Published ahead of print on April 14, 2005, doi:10.1164/rccm.200409-1244OC Am. J. Respir. Crit. Care Med., Volume 172, Number 1, July 2005, 99-104 A more recent version of this article appeared on July 1, 2005
Submitted on September 20, 2004 The Effect of Infective Exacerbations on Sleep and Neurobehavioural Function in Cystic FibrosisCatherine J Dobbin1*,1 Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Australia, 2 Woolcock Institute for Medical Research, Sydney, Australia, 3 Sleep Research Group, Woolcock Institute for Medical Research, University of Sydney, Sydney, Australia * To whom correspondence should be addressed. E-mail: cathd{at}mail.med.usyd.edu.au.
Rationale: Adults with CF are susceptible to hypoxemia, hypercapnia, arousal from sleep and neurobehavioural impairment. Objectives: We hypothesised that pulmonary exacerbations would adversely affect sleep and neurobehavioural performance. Methods: Patients with exacerbations (cases) had sleep studies and neurobehavioural testing before and after inpatient intravenous therapy. Stable CF adults underwent the same testing procedures (controls). Measurements and Main Results: When clinically stable, cases and controls had similar lung function, intelligence and BMI. Amongst cases, treatment of an exacerbation improved lung function, quality of life, mood, sleepiness and activation. Cases spent more time awake after sleep onset (p=0.02), less time in REM sleep (p=0.03) and were more hypoxemic than controls when unwell. The severity of hypoxemia correlated with lung function. On admission, cases had slower throughput than controls in the serial addition and subtraction task (SAST) (cases 16±4 versus controls 17±3; F(1,36)=5.15, p=0.03) and a slower response time on the digit symbol substitution task (F(1,36)=11.91, p=0.001), which persisted after treatment (F(1,36)=8.48, p=0.006). Cases experienced significant improvements in sleep efficiency, amount of REM sleep and hypoxia with treatment. Their performance in the SAST, psychomotor vigilance task and simulated driving task also improved with treatment. Gender modified the effect of an exacerbation on some aspects of performance. Conclusions: Exacerbations of lung disease in adults with CF adversely affect sleep and tests of neurobehavioural performance regardless of underlying disease severity. The implications for performance in daily life need further evaluation as patients often delay admission to hospital in order to fulfil study or work commitments. Key words: Infective exacerbations, Sleep architecture, Sleep-disordered breathing, Neurobehavioural function
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