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Papale M, Manti S, Presti S, Mollica F, Parisi GF, Leonardi S. Sleep Respiratory Disorders in Children and Adolescents with Cystic Fibrosis and Primary Ciliary Dyskinesia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1707. [PMID: 37892370 PMCID: PMC10605080 DOI: 10.3390/children10101707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
Cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) are genetic respiratory diseases featured by chronic upper and lower airway inflammation and infection, mainly due to impaired mucociliary clearance due to genetic mutations. Sleep is crucial to healthy children's normal physical and psychological development and has an important value in chronic respiratory diseases. Impaired sleep quality, such as sleep deprivation or insufficient sleep during the night, and sleep respiratory disorders (SRDs) are common in 5% to 30% of the general population. Sleep disruption leads to attention deficits, daytime sleepiness, fatigue and mood disorders and correlates to a worsened quality of life. Furthermore, sleep respiratory disorders (SRSs) are under-recognized comorbidities in CF and PCD patients. SRSs include a spectrum of symptoms ranging from primary snoring through upper airway resistance to obstructive sleep apnea (OSA), nocturnal hypoventilation and hypoxemia occurring in people with moderate to severe lung disease and damaging the disease-related outcomes and quality of life. Effective screening during sleep with polysomnography is very important for the timely initiation of efficacious treatments and to prevent worsened respiratory, metabolic and cardiovascular outcomes. However, the impact of SRDs on health and quality of life is still underinvestigated.
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Affiliation(s)
- Maria Papale
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (M.P.); (G.F.P.); (S.L.)
| | - Sara Manti
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (M.P.); (G.F.P.); (S.L.)
- Pediatric Unit, Department of Human and Pediatric Pulmonology “Gaetano Barresi”, AOUP G. Martino, University of Messina, 98122 Messina, Italy
| | - Santiago Presti
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (M.P.); (G.F.P.); (S.L.)
| | - Federico Mollica
- Department of Pediatric Pulmonology and Allergology, Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Giuseppe F. Parisi
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (M.P.); (G.F.P.); (S.L.)
| | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (M.P.); (G.F.P.); (S.L.)
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Reiter J, Gileles-Hillel A, Cohen-Cymberknoh M, Rosen D, Kerem E, Gozal D, Forno E. Sleep disorders in cystic fibrosis: A systematic review and meta-analysis. Sleep Med Rev 2020; 51:101279. [PMID: 32145647 DOI: 10.1016/j.smrv.2020.101279] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/09/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022]
Abstract
Cystic fibrosis (CF) is a genetic disorder that leads to airway mucus accumulation, chronic inflammation, and recurrent respiratory infections - all likely impacting sleep. However, controlled studies of sleep in CF patients are limited, and have shown mixed results. We reviewed all publications on CF and sleep indexed in PubMed, CINAHL, and Scopus through April 2019. In the meta-analysis, we calculated pooled weighted mean differences for sleep quality, sleepiness, oximetry, and polysomnographic (PSG) parameters, using fixed or random-effects models as appropriate. A total of 87 manuscripts were reviewed. Compared to controls, children with CF had lower nighttime oxygen saturation nadirs, decreased sleep efficiency and a higher respiratory event index, with no differences in the percentage of REM sleep. Adults with CF had lower oxygen saturation nadirs, with a trend towards reduced sleep efficiency and no differences in REM sleep. In addition, patients with CF cough more during sleep and experience painful events that interfere with sleep. Actigraphy and questionnaires suggest disturbed sleep and daytime sleepiness. Noninvasive ventilation appears to improve gas exchange and symptoms. We conclude that when sleep is evaluated objectively or subjectively in patients with CF, perturbations are common, emphasizing the importance of their identification and treatment and inclusion as part of routine care. Additional research, with larger sample sizes and standardized outcomes, are necessary.
