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Clinical Investigations: SLEEP AND BREATHING |

Predictability of Oxygen Desaturation During Sleep in Patients With Cystic Fibrosis*: Clinical, Spirometric, and Exercise Parameters

Despina D. Frangolias, MPE, MPG, MSc; Pearce G. Wilcox, MD
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*From the Pulmonary Research Laboratory, University of British Columbia, Vancouver, BC, Canada.

Correspondence to: Pearce G. Wilcox, MD, Department of Medicine, Pulmonary Research Laboratory, McDonald Research Wing, Room 292, 1081 Burrard St, St. Paul’s Hospital, Vancouver, British Columbia, V6Z 1Y6, Canada.



Chest. 2001;119(2):434-441. doi:10.1378/chest.119.2.434
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Background: The purpose of this study was to determine how common sleep-related desaturation with preserved awake resting pulse oximetric saturation (Spo2) was in a large cohort of adult cystic fibrosis (CF) patients with variable degrees of pulmonary disease. We then determined whether nocturnal desaturation could reliably be predicted from standard clinical and exercise parameters.

Methods: Seventy CF patients participated in the study (mean [SD] age, 27.3 [8.7] years; women, 54%; percent predicted FEV1 [%predFEV1], 55.7% [23.9%]). Nocturnal, resting, and exercise Spo2 were measured. Nocturnal oximetry was measured in the patient’s home. Maximal oxygen capacity (V̇o2max) was determined from a graded exercise test on a stationary bicycle ergometer. The Shwachman-Kulczycki (S-K) illness severity score was calculated incorporating categories of functional capacity, physical examination, nutrition, and chest radiograph.

Results: Multivariate analysis reported significant differences (p < 0.0001) between pulmonary disease severity and overall distribution of nocturnal Spo2, with the main difference being for patients with severe pulmonary disease (%predFEV1 of< 50%) compared to patients with mild or moderate disease in the Spo2 intervals of 100 to 96% (p < 0.0001) and 90 to 86% (p = 0.0001). Pulmonary function, S-K clinical scores, V̇o2max, and resting and maximal Spo2 correlated significantly (p < 0.05) with nocturnal Spo2 levels. Stepwise discriminant analysis identified %predFEV1 (or S-K scores) and resting Spo2 as the parameters that could best discriminate patients not likely to experience nocturnal desaturation. Specifically, our equation could predict 91% of cases less likely to nocturnally desaturate, but could only modestly predict those more likely to desaturate (ie, 26% of cases).

Conclusions: Spirometric parameters and measurements of awake resting oxygenation are of limited utility in predicting nocturnal desaturation. Nocturnal oximetry should be considered in patients with moderate to severe lung disease even with preserved awake resting Spo2.

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