Sleep and Breathing

, Volume 16, Issue 2, pp 483–489 | Cite as

Sleep in patients with large pleural effusion: impact of thoracentesis

  • Bianca Fernandes MarcondesEmail author
  • Francisco Vargas
  • Fabio Henrique Paschoal
  • Ana Maria Cartaxo
  • Lisete R. Teixeira
  • Eduardo Henrique Genofre
  • Roberto Onishi
  • Robert Skomro
  • Geraldo Lorenzi-Filho
Original Article



This study aimed to evaluate the sleep quality and impact of thoracentesis on sleep in patients with a large pleural effusion.


Patients with large unilateral pleural effusion were evaluated by the Pittsburgh Sleep Quality Index (PSQI) questionnaire and dyspnea Borg scale. Full polysomnography (PSG) was performed on the night before and 36 h after thoracentesis.


We studied 19 patients, 11 males and 8 females, age 55 ± 18 years and body mass index of 26 ± 5 kg/m2. The baseline sleep quality was poor (PSQI = 9.1 ± 3.5). Thoracentesis removed 1.624 ± 796 mL of pleural fluid and resulted in a significant decrease in dyspnea Borg scale (2.3 ± 2.1 vs. 0.8 ± 0.9, p < 0.001). The PSG before and after thoracentesis showed no significant change in apnea–hypopnea index and sleep time with oxygen saturation <90%. There was a significant improvement in sleep efficiency (76% vs. 81%, p = 0.006), decrease percent sleep stage 1 (16% vs. 14%, p = 0.002), and a trend improvement in total sleep time (344 ± 92 vs. 380 ± 69 min, p = 0.056) and percentage of rapid eye movement sleep (15% vs. 20%, p = 0.053). No significant changes occurred in six patients that performed two consecutive PSG before thoracentesis. The improvement in sleep quality was not associated with the volume of pleural fluid withdrawn or changes in dyspnea.


Patients with large pleural effusion have poor subjective and objective sleep quality that improves after thoracentesis.


Pleural effusion Thoracentesis Pittsburgh Sleep Quality Index questionnaire Full polysomnography 



Apnea–hypopnea index


Body mass index






Epworth Sleepiness Scale


Non-rapid eye movement sleep


Obstructive sleep apnea




Pittsburgh Sleep Quality Index


Rapid eye movement sleep


Sleep stage 1


Sleep stage 2

S 3+4

Sleep stages 3 and 4


Oxygen saturation


Total sleep time


Wake after sleep onset



This work was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

Conflicts of interest

Ms. Marcondes, Dr. Vargas, Dr. Paschoal, Ms. Cartaxo, Dr. Teixeira, Dr. Onishi, and Dr. Lorenzi-Filho have no conflicts of interest to disclose. Dr. Genofre is working as a manager in Nycomed Company since April 2010; however, his participation in this study is prior to this recent job. So, he reported no potential conflict.


