The effect of infective exacerbations on sleep and neurobehavioral function in cystic fibrosis
The effect of infective exacerbations on sleep and neurobehavioral function in cystic fibrosis
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DOI：
10.1164/rccm.200409-1244oc
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发表时间：
2005-07-01
影响因子：
24.7
通讯作者：
Bye, PTP
中科院分区：
文献类型：
--
作者：
Dobbin, CJ;Bartlett, D;Bye, PTP
原理：囊性纤维化（CF）成人患者易患低氧血症、高碳酸血症、睡眠觉醒和神经行为障碍。目的：我们假设肺部疾病加重会对睡眠和神经行为产生不良影响。方法：例急性发作患者在住院静脉治疗前后进行睡眠检查和神经行为测试。具有稳定CIF的成人经历相同的测试程序（对照受试者）。测量结果和主要结果：当临床稳定时，病例和对照受试者的肺功能、智力和体重指数相似。在这些病例中，急性发作的治疗改善了肺功能、生活质量、情绪、嗜睡和活动。与对照组相比，病例组在入睡后醒着的时间更多（p = 0.02），REM睡眠时间更短（p = 0.03），并且在不适时更容易出现低氧血症。低氧血症的严重程度与肺功能相关。入院时，病例组在串行加减任务中的吞吐量低于对照组（病例组16 4例，对照组17 3例; F[1，36] = 5.15，p = 0.03）和数字符号替换任务的反应时间较慢（F[1，36] = 11.91，p = 0.001），治疗后持续存在（F[1，36] = 8.48，p = 0.006）。治疗后，患者的睡眠效率、REM睡眠量和缺氧情况均有显著改善。他们在连续加减任务、精神警觉任务和模拟驾驶任务中的表现也随着治疗而改善。性别改变了急性发作对某些方面表现的影响。结论：成人CIF患者的肺部疾病加重会对睡眠和神经行为表现测试产生不利影响，无论基础疾病的严重程度如何。对日常生活表现的影响需要进一步评估，因为患者经常推迟入院以履行学习或工作承诺。
Rationale: Adults with cystic fibrosis (CF) are susceptible to hypoxemia, hypercapnia, arousal from sleep, and neurobehavioral impairment. Objectives: We hypothesized that pulmonary exacerbations would adversely affect sleep and neurobehavioral performance. Methods: Patients with exacerbations (cases) had sleep studies and neurobehavioral testing before and after inpatient intravenous therapy. Adults with stable CIF underwent the same testing procedures (control subjects). Measurements and Main Results: When clinically stable, cases and control subjects had similar lung function, intelligence, and body mass index. Among 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 control subjects when unwell. The severity of hypoxemia correlated with lung function. On admission, cases had slower throughput than control subjects in the serial addition and subtraction task (cases, 16 4, vs. control subjects, 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 serial addition and subtraction task, psychomotor vigilance task, and simulated driving task also improved with treatment. Sex modified the effect of an exacerbation on some aspects of performance. Conclusions: Exacerbations of lung disease in adults with CIF adversely affect sleep and tests of neurobehavioral performance regardless of underlying disease severity. The implications for performance in daily life need further evaluation because patients often delay admission to hospital to fulfill study or work commitments.