Sleep in patients with large pleural effusion: impact of thoracentesis
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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 The improvement in sleep quality was not associated with the volume of pleural fluid withdrawn or changes in dyspnea.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.
KeywordsPleural effusion Thoracentesis Pittsburgh Sleep Quality Index questionnaire Full polysomnography
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
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.
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