Association between habitual physical activity (HPA) and sleep quality in patients with cystic fibrosis

Association between habitual physical activity (HPA) and sleep quality in patients with cystic fibrosis

Sarah Dietz-Terjung1, Wolfgang Gruber2, Sivagurunathan Sutharsan1, Christoph Schöbel1, Christian Taube1, Margarete Olivier2, Uwe Mellies2, Cordula Koerner-Rettberg3, Stefanie Dillenhöfer3, Florian Stehling2, Matthias Welsner1

1Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Essen, Germany;2Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children´s Hospital, University of Duisburg-Essen, Essen, Germany;3Department of Pediatric Pneumology, University Children’s Hospital, Ruhr University Bochum, Bochum, Germany

Correspondence to: Sarah Dietz-Terjung, MSc. University Medicine Essen, Ruhrlandklinik – West German Lung Center, Tüschener Weg 40, D-45239 Essen, Germany. Email:

Background: Sleep disturbances and poor sleep quality are a known phenomenon in patients with Cystic Fibrosis (CF). Habitual physical activity (HPA) plays an important role in the treatment of CF patients due to its positive influence on progression of disease and quality of life. The aim of this work is to create a home-based sleep and activity profile and to investigate the influence of habitual physical activity (HPA) on sleep quality of children, adolescents and adults with CF.

Methods: One hundred and nine CF patients (64 male, mean age 22.7±12.0 years; mean ppFEV1 63.0±26.7) were equipped with an actigraph (Actigraph Corp., Pensacola, FL, United States) for home-based collection of activity and sleep data for a total of 4 weeks. Evaluation of recorded raw data was performed by ActiLife software, Version 6.11.9 (Actigraph Corp., Pensacola, FL, United States).

Results: CF patients under the age of 18 show the best sleep efficiency (92%±3%), the longest time in bed (TIB) (545±71 min) and Total Sleep Time (504±72 min) and the lowest Wake after sleep Onset (WASO) (39±15 min). With increasing age there is a decrease in Sleep efficiency (SE) (P<0.01), TST (P<0.01) and TIB (P<0.01) and an increase in WASO (P>0.05). In terms of lung function, CF patients with FEV1 values > 70%pred. have the best SE (92%±3%), the highest TST (490±72 min) and TIB (531±71 min) and the lowest WASO (39±13 min). As FEV1 deteriorates, a change in sleeping behavior can be detected. SE (P<0.05), TST (P<0.05) and TIB (P>0.05) decrease, whereas WASO (P>0.05) increases. Interestingly, there is no difference in the number of awakenings between the different age and FEV1 groups (all P>0.05). Statistical analysis was performed using version 25 of the SPSS statistics package (SPSS Inc., Chicago, USA).

Conclusions: Besides younger age and higher FEV1, daily activity in higher intensities influences sleep of CF patients in a positive way. Patients with poor quality and disturbances of sleep possibly benefit from an intensification of physical activity in the home environment.

Keywords: Rehabilitation; quality of life; actigraphy; pulmonary function test


Funding: None.


Provenance and Peer Review: This letter was commissioned by the Guest Editor (Joerg Steier) for the series “5th Clinical Update Sleep” published in Journal of Thoracic Disease. The article was sent for external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at The series “5th Clinical Update Sleep” was commissioned by the editorial office without any funding or sponsorship. CS reports grants and other from Novartis, grants and other from ResMed, other from Löwenstein Medical, grants from novamed, grants from JAZZ, other from Berlin Chemie, other from Bristol-Myers Squibb, grants and other from Astra Zeneca, outside the submitted work. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See:

doi: 10.21037/jtd-cus-2020-010-ab

Cite this abstract as: Dietz-Terjung S, Gruber W, Sutharsan S, Schöbel C, Taube C, Olivier M, Mellies U, Koerner-Rettberg C, Dillenhöfer S, Stehling F, Welsner M. Association between habitual physical activity (HPA) and sleep quality in patients with cystic fibrosis. J Thorac Dis 2020;12(Suppl 2):AB001. doi: 10.21037/jtd-cus-2020-010-ab

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