  1. 1.
    Light RW (1995) Pleural diseases, 3rd edn. Williams & Wilkins, Baltimore, pp 36–74Google Scholar
  2. 2.
    Brown NE, Zamel N, Aberman A (1978) Changes in pulmonary mechanics and gas exchange following thoracocentesis. Chest 74:540–542PubMedCrossRefGoogle Scholar
  3. 3.
    Karetzky MS, Kothari GA, Fourre JA, Khan AU (1978) Effects of thoracocentesis on arterial oxygen tension. Respiration 36:96–103PubMedCrossRefGoogle Scholar
  4. 4.
    Estenne M, Yernault JC, Troyer A (1983) Mechanism of relief of dyspnea after thoracocentesis in patients with large pleural effusions. Am J Med 74:813–819PubMedCrossRefGoogle Scholar
  5. 5.
    Perpina M, Benlloch E, Marco V, Abad F, Nauffal D (1983) Effect of thoracocentesis on pulmonary gas exchange. Thorax 38:747–750PubMedCrossRefGoogle Scholar
  6. 6.
    Perez-Padilla R, West P, Lertzman M, Kryger MH (1985) Breathing during sleep in patients with interstitial lung disease. Am Rev Respir Dis 132:224–229PubMedGoogle Scholar
  7. 7.
    Bye PT, Issa F, Berthon-Jones M, Sullivan CE (1984) Studies of oxygenation during sleep in patients with interstitial lung disease. Am Rev Respir Dis 129:27–32PubMedGoogle Scholar
  8. 8.
    Wang JS, Tseng CH (1995) Changes in pulmonary mechanics and gas exchange after thoracentesis on patients with inversion of a hemidiaphragm secondary to large pleural effusion. Chest 107:1610–1614PubMedCrossRefGoogle Scholar
  9. 9.
    Rechtschaffen A, Verdone P (1964) Amount of dreaming: effect of incentive, adaptation to laboratory, and individual differences. Percept Mot Skills 19:947–958PubMedCrossRefGoogle Scholar
  10. 10.
    Agnew HW Jr, Webb WB, Williams RL (1966) The first night effect: an EEG study of sleep. Psychophysiology 2:263–266PubMedCrossRefGoogle Scholar
  11. 11.
    Mendels J, Hawkins DR (1967) Sleep laboratory adaptation in normal subjects and depressed patients (“first night effect”). Electroencephalogr Clin Neurophysiol 22:556–558PubMedCrossRefGoogle Scholar
  12. 12.
    Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213PubMedCrossRefGoogle Scholar
  13. 13.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545PubMedGoogle Scholar
  14. 14.
    Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14:377–381PubMedGoogle Scholar
  15. 15.
    Mador MJ, Rodis A, Magalang UJ (1995) Reproducibility of Borg scale measurements of dyspnea during exercise in patients with COPD. Chest 107:1590–1597PubMedCrossRefGoogle Scholar
  16. 16.
    Rechstschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. UCLA Brain Information Service/Brain Research Institute, Los AngelesGoogle Scholar
  17. 17.
    American Sleep Disorders Association (1992) EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 15:174–184Google Scholar
  18. 18.
    American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine Task Force. Sleep 22:667–689Google Scholar
  19. 19.
    Light RW, Jenkinson SG, Minh VD, George RB (1980) Observations on pleural fluid pressures as fluid is withdrawn during thoracentesis. Am Rev Respir Dis 121:799–804PubMedGoogle Scholar
  20. 20.
    Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr (1972) Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 77:507–513PubMedGoogle Scholar
  21. 21.
    Light RW (2001) Pleural effusions following cardiac injury and coronary artery bypass graft surgery. Semin Respir Crit Care Med 22:657–664PubMedCrossRefGoogle Scholar
  22. 22.
    Osorio CD, Gallinaro AL, Lorenzi-Filho G, Lage LV (2006) Sleep quality in patients with fibromyalgia using the Pittsburgh Sleep Quality Index. J Rheumatol 33:1863–1865PubMedGoogle Scholar
  23. 23.
    Le Guen Y, Gagnadoux F, Hureaux J, Jeanfaivre T, Meslier N, Racineux JL et al (2007) Sleep disturbances and impaired daytime functioning in outpatients with newly diagnosed lung cancer. Lung Cancer 58:139–143PubMedCrossRefGoogle Scholar
  24. 24.
    Gooneratne NS, Dean GE, Rogers AE, Nkwuo JE, Coyne JC, Kaiser LR (2007) Sleep and quality of life in long-term lung cancer survivors. Lung Cancer 58:403–410PubMedCrossRefGoogle Scholar
  25. 25.
    Montagnese S, Middleton B, Skene DJ, Morgan MY (2009) Sleep–wake patterns in patients with cirrhosis: all you need to know on a single sheet. A simple sleep questionnaire for clinical use. J Hepatol 51:690–695PubMedCrossRefGoogle Scholar
  26. 26.
    Sawicka EH, Branthwaite MA (1987) Respiration during sleep in kyphoscoliosis. Thorax 42:801–808PubMedCrossRefGoogle Scholar
  27. 27.
    Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP (2010) Pathophysiology of sleep apnea. Physiol Rev 90:47–112PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Bianca Fernandes Marcondes
    • 1
    Email author
  • Francisco Vargas
    • 2
  • Fabio Henrique Paschoal
    • 3
  • Ana Maria Cartaxo
    • 2
  • Lisete R. Teixeira
    • 2
  • Eduardo Henrique Genofre
    • 2
  • Roberto Onishi
    • 2
  • Robert Skomro
    • 4
  • Geraldo Lorenzi-Filho
    • 3
  1. 1.Sleep Laboratory, Pulmonary Division—Heart Institute (InCor)University of São PauloSão PauloBrazil
  2. 2.Pleura Laboratory, Pulmonary Division—Heart Institute (InCor)University of São PauloSão PauloBrazil
  3. 3.Sleep Laboratory, Pulmonary Division—Heart Institute (InCor)University of São PauloSão PauloBrazil
  4. 4.University of SaskatoonSaskatoonCanada

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