title: Sleep-disordered breathing and nocturnal hypoxemia in young adults with sickle cell disease.
abstract: Sleep-disordered breathing (SDB) is reported in up to 69% of adolescents and children with sickle cell disease (SCD) [1], but data regarding the prevalence of SDB in adults with SCD are limited. In order to obtain a preliminary assessment of the frequency and degree of sleep-related hypoxemia and potential associations with cardiovascular function in adults with SCD, we conducted overnight sleep studies, 6-min walk tests, echocardiograms, and hematologic and chemistry panels, calculated the Pittsburgh sleep quality index (PSQI), and conducted fatigue- and health-related quality-of-life measurement in 20 young adults with SCD visiting a sickle cell clinic for routine care. Sleep apnea, defined as an apnea-hypopnea index (AHI) > 5 events/h, was found in 50% of patients. Traditional clinical indicators, such as obesity, the presence of snoring, and reported sleep complaints, did not reliably differentiate them. The patients with AHI > 5 had higher mean systolic blood pressure (p = 0.03), evidence of impaired left ventricular diastolic function (i.e., increased mitral valve E/A ratio, p = 0.05), a trend toward higher reduction in 6-min walk distances (p = 0.06), and lower health-related quality-of-life scores (p ≤ 0.01). Three of nine patients with more severe anemia (total Hb < 9.0) showed nocturnal hypoxemia in the absence of sleep apnea. As prolonged and frequent hypoxemic episodes likely increase risks for vaso-occlusive, cardiovascular, and neurologic complications of SCD, these results suggest that the prevalence and severity of SDB should be investigated further in studies of larger patient populations. If confirmed, these findings could identify opportunities to prevent or reduce nocturnal hypoxia and improve outcomes.
authors.affiliation: Department of Medicine, Howard University College of Medicine, Washington D.C., USA. Electronic address: peter.whitesell@howard.edu.
authors.forename: P L
authors.initials: PL
authors.lastname: Whitesell
authors.affiliation: Center for Hemoglobin Research in Minorities, Howard University College of Medicine, Washington D.C., USA.
authors.forename: O
authors.initials: O
authors.lastname: Owoyemi
authors.affiliation: Center for Hemoglobin Research in Minorities, Howard University College of Medicine, Washington D.C., USA.
authors.forename: P
authors.initials: P
authors.lastname: Oneal
authors.affiliation: Department of Medicine, Howard University College of Medicine, Washington D.C., USA; Center for Hemoglobin Research in Minorities, Howard University College of Medicine, Washington D.C., USA.
authors.forename: M
authors.initials: M
authors.lastname: Nouraie
authors.affiliation: Hemoglobinopathy Thalassemia Research Unit, The Pulmonary Center, Center of Excellence in Sickle Cell Disease, Boston University School of Medicine, Boston, MA, USA.
authors.forename: E S
authors.initials: ES
authors.lastname: Klings
authors.affiliation: Center for Hemoglobin Research in Minorities, Howard University College of Medicine, Washington D.C., USA.
authors.forename: A
authors.initials: A
authors.lastname: Rock
authors.affiliation: Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA; Department of Psychiatry and Behavioral Sciences, Howard University College of Medicine, Washington D.C., USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Mellman
authors.affiliation: Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA.
authors.forename: T
authors.initials: T
authors.lastname: Berihun
authors.affiliation: Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lavella
authors.affiliation: Department of Medicine, Howard University College of Medicine, Washington D.C., USA; Center for Hemoglobin Research in Minorities, Howard University College of Medicine, Washington D.C., USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Taylor
authors.affiliation: Center for Hemoglobin Research in Minorities, Howard University College of Medicine, Washington D.C., USA; Hemoglobinopathy Thalassemia Research Unit, The Pulmonary Center, Center of Excellence in Sickle Cell Disease, Boston University School of Medicine, Boston, MA, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Perrine
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications*; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension; D000860:Hypoxia; D008297:Male; D017286:Polysomnography; D015995:Prevalence; D012891:Sleep Apnea Syndromes / Q000150:complications*
keywords: Hypertension; Hypoxia; Sickle cell disease; Sleep apnea