Chest
Volume 84, Issue 4, October 1983, Pages 388-393
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Ventilation And Oxygenation Changes During Sleep In Cystic Fibrosis

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Oxygen desaturation during sleep in patients with cystic fibrosis has been attributed to changes in the end-expiratory volume during rapid eye movement (REM) sleep, leading to worsening of the ventilation-perfusion distribution. The purpose of this study was to describe the changes in ventilation during sleep that may contribute to the oxygen desaturation. Six adolescent males with moderate to severe cystic fibrosis were studied. It was concluded that hypoventilation during REM may contribute to oxygen desaturation in patients with cystic fibrosis.

Section snippets

METHODS

Six adolescent males, ages 10 to 16, with the diagnosis of CF confirmed by an elevated pilocarpine iontophoretic sweat chloride, were studied both awake and asleep. Informed consent of patients and parents was obtained in all cases. The patients’ anthropometric data are presented in Table 1. The mean height was 155 cm (range of 137 to 175 cm); and the mean weight was 37.9 kg (range of 30.0 to 47.7 kg). Only one of six patients was <5 percent predicted for height, while five of six patients were

Awake

The awake pulmonary function tests, oxygen saturation, and acid base status are shown in Table 1. The patients represent a heterogeneous group with respect to all the parameters. All patients demonstrated airways obstruction of a moderate to severe degree, with a mean FEV1/FVC = 0.52 ±.05 (range: 0.41 to 0.72), and a variable degree of air trapping (RV/TLC) with a reduced mean FVC of 61 percent predicted (range: 43 percent to 99 percent). All patients demonstrated oxygen desaturation at rest

DISCUSSION

This study examined the contributions of alveolar hypoventilation and ventilatory pattern to sleep-induced arterial hypoxemia in patients with CF. Although these patients varied substantially, the general trend during NREM and REM sleep showed a reduced minute ventilation and tidal volume along with a more variable breathing pattern during REM as compared to either NREM or wakefulness. The contribution of alveolar hypoventilation and CO2 retention to oxygen desaturation was most evident during

ACKNOWLEDGMENTS

The authors would like to acknowledge the support of the Medical Research Service of the Veterans Administration as well as the Graduate and Medical Schools of the University of Wisconsin. In addition, we would like to thank Drs. Phillip Farrell and Elaine Mischler for their cooperation in obtaining patients for this study, and also Gary Thomas and Elfie Garber for their technical assistance.

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    Manuscript received November 29; revision accepted February 22.

    From the Department of Pediatrics, University of Arizona, Arizona Health Sciences Center, Tucson; and the Department of Medicine, William Middleton Memorial VA Hospital, and Department of Preventive Medicine, University of Wisconsin, Madison.

    This investigation was supported in part by grants NHLI 15469 and NHLI Research Career Development Award IK04HL00149.

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