Neurocognitive and neurophysiological consequences of sleep-disordered breathing in bronchiectasis: the role of respiratory rehabilitation.
Elvia Giovanna Battaglia, Gloria Leonardi, Paolo Innocente Banfi and 1 others
About half of bronchiectasis patients have undiagnosed sleep apnea that may worsen thinking, mood, and daily function.
Treating it with a breathing mask shows some benefit, but the evidence is thin and mostly from cystic fibrosis patients.
Key findings
140%–60% of people with bronchiectasis have obstructive sleep apnea, with higher apnea–hypopnea index values in those colonized by Pseudomonas aeruginosa; older age, male sex, and increased neck circumference were additional risk factors, while body mass index and lung function were not significantly associated.
2Patients with bronchiectasis score lower on verbal and performance cognitive tests than healthy controls, and poorer cognitive performance is associated with lower oxygen saturation and greater depressive symptoms.
3A 6-week course of non-invasive ventilation improved nocturnal CO₂, quality of life, and exercise capacity in a randomized placebo-controlled trial, but the authors note that most supporting evidence comes from cystic fibrosis cohorts and cannot be directly applied to non-cystic fibrosis bronchiectasis.
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What it does not show
Narrative review without a predefined search protocol, quality-assessment framework, or systematic inclusion/exclusion criteria, so the evidence base may be incomplete or selectively represented. Underlying studies are small (cohorts of 43–49), mostly retrospective, and show substantial clinical heterogeneity. The treatment evidence (NIV, PAP) derives predominantly from cystic fibrosis populations; the authors explicitly state it cannot be directly extrapolated to non-cystic fibrosis bronchiectasis. Neurocognitive findings are largely extrapolated from OSA literature rather than bronchiectasis-specific studies; only limited direct cognitive testing data in BE are available. No prospective randomised trials specifically in bronchiectasis with SDB are cited; the strongest treatment evidence is a single RCT in CF. Subjective sleep questionnaires did not correlate with polysomnographic findings in the cited pediatric studies, raising questions about the reliability of self-report screening tools.
Declared interests
The authors declared that no financial support was received for the work or its publication. No conflicts of interest are listed.
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