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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

Abstract

Purpose

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

Methods

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.

Results

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 The improvement in sleep quality was not associated with the volume of pleural fluid withdrawn or changes in dyspnea.

Conclusions

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

Keywords

Pleural effusion Thoracentesis Pittsburgh Sleep Quality Index questionnaire Full polysomnography 

Abbreviation

AHI

Apnea–hypopnea index

BMI

Body mass index

EEG

Electroencephalogram

EMG

Electromyogram

ESS

Epworth Sleepiness Scale

NREM

Non-rapid eye movement sleep

OSA

Obstructive sleep apnea

PSG

Polysomnography

PSQI

Pittsburgh Sleep Quality Index

REM

Rapid eye movement sleep

S1

Sleep stage 1

S2

Sleep stage 2

S 3+4

Sleep stages 3 and 4

SpO2

Oxygen saturation

TST

Total sleep time

WASO

Wake after sleep onset

Notes

Acknowledgments

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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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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