0925 SLEEP DISORDERS IN CHILDREN WITH CYSTIC FIBROSIS: A META-ANALYSIS AND SYSTEMATIC REVIEW

Abstract

Introduction: Cystic fibrosis (CF) is a disorder affecting mainly the respiratory and gastrointestinal systems. As such, CF is expected to have an impact on sleep, yet studies focusing on sleep in children with CF are scarce and conflicting. We performed a systematic review and meta-analysis of the literature to assess current knowledge on sleep disorders in children with CF, and their relationship with disease severity. Method(s): All publications on sleep and CF in children, appearing in Pubmed, CINAHL and Scopus, up to November 2016 were reviewed. Outcomes included sleep quality, nocturnal cough, oximetry, and polysomnographic (PSG) parameters. Fixed effects models were used to calculate weighted mean differences (WMD). Result(s): Ten PSG studies were found; four compared children with CF to healthy age-matched controls. Pooled analysis showed decreased REM percent (WMD -2.6% [95%CI -2.6 to 0.6%]), lower nighttime SaO2 nadir (3 trials, CF n=67, control n=54; WMD -4.1% [-5.6 to -2.6%]), and lower sleep efficiency (3 trials, CF n=88, control n=52; WMD -8.9%[-14.1 to -3.7%]). One study reported a higher AHI in children with CF, particularly in preschoolers. Six studies reported the relationship between disease severity and nocturnal oximetry: four reported a positive correlation (n=168) while two found no significant correlation (n=64). A single study (n=9) reported improvement in respiratory status with nighttime non-invasive ventilation. Six studies that included questionnaires found more behavioral sleep problems, lower sleep quality, sleep onset and sleep maintenance difficulties in children with CF. One cough recorder study showed higher nocturnal cough rates in children with CF, with high night-to-night variability. Conclusion(s): There is both objective and subjective evidence of frequent sleep disorders in children with CF, emphasizing the importance of addressing these concerns on routine patient visits. Additional research is needed, with larger sample sizes and standardized outcomes, in order to better define these sleep abnormalities and their relationship with disease severity.