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Affiliation(s)
- Joel Reiter
- Pediatric Pulmonary & Sleep Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Alex Gileles-Hillel
- Pediatric Pulmonary & Sleep Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonary & Sleep Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dennis Rosen
- Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eitan Kerem
- Pediatric Pulmonary & Sleep Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Gozal
- Department of Child Health and Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh and University of Pittsburgh, PA, USA
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Yue HJ, Conrad D, Dimsdale JE. Sleep disruption in cystic fibrosis. Med Hypotheses 2008; 71:886-8. [DOI: 10.1016/j.mehy.2008.07.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 07/04/2008] [Accepted: 07/06/2008] [Indexed: 11/28/2022]
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Dobbin CJ, Milross MA, Piper AJ, Sullivan C, Grunstein RR, Bye PTP. Sequential use of oxygen and bi-level ventilation for respiratory failure in cystic fibrosis. J Cyst Fibros 2004; 3:237-42. [PMID: 15698941 DOI: 10.1016/j.jcf.2004.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Accepted: 07/27/2004] [Indexed: 11/30/2022]
Abstract
BACKGROUND Supplemental nocturnal oxygen is widely used for hypoxaemic respiratory failure in adults with CF. METHODS In order to determine the factors that predict the development of progressive hypercapnia on oxygen ("failure of oxygen therapy") and the subsequent role of bi-level pressure support ventilation (BVS), we reviewed the outcomes of 39 adults with CF who were treated for hypoxaemic respiratory failure between 1991 and 2002 using strict physiological criteria for the commencement of oxygen and the subsequent commencement of BVS. RESULTS Twenty of the 39 failed oxygen therapy, 13 of these within 12 months. Baseline PaCO2, rather than age, BMI or FEV1, predicted failure of oxygen therapy within 12 months. A PaCO2>6.5 kPa (49 mm Hg) was significantly associated with failure within 12 months (p=0.04). Twenty patients with mean PaCO2 7.9+/-1.3 kPa (59+/-10 mm Hg) and mean pH 7.38+/-0.05 had a significant reduction in their mean PaCO2 after 1 month of BVS (p=0.007). CONCLUSIONS Both oxygen and BVS can successfully stabilise patients to transplant. In patients commencing oxygen, baseline PaCO2 is predictive of the development of progressive hypercapnia within 12 months. BVS can successfully attenuate the rise in PaCO2 in the short term.
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Affiliation(s)
- Catherine J Dobbin
- Department of Respiratory Medicine, E 11 West, Royal Prince Alfred Hospital, Missenden Road, NSW 2050, Australia.
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Milross MA, Piper AJ, Dobbin CJ, Bye PTP, Grunstein RR. Sleep disordered breathing in cystic fibrosis. Sleep Med Rev 2004; 8:295-308. [PMID: 15233957 DOI: 10.1016/j.smrv.2004.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cough, sleep fragmentation and oxyhaemoglobin desaturation have all been documented during sleep in patients with cystic fibrosis (CF). It has been proposed that repeated episodes of nocturnal hypoxia act as a stimulus for the development of pulmonary hypertension and right ventricular failure, a complication that is associated with a poor prognosis. In addition, sleep disturbance from these events could lead to poor daytime function and quality of life. This review provides a detailed description of the mechanisms underlying sleep disordered breathing in this population, what is known regarding its effects upon daytime function and current treatment options. Most importantly, we review what is needed from future research in this challenging area of care in patients with CF.
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Affiliation(s)
- Maree A Milross
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Sydney NSW, Australia.
