Neurocognitive and neurophysiological consequences of sleep-disordered breathing in bronchiectasis: the role of respiratory rehabilitation.

Bronchiectasis (BE) is a chronic respiratory disease characterized by a vicious cycle of irreversible bronchial dilatation and persistent respiratory infections which results in progressive functional impairment and reduced quality of life. Increasing attention has been directed toward comorbidities that may aggravate disease burden, including sleep-disordered breathing (SDB), which remains underrecognized in this population. Emerging evidence suggests that SDB, particularly obstructive sleep apnea (OSA), is highly prevalent in BE and may contribute to adverse outcomes through mechanisms such as intermittent hypoxia, systemic inflammation, microbiome alterations, and ventilatory instability. This narrative review synthesizes current evidence on the relationship between BE and SDB, with a focus on the underlying pathophysiological mechanisms, the neurophysiological and cognitive consequences and the implications for rehabilitation. A comprehensive literature search was conducted using PubMed, Embase, and the Cochrane Library, supplemented by evidence from related chronic respiratory diseases. Available data indicate that sleep disturbances are common in BE and are associated with impaired daytime functioning, reduced quality of life as well as increased symptom burden, independent of disease severity. Rehabilitation interventions, in particular pulmonary rehabilitation, positive airway pressure (PAP), and non-invasive ventilation (NIV), may offer clinically meaningful benefits by enhancing gas exchange, improving sleep quality and patient-reported outcomes. However, high-quality evidence specific to BE populations remains limited. In conclusion, we consider that recognizing SDB as a potentially modifiable trait in bronchiectasis highlights the need for integrated, multidisciplinary management strategies. Future research should prioritize prospective studies to clarify the role of targeted rehabilitation interventions and to support evidence-based clinical practice.