDB. Ten patients (48%) had poor sleep quality. Four patients (19%) had an OAHI of >1/hr. Nineteen patients (90%) had a high desaturation index. Four patients (19%) had a mean oxygen saturation of <93%. Median central apnea time was 7.5 (IQR: 6.9-9.1) seconds. Central apnea index of the patients correlated positively with R5, R10, R15, R20, Z5, and negatively with X10 and X15 at IOS. There was a positive correlation between the lowest oxygen saturation and FVC, FEV1 , X5, X10, X15, X20 while there was a negative correlation between lowest saturation and the central apnea index at PSG, R5, R10, and Z5 at IOS. Mean oxygen saturation during PSG correlated positively with FVC, FEV1, FEF(25-75), X5, X10, X15, X20 results. The risk of nocturnal hypoxia is increased in patients with BO and correlated to the severity of lung disease determined by pulmonary function tests. Although BO patients have a shorter duration of central apneas, they are more prone to desaturate.

Sleep Structure in Children With Attention-Deficit/Hyperactivity Disorder

The authors evaluated basic sleep architecture and non-rapid eye movement (NREM) sleep alterations in drug-naïve attention-deficit/hyperactivity disorder (ADHD) children without psychiatric or other comorbidities. This cross-sectional case-control study included 28 drug-naïve children with ADHD and 15 healthy controls. This subjective studies revealed that children with ADHD had a worse sleep quality and increased daytime sleepiness. Polysomnography data showed that the sleep macrostructure was not significantly different in children with ADHD. Sleep microstructure was altered in ADHD children by means of reduced total cyclic alternating pattern rate and duration of cyclic alternating pattern sequences. This reduction was associated with a selective decrease of A1 index during stage 2 NREM. SpO2 in total sleep was slightly decreased; however, the incidence of sleep disordered breathing showed no significant difference. The authors suggest that cyclic alternating pattern scoring would provide a further insight to obtain a better understanding of the sleep structure in children with ADHD.

Observational study of sleep, respiratory mechanics and quality of life in patients with non-cystic fibrosis bronchiectasis: a protocol study

INTRODUCTION

Bronchiectasis is a chronic disorder characterised by permanent and irreversible abnormal dilation of the bronchi and bronchioles, primarily caused by repeated cycles of pulmonary infections and inflammation, which lead to reduced mucociliary clearance and to the excessive production of sputum. Patients with non-cystic fibrosis bronchiectasis may be predisposed to hypoxemia during sleep, or to symptoms that may lead to arousals and thereby reduce the quality of life, because of the irreversible dilation of the bronchi and the presence of secretions and airflow obstruction.

METHODS AND ANALYSIS

For this cross-sectional observational study, patients with a clinical diagnosis of non-cystic fibrosis bronchiectasis will be recruited from the Bronchiectasis Clinic of the Pneumology Department of the Santa Casa de Misericordia Hospital and the Federal University of São Paulo (São Paulo, Brazil). Patients of either sex will be included if high-resolution CT of the thorax and classic sweat test confirms they have non-cystic fibrosis bronchiectasis, are between 18 and 80 years old, use long-acting bronchodilators, are clinically stable for a least 1 month, agree to participate in the study and they sign a statement of informed consent. The first part of the study will involve a clinical evaluation, maximal respiratory pressures, spirometry and the Saint George's Respiratory Questionnaire. The Sleep Laboratory of the Master's and Doctoral Postgraduate Program in Rehabilitation Sciences of the Nove de Julho University (São Paulo, Brazil) will perform the polysomnographic studies, Berlin Questionnaire, Epworth Sleepiness Scale, waist and neck circumferences, modified Mallampati classification and tonsil index.

ETHICS AND DISSEMINATION

This protocol has been approved by the Human Research Ethics Committees of Santa Casa de Misericordia Hospital (process number 178/2012) and Human Research Ethics Committee of Nove de Julho University (process number 370474/2010). All participants will sign a statement of informed consent. The study findings will be published in peer-reviewed journals and presented at conferences.

Sleep disturbances and health-related quality of life in adults with steady-state bronchiectasis

Background

Sleep disturbances are common in patients with chronic lung diseases, but little is known about the prevalence in patients with bronchiectasis. A cross sectional study was conducted to investigate the prevalence and determinants associated with sleep disturbances, and the correlation between sleep disturbances and quality of life (QoL) in adults with steady-state bronchiectasis.

Methods

One hundred and forty-four bronchiectasis patients and eighty healthy subjects were enrolled. Sleep disturbances, daytime sleepiness, and QoL were measured by utilizing the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and St. George Respiratory Questionnaire (SGRQ), respectively. Demographic, clinical indices, radiology, spirometry, bacteriology, anxiety and depression were also assessed.

Results

Adults with steady-state bronchiectasis had a higher prevalence of sleep disturbances (PSQI>5) (57% vs. 29%, P<0.001), but not daytime sleepiness (ESS≥10) (32% vs. 30%, P = 0.76), compared with healthy subjects. In the multivariate model, determinants associated with sleep disturbances in bronchiectasis patients included depression (OR, 10.09; 95% CI, 3.46–29.37; P<0.001), nocturnal cough (OR, 1.89; 95% CI, 1.13–3.18; P = 0.016), aging (OR, 1.04; 95% CI, 1.01–1.07; P = 0.009) and increased 24-hour sputum volume (OR, 2.01; 95% CI, 1.22–3.33; P = 0.006). Patients with sleep disturbances had more significantly impaired QoL affecting all domains than those without. Only 6.2% of patients reported using a sleep medication at least weekly.

Conclusions

In adults with steady-state bronchiectasis, sleep disturbances are more common than in healthy subjects and are related to poorer QoL. Determinants associated with sleep disturbances include depression, aging, nighttime cough and increased sputum volume. Assessment and intervention of sleep disturbances are warranted and may improve QoL.

Sleep disordered breathing in patients with primary ciliary dyskinesia

BACKGROUND

Upper airway manifestations of primary ciliary dyskinesia (PCD) can cause obstructive sleep apnea syndrome (OSAS). Also abnormalities of lung mechanics and gas exchange may lead to sleep abnormalities in these patients.

OBJECTIVES

To determine the rate of OSAS and sleep quality in PCD patients, and whether these are related to upper respiratory system manifestations and severity of lung disease in these patients.

METHODS

Twenty-nine PCD patients and healthy controls were included to the study. Respiratory symptoms within the previous month were separately scored with the severity of the symptoms. Physical examination, pulmonary function tests, and ear-nose-throat assessments were obtained. All patients completed the Turkish version of Pittsburgh Sleep Quality Index (PSQI), sleep questionnaire, and underwent overnight polysomnography. Categorical variables were compared with chi-square and Fisher's exact test while continuous variables were compared with Student's t-test.

RESULTS

Eleven PCD patients reported themselves to be "poor" sleepers, compared to only one subject in the control group (P = 0.002). Sixty-five percent of PCD patients had habitual snoring (HS). Fifty-two percent of the PCD patients had OSAS in polysomnography. OSAS rate was higher in PCD patients who snored (P = 0.008). HS and OSAS were more common in PCD patients who had cigarette smoke exposure in their homes (P < 0.001 and P = 0.02, respectively).

CONCLUSIONS

Patients with PCD have decreased sleep quality and higher rate of sleep disordered breathing compared to controls and higher rate of OSAS compared to population rates. Cigarette smoke exposure is an important risk factor for OSAS in PCD patients. Assessment and treatment of sleep disorders in PCD should be a part of disease management. Periodicals, Inc.