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Milross MA, Piper AJ, Norman M, Dobbin CJ, Grunstein RR, Sullivan CE, Bye PTP. Subjective sleep quality in cystic fibrosis. Sleep Med 2003; 3:205-12. [PMID: 14592209 DOI: 10.1016/s1389-9457(01)00157-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To evaluate sleep quality in patients with cystic fibrosis (CF). METHODS The Pittsburgh Sleep Quality Index (PSQI) questionnaire was administered to 37 CF patients with moderate to severe lung disease in a clinically stable state. Sleep studies were performed concurrently. PSQI scores were correlated with results of anthropometric variables, arterial blood gas tensions, lung function variables, and polysomnographic variables. Potential differences in objective measurements between patients with high and low scores on the PSQI were assessed. RESULTS Thirty-seven patients with CF were studied, aged 27+/-8 (mean+/-1 SD) years and forced expiratory volume in 1 s (FEV(1)) 36+/-12% predicted. The mean PSQI was 5.7+/-4.0. Fourteen of the 37 patients had a high PSQI, i.e. >5. Significant correlations between objective variables and both component scores and total PSQI were as follows: age and 'subjective sleep quality' (r=0.4, P<0.05), age and 'sleep duration' (r=0.3, P<0.05), FEV(1) % predicted and 'subjective sleep quality' (r=-0.4, P<0.05), carbon monoxide transferred per litre of lung volume (KCO) % predicted and 'daytime dysfunction' (r=-0.4, P<0.01), PaCO(2) and 'sleep latency' (r=0.4, P<0.01), arterial carbon dioxide tension (PaCO(2)) and 'habitual sleep efficiency' (r=0.3, P<0.05), PaCO(2) and total PSQI (r=0.4, P<0.05), absolute minimum sleep oxyhemoglobin saturation by pulse oximetry (SpO(2) %) and 'sleep latency' (r=-0.4, P<0.05), absolute minimum sleep SpO(2) % and 'sleep duration' (r=-0.4, P<0.05), absolute minimum sleep SpO(2) % and total PSQI (r=-0.4, P<0.05) and awake transcutaneous CO(2) and 'sleep duration' (r=0.45, P<0.05). Better sleep efficiency (P<0.05) and a greater % of rapid eye movement (REM) sleep (P<0.05) were found in those patients with a PSQI of < or =5. CONCLUSIONS A number of CF patients reported poor sleep quality. A relationship was shown between subjective sleep quality and physiological variables describing disease severity. Better sleep efficiency and % REM sleep were seen in patients with low PSQI scores. These results suggest a useful role for the PSQI in assessing sleep quality in patients with CF.
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Affiliation(s)
- Maree A Milross
- Royal Prince Alfred Hospital, Camperdown, Sydney, and Faculty of Medicine, University of Sydney, NSW, Australia
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Salvatore D, D'Andria M. Effects of salmeterol on arterial oxyhemoglobin saturations in patients with cystic fibrosis. Pediatr Pulmonol 2002; 34:11-5. [PMID: 12112791 DOI: 10.1002/ppul.10117] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sleep-related oxygen desaturation has been described in patients with cystic fibrosis (CF). Thus we studied the effects of inhaled Salmeterol xinafoate, a long-acting beta-2 agonist, on transcutaneous oxyhemoglobin saturation in sleeping, stable CF patients. Patients with stable CF (n = 23) were divided into responders and nonresponders to beta-2 agonists, based on an albuterol challenge during daytime testing, and then they received salmeterol before sleep, in a double-blind crossover design. Overnight oxyhemoglobin saturation measurements and spirometry on awakening were performed. Salmeterol administration before sleep resulted in statistically significant increases in mean arterial oxyhemoglobin saturation and in FEV(1) and FEF(25-75) on awakening compared to placebo values, but only in patients responding to daytime albuterol inhalation by showing improvement in lung function. We conclude that salmeterol inhalation at bedtime could prevent or reduce nocturnal hypoxemia in daytime albuterol-responsive CF patients, thus improving the long-term clinical outcome of CF lung disease.
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Affiliation(s)
- Donatello Salvatore
- Pediatric Division, Cystic Fibrosis Center, San Carlo Hospital, Potenza, Italy.
