Poor sleep quality tied to higher malnutrition risk in teens with CF
55 adolescents recruited from CF Patient and Family Association of Turkey
Poor sleep quality is linked to a higher risk of malnutrition in adolescents with cystic fibrosis (CF), suggesting that sleep disturbances may contribute to added nutritional challenges in these patients, a study in Turkey shows.
The effects weren’t influenced by patients’ body mass index (BMI) percentile, a measure of body fat based on weight and height that’s used to assess if adolescents are at a healthy weight for their age and gender, or by the energy derived from their diet.
“Sleep quality should be considered a key factor in assessing malnutrition risk among adolescents with CF and integrated into clinical practice to develop comprehensive management strategies addressing sleep disturbances and nutritional challenges,” the researchers wrote. The study, “The overlooked factor: Sleep quality in assessing malnutrition risk and nutritional status in adolescents with cystic fibrosis,” was published in Sleep Medicine.
CF is caused by mutations in the CFTR gene that result in thick, sticky mucus accumulating in several organs, particularly the lungs, liver, and the organs of the digestive system. Pancreatic exocrine insufficiency, when the pancreas doesn’t release enough enzymes that help break down food, together with the high energy demand associated with respiratory issues, may contribute to poor nutritional status.
CF patients also have a high prevalence of sleep disorders, which may disrupt appetite regulation and contribute to poor nutritional status. On the other hand, malnutrition can intensify fatigue and contribute to disrupted sleep patterns.
“Malnutrition increases the severity of respiratory issues, compromises immune function, and lowers quality of life, highlighting the need for comprehensive nutritional strategies,” wrote the researchers, adding “while the nutritional challenges associated with CF have been extensively studied, the impact of sleep quality on these challenges remains insufficiently explored.”
Sleep and nutrition
To know more about the relationship between sleep quality and nutritional status in adolescents with CF, researchers in Turkey studied 55 adolescents, ages 10-18, recruited through the Cystic Fibrosis Patient and Family Association of Turkey.
Almost all the adolescents (94.5%) were using dietary supplements, primarily fat-soluble vitamins. Additionally, 87.2% were receiving pancreatic enzyme therapy to compensate for missing digestive enzymes. Most (94.5%) were also taking dornase alfa (sold as Pulmozyme, among others), a mucus-thinning medication that improves lung function. About a third were on CFTR modulators, while 23.6% took inhaled antibiotics.
Participants had an average physical activity level of 1.68, indicating a mostly sedentary lifestyle with some standing and walking activities. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), with half the patients having good sleep quality (score below 5), while the other half had poor sleep quality (score of 5 or higher).
Regarding malnutrition risk factors, 27.3% had a body mass index (BMI) below the 10th percentile compared with healthy peers of the same age, gender, and height. This suggests a need for closer monitoring and possible nutritional intervention. Additionally, 23.6% exhibited severe pancreatic insufficiency.
Most adolescents (72.7%) had dietary intakes below the recommended average daily intakes, while 14.5% struggled to gain weight and 27.3% had insufficient height gain. The majority (65.5%) required enteral feeding, a method of delivering nutrients directly to the stomach or intestines. Also, 10.9% had CF-related diabetes, a condition characterized by high blood sugar.
Reduced lung function, defined as a forced expiratory volume in one second (FEV₁) below 80%, was observed in 38.2%. Based on malnutrition risk classification, 47.3% were categorized as medium risk, while 29.1% were at high risk and 23.6% at low risk.
Poor sleep quality was a predictor of a higher risk for malnutrition, independent of BMI and dietary energy intake, analyses showed. Lower BMI percentiles were tied to a higher malnutrition risk, but not dietary energy intake.
“These results suggest that, in addition to nutritional interventions, addressing sleep disturbances should be an additional component of CF management to improve both nutritional status and overall health outcomes,” the researchers wrote.
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