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Meta-Analysis
. 2020 Jun:51:101279.
doi: 10.1016/j.smrv.2020.101279. Epub 2020 Feb 19.

Sleep disorders in cystic fibrosis: A systematic review and meta-analysis

Joel Reiter  1 , Alex Gileles-Hillel  2 , Malena Cohen-Cymberknoh  2 , Dennis Rosen  3 , Eitan Kerem  2 , David Gozal  4 , Erick Forno  5
Affiliations
Meta-Analysis

Sleep disorders in cystic fibrosis: A systematic review and meta-analysis

Joel Reiter et al. Sleep Med Rev. 2020 Jun.

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.

Keywords: AHI; Actigraphy; Cystic fibrosis; Epworth sleepiness scale; Pittsburgh sleep quality index; Polysomnography; Sleep; Sleep efficiency.

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Conflict of interest statement

Conflicts of interest The authors do not have any conflicts of interest to disclose.

Figures

Figure 1 –
Figure 1 –. Flow diagram of study selection
Adapted from PRISMA statement guidelines[28]. ESS: Epworth sleepiness scale; PSG: Polysomnogram; PSQI: Pittsburgh sleep quality index.
Figure 2 –
Figure 2 –. Meta-analysis of polysomnography parameters in patients with CF vs. controls
WMD: Weighted mean difference.
Figure 2 –
Figure 2 –. Meta-analysis of polysomnography parameters in patients with CF vs. controls
WMD: Weighted mean difference.
Figure 2 –
Figure 2 –. Meta-analysis of polysomnography parameters in patients with CF vs. controls
WMD: Weighted mean difference.
Figure 2 –
Figure 2 –. Meta-analysis of polysomnography parameters in patients with CF vs. controls
WMD: Weighted mean difference.
See this image and copyright information in PMC

References

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