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Milross MA, Piper AJ, Norman M, Willson GN, Grunstein RR, Sullivan CE, Bye PTP. Night-to-night variability in sleep in cystic fibrosis. Sleep Med 2002; 3:213-9. [PMID: 14592210 DOI: 10.1016/s1389-9457(02)00030-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The impact of night-to-night variability (NNV) on polysomnography (PSG) has been reported mainly in normal subjects, the elderly and patients with obstructive sleep apnea with focus on changes in the apnea/hypopnea index, rather than measures of nocturnal oxygenation. There is very limited data on NNV in patients with cystic fibrosis (CF). The goal of this study was to assess for first-night effect and reliability of PSG measurements on nocturnal oxygenation and respiratory disturbance in CF. METHODS A prospective observational study was performed in patients with CF who consented to PSG on two consecutive nights. Paired t-tests and intra-class correlation coefficients (ICCs) were calculated for repeated measures of sleep stage time, sleep efficiency, arousal indices, measures of nocturnal oxygenation, and respiratory events in all sleep stages. RESULTS Thirty-one patients with CF were studied, aged 27+/-8 (mean+/-1 SD) years and forced expiratory volume in 1 s (FEV(1)) of 37+/-11% of predicted. Relative to the first-night PSG, on the second PSG, we observed the following: shorter latency to rapid eye movement (REM) sleep (P<0.001), increased sleep efficiency (P<0.01), decreased wake after sleep onset (WASO) time (P<0.01), decreased percentage of non-REM time with oxyhemoglobin saturation by pulse oximetry (SpO(2))< or =90% (P<0.05), decreased number of central apneas per hour (P<0.05) and reduced respiratory rate in stage 2 sleep on night 2 (P<0.05). Despite these changes, the ICCs between night 1 and night 2 showed good repeatability/reliability for measures of nocturnal oxygenation and indices of respiratory disturbance, including the percentage of total sleep time with SpO(2)< or =90% (ICC=0.85) and apnea-hypopnea index (ICC=0.75). Likewise, the ICCs were extremely high for respiratory rate in stage 2 (ICC=0.94), slow wave sleep (ICC=0.97), and REM sleep (ICC=0.96). CONCLUSION Although a first-night effect is seen with sleep efficiency, REM latency, and WASO, a single-night PSG in patients with CF yields reliable information on nocturnal oxygenation and respiratory disturbance.
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Affiliation(s)
- Maree A Milross
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, and Faculty of Medicine, University of Sydney, NSW, Australia
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Milross MA, Piper AJ, Norman M, Willson GN, Grunstein RR, Sullivan CE, Bye PT. Predicting sleep-disordered breathing in patients with cystic fibrosis. Chest 2001; 120:1239-45. [PMID: 11591567 DOI: 10.1378/chest.120.4.1239] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
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 FEV(1) < 65% predicted, in stable clinical condition. Patients were aged 27 +/- 8 years (mean +/- 1 SD) with FEV(1) of 36 +/- 10% predicted, evening PaO(2) of 68 +/- 8 mm Hg, and PaCO(2) of 43 +/- 5 mm Hg. RESULTS Evening PaO(2) (p < 0.0001) and morning PaCO(2) (p < 0.01) were predictive of the average minimum oxyhemoglobin saturation per 30-s epoch of sleep (r(2) = 0.74; p < 0.0001). Evening PaO(2) (p < 0.001) was predictive of the rise in transcutaneous carbon dioxide (TcCO(2)) seen from non-rapid eye movement (NREM) to rapid eye movement (REM) sleep (r(2) = 0.37; p < 0.001). In addition, there was some relationship between expiratory respiratory muscle strength and the REM respiratory disturbance index (r(2) = 0.22; p < 0.01). CONCLUSION Evening PaO(2) was found to contribute significantly to the ability to predict both sleep-related desaturation and the rise in TcCO(2) from NREM sleep to REM sleep in this subgroup of patients with CF.
