Sleep-Disordered Breathing in Cystic Fibrosis in Low- and Middle-Income Countries

Sleep-disordered breathing (SDB) is an increasingly recognized yet underappreciated contributor to morbidity in people with cystic fibrosis (pwCF). While SDB, including nocturnal hypoxemia, hypoventilation, and obstructive sleep apnea (OSA), is well documented in high-income countries (HICs), evidence from low- and middle-income countries (LMICs) remains limited.

This narrative review synthesizes available evidence on the prevalence, clinical characteristics, diagnostic practices, and management approaches of SDB in pwCF living in LMICs, with a particular focus on studies using polysomnography (PSG) and overnight oximetry.

Findings from upper-middle-income countries such as Brazil and Turkey indicate substantial rates of OSA and nocturnal desaturation, even among clinically stable individuals. Studies using PSG or overnight oximetry have linked these disturbances to lower lung function, poor nutritional status, and increased healthcare utilization. Despite the clinical relevance of these findings, access to diagnostic tools such as PSG and treatment modalities such as non-invasive ventilation remain severely limited.

SDB represents a clinically relevant but underdiagnosed comorbidity in pwCF residing in LMICs. There is an urgent need for increased clinical awareness, implementation of low-cost screening tools, and development of resource-adapted diagnostic and management strategies to improve comprehensive CF care in underserved regions.