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Pulmonary Dysfunction Is Associated With Sleep Study Abnormalities in Children With Sickle Cell Disease: A
Ammar Saadoon Alishlash1, Anis Rabbani Nourani1, A K M Fazlur Rahman2
1Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Insights
Pulmonary dysfunction in children with sickle cell disease (SCD) is linked to nocturnal hypoxemia. Abnormal spirometry may indicate sleep-related breathing issues, aiding early intervention for better outcomes.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Hematology
Background:
- Children with sickle cell disease (SCD) frequently experience pulmonary dysfunction and sleep abnormalities.
- These conditions are linked to poorer clinical outcomes in pediatric SCD patients.
- The relationship between spirometry findings and polysomnography (PSG) results in this population is not well understood.
Purpose of the Study:
- To investigate the association between spirometry abnormalities and polysomnography (PSG) findings, specifically markers of nocturnal hypoxemia, in children with SCD.
Main Methods:
- A multicenter, cross-sectional study involving 109 children with SCD.
- Participants underwent both spirometry and PSG at accredited pediatric pulmonary centers.
- Correlation and multivariable regression models were used to analyze associations between spirometry indices and PSG hypoxemia markers.
Main Results:
- Abnormal spirometry was common: 26% had reduced forced expiratory volume in 1 second (FEV1), and 21% had reduced forced vital capacity (FVC).
- Over 50% showed an elevated obstructive apnea-hypopnea index, and 31% experienced nocturnal hypoxemia.
- Lower FEV1 and FVC correlated with increased odds of nocturnal hypoxemia; FEV1% remained independently associated with mean oxygen saturation (SpO2).
Conclusions:
- Impaired lung function, indicated by abnormal spirometry, correlates with nocturnal hypoxemia in pediatric SCD.
- Spirometry results may serve as a potential marker for nocturnal hypoxemia, suggesting targeted interventions.
- Further research is needed to confirm these findings and explore if improving pulmonary function mitigates sleep complications in pediatric SCD.
Introduction:
Pulmonary dysfunction and sleep abnormalities are common in children with sickle cell disease (SCD) and are associated with worse clinical outcomes. Whether spirometry abnormalities are associated with polysomnography (PSG) findings remains unclear.
Methods:
We conducted a multicenter cross-sectional study of 109 children with SCD who underwent both spirometry and PSG at three accredited pediatric pulmonary centers. Associations between spirometry indices and PSG markers of hypoxemia were assessed using correlation and multivariable regression models.
Results:
Abnormal spirometry was frequent: 26% had reduced forced expiratory volume in 1 second (FEV1), and 21% had reduced forced vital capacity (FVC). PSG revealed an elevated obstructive apnea-hypopnea index in more than 50%, and nocturnal hypoxemia in 31% of the cohort. Univariate analysis showed that lower FEV1 and FVC were associated with increased odds of nocturnal hypoxemia. After adjustment for multiple confounders, FEV and FEV1% remained independently positively associated with the nocturnal hypoxemia marker, mean oxygen saturation (SpO2), but not with the percentage of total sleep time with oxygen saturation less than 90% (%TST90).
Discussion:
This is one of the first studies to demonstrate that impaired lung function correlates with nocturnal hypoxemia in pediatric SCD. Abnormal spirometry results may serve as a marker of nocturnal hypoxemia, and vice versa, enabling targeted interventions. Further prospective studies are needed to confirm these findings and to evaluate whether improving pulmonary function mitigates sleep-related complications in children with SCD.
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