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Affiliation(s)
- M A Milross
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Sydney
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Frangolias DD, Wilcox PG. Predictability of oxygen desaturation during sleep in patients with cystic fibrosis : clinical, spirometric, and exercise parameters. Chest 2001; 119:434-41. [PMID: 11171720 DOI: 10.1378/chest.119.2.434] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine how common sleep-related desaturation with preserved awake resting pulse oximetric saturation (SpO(2)) was in a large cohort of adult cystic fibrosis (CF) patients with variable degrees of pulmonary disease. We then determined whether nocturnal desaturation could reliably be predicted from standard clinical and exercise parameters. METHODS Seventy CF patients participated in the study (mean [SD] age, 27.3 [8.7] years; women, 54%; percent predicted FEV(1) [%predFEV(1)], 55.7% [23.9%]). Nocturnal, resting, and exercise SpO(2) were measured. Nocturnal oximetry was measured in the patient's home. Maximal oxygen capacity (Vo(2)max) was determined from a graded exercise test on a stationary bicycle ergometer. The Shwachman-Kulczycki (S-K) illness severity score was calculated incorporating categories of functional capacity, physical examination, nutrition, and chest radiograph. RESULTS Multivariate analysis reported significant differences (p < 0.0001) between pulmonary disease severity and overall distribution of nocturnal SpO(2), with the main difference being for patients with severe pulmonary disease (%predFEV(1) of < 50%) compared to patients with mild or moderate disease in the SpO(2) intervals of 100 to 96% (p < 0.0001) and 90 to 86% (p = 0.0001). Pulmonary function, S-K clinical scores, f1.gif" BORDER="0">O(2)max, and resting and maximal SpO(2) correlated significantly (p < 0.05) with nocturnal SpO(2) levels. Stepwise discriminant analysis identified %predFEV(1) (or S-K scores) and resting SpO(2) as the parameters that could best discriminate patients not likely to experience nocturnal desaturation. Specifically, our equation could predict 91% of cases less likely to nocturnally desaturate, but could only modestly predict those more likely to desaturate (i.e., 26% of cases). CONCLUSIONS Spirometric parameters and measurements of awake resting oxygenation are of limited utility in predicting nocturnal desaturation. Nocturnal oximetry should be considered in patients with moderate to severe lung disease even with preserved awake resting SpO(2).
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Affiliation(s)
- D D Frangolias
- Pulmonary Research Laboratory, University of British Columbia, Vancouver, BC, Canada
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Vic P, Ategbo S, Turck D, Husson MO, Tassin E, Loeuille GA, Deschildre A, Druon D, Elian JC, Arrouet-Lagandre C, Farriaux JP. Tolerance, pharmacokinetics and efficacy of once daily amikacin for treatment of Pseudomonas aeruginosa pulmonary exacerbations in cystic fibrosis patients. Eur J Pediatr 1996; 155:948-53. [PMID: 8911895 DOI: 10.1007/bf02282885] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Twenty cystic fibrosis patients aged 1.8-22 years (mean +/- SD: 9.6 +/- 4.8 years) with Pseudomonas aeruginosa pulmonary exacerbations were treated with amikacin (AM) (35 mg/kg/day in one daily 30 min infusion) associated with either ceftazidime (200 mg/kg/day in 3 i.v. injections) (n = 19) or imipenem (n = 1) at the same dose. Glomerular and tubular functions (creatinine clearance, 24-h proteinuria, beta 2 microglobulinuria, lysozymuria) and audiometry remained within normal ranges from day 0 to day 14. A peak concentration of AM of 83 +/- 19 mg/l and a trough concentration of 0.8 +/- 0.5 mg/l were observed in blood while AM levels in sputum were above the minimal inhibitory concentration 50 from 30 min to 16 h. No serum accumulation of AM was observed during the treatment. From day 0 to day 14, the following changes were observed: weight/height ratio: 96%-100% (P < 0.001); daily energy intake: 111%-128% of RDA (P < 0.001); prealbumin: 195-290 mg/l (P < 0.001); forced vital capacity (FVC): 66%-81% (P < 0.01); forced expiratory volume in 1 s: 60%-75% (P < 0.01); forced expiratory flow between 25% and 75% of FVC: 42%-56% (P < 0.01); nocturnal SaO2 also improved significantly; cardiac rate decreased from 89 +/- 18/min to 76 +/- 16/min (P < 0.001); respiratory rate decreased from 31 +/- 15/min to 26 +/- 10/min (P < 0.05); inflammatory parameters (white blood cells, polymorphonuclear cells, erythrocyte sedimentation rate) also improved. CONCLUSION Once daily amikacin administration associated with ceftazidime is well tolerated for the treatment of Pseudomonas aeruginosa pulmonary exacerbations in cystic fibrosis patients. Serum peak levels and diffusion in sputum are higher than with a conventional schedule.
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Affiliation(s)
- P Vic
- Service de Pédiatrie, Hôpital Huriez, Lille, France
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Abstract
There is a significant interaction between obstructive lung disease and sleep--sleep is associated with clinical deterioration in obstructive lung disease, and vice versa. Knowledge of the pathophysiology of deterioration in obstructive lung disease during sleep is essential to the understanding of the management of this problem. Recent information has helped to clarify this pathophysiology and has led to more aggressive treatment for deterioration of obstructive lung disease during sleep. Whether this newer and more aggressive treatment strategy improves survival or morbidity in these conditions is a challenge for future research.
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Affiliation(s)
- R Jokic
- Department of Medicine, University of Saskatchewan, Sasakatoon, Canada
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Pond MN, Conway SP. Nocturnal oxygen desaturation and spirometric parameters in adults with cystic fibrosis. Thorax 1995; 50:539-42. [PMID: 7597668 PMCID: PMC1021225 DOI: 10.1136/thx.50.5.539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Correction of nocturnal hypoxaemia in patients with cystic fibrosis may delay the development of pulmonary hypertension. Descriptive statistics used for nocturnal arterial oxygen saturation (SpO2) lack uniformity. The relationship between SpO2 and spirometric parameters has not previously been explored in a large number of exacerbations in adult patients with cystic fibrosis. METHODS Over a 21 month period overnight SpO2, forced expiratory volume in one second (FEV1), and forced vital capacity (FVC) were recorded on admission and discharge in 120 treatments of pulmonary exacerbations in 47 patients with cystic fibrosis who did not receive supplemental oxygen during recording. Nocturnal SpO2 was related to spirometric parameters for the whole group and individually in 11 patients, each of whom had at least five treatments. RESULTS There was a close linear relationship between the percentage of the recording spent with SpO2 < 90% and mean overnight SpO2. Mean SpO2 correlated moderately with percentage predicted FEV1(%FEV1), r = 0.6, and poorly with percentage predicted FVC (%FVC), r = 0.34. The relationship between mean SpO2 and % FEV1 was non-linear at mean SpO2 < 89%, but approximated to linearity above this value. After exclusion of treatments with mean SpO2 < 89% the regression relationship between mean SpO2 and %FEV1 was the same on admission and discharge. Individual correlation coefficients of mean SpO2 versus % FEV1 in the 11 patients with repeated treatments ranged from 0.57 to 0.77. The slopes of the regression lines did not differ, with a pooled slope of 0.116, but the intercepts varied widely. CONCLUSIONS In patients with cystic fibrosis mean overnight SpO2 can be substituted for percentage of recording < 90%. The relationship between mean SpO2 and percentage predicted FEV1 is non-linear at low values of SpO2 and is not influenced by treatment of pulmonary exacerbations. Patients with cystic fibrosis desaturate at a uniform rate compared with percentage predicted FEV1, but the value of FEV1 at which desaturation first occurs varies between patients. The spirometric values do not accurately predict nocturnal desaturation in a cystic fibrosis population, but FEV1 is a useful guide in individual patients with moderate desaturation.
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Affiliation(s)
- M N Pond
- Adult Cystic Fibrosis Centre, Seacroft Hospital, Leeds, UK
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Lindberg LG, Lennmarken C, Vegfors M. Pulse oximetry--clinical implications and recent technical developments. Acta Anaesthesiol Scand 1995; 39:279-87. [PMID: 7793201 DOI: 10.1111/j.1399-6576.1995.tb04062.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The pulse oximeter has been shown to be a reliable monitor of arterial oxygen saturation and has therefore been recommended as mandatory monitoring for patients during anaesthesia and intensive care. In 1989 two review articles on pulse oximetry were published (1, 2) and two years ago Severinghaus and Kelleher summarized the literature between 1989 and October 1991 (3). Our aim is to focus the discussion on technical aspects and applications of pulse oximetry with special attention centered on recent developments. This review is consequently an update on pulse oximetry since the end of 1991, and the first on technically-based publications in the two last decades.
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Affiliation(s)
- L G Lindberg
- Department of Biomedical Engineering, Linköping University, Sweden
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