RESUMEN
Down syndrome (DS), or trisomy 21, is a genetic disorder caused by the presence of an extra copy of chromosome 21, leading to various characteristic physical features as well as developmental and cognitive delays. Obstructive sleep apnea syndrome (OSAS) is a common disorder in both adult and pediatric patients with DS. Several characteristics of DS may contribute to the development or worsening of OSAS. Numerous murine models of DS exist. A number of studies have explored apneas and the risk of upper airway obstruction in these models, but up until now, only in adulthood.
Asunto(s)
Síndrome de Down , Apnea Obstructiva del Sueño , Adulto , Humanos , Animales , Niño , Ratones , Síndrome de Down/complicaciones , Modelos Animales de Enfermedad , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/epidemiología , Presión de las Vías Aéreas Positiva ContínuaRESUMEN
OBJECTIVES: Despite international efforts to identify biomarkers of depression, none has been transferred to clinical practice, neither for diagnosis, evolution, nor therapeutic response. This led us to build a French national cohort (through the clinical and research network named SoPsy within the French biological psychiatry society (AFPBN) and sleep society (SFRMS)), to better identify markers of sleep and biological rhythms and validate more homogeneous subgroups of patients, but also to specify the manifestations and pathogeneses of depressive disorders. Before inclusions, we sought to provide a predefined, standardized, and robust set of data to be collected in all centers. METHODS: A Delphi process was performed to achieve consensus through the independent rating of invited experts, the SoPsy-depression co-investigators (n=34). The initial set open for vote included 94 questionnaires targeting adult and child psychiatry, sleep and addiction. RESULTS: Two questionnaire rounds were completed with 94% participation in the first round and 100% participation in the second round. The results of the Delphi survey incorporated the consensus opinion of the 32 members who completed both rounds. Nineteen of the 94 questionnaires achieved consensus at the first round and seventy of 75 at the second round. The five remaining questionnaires were submitted to three experts involved in the steering committee during a dedicated meeting. At the end, 24 questionnaires were retained in the mandatory and 26 in the optional questionnaire set. CONCLUSIONS: A validated data collection set of questionnaires is now available to assess psychiatry, addiction, sleep and chronobiology dimensions of depressive disorders.
Asunto(s)
Depresión , Sueño , Adulto , Niño , Humanos , Técnica Delphi , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Sleep health is a major public health concern because of its correlation with physical and mental health, and it may be particularly altered in medical students. This study aims: i) to examine the sleep characteristics of French medical students and their knowledge about basic sleep hygiene rules and; ii) to examine the correlations between sleep quality and academic performances, as well as between sleep quality and sleep knowledge. METHODS: Students from 4th, 5th and 6th years of medicine, of the Faculty of Paris Diderot, voluntarily responded to an online questionnaire including PSQI and multiple-choice quizzes (MCQ) about basic sleep hygiene rules. RESULTS: From the 177 participants, 49.7% had a poor sleep (PSQI>5). Regarding sleep latency, 44.6% needed>30min to fall asleep at least once a week, 26.5% slept 6 hours or less by night, 42.4% of them qualified their sleep quality as bad or very bad. A serious lack of knowledge about basic sleep hygiene rules was observed, with an average score at the MCQ of 6.61/10, and only 31% of medical students were aware of basic good sleep habits. Significant correlations were observed between sleep efficiency and all academic mean scores (both regarding the morning, afternoon, and pooled mean scores), and between sleep disturbances and the morning mean score. CONCLUSIONS: French medical students have a poor sleep quality, correlating with academic performances, and present a poor knowledge of basic sleep rules. These findings are a call to improve medical training schedules and to develop prevention and training programs.
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Rendimiento Académico , Trastornos del Sueño-Vigilia , Estudiantes de Medicina , Humanos , Calidad del Sueño , Sueño , Encuestas y CuestionariosRESUMEN
BACKGROUND: Fibrotic Interstitial lung diseases (ILD) are a heterogeneous group of chronic lung diseases characterized by diverse degrees of lung inflammation and remodeling. They include idiopathic ILD such as idiopathic pulmonary fibrosis (IPF), and ILD secondary to chronic inflammatory diseases such as connective tissue disease (CTD). Precise differential diagnosis of ILD is critical since anti-inflammatory and immunosuppressive drugs, which are beneficial in inflammatory ILD, are detrimental in IPF. However, differential diagnosis of ILD is still difficult and often requires an invasive lung biopsy. The primary aim of this study is to identify volatile organic compounds (VOCs) patterns in exhaled air to non-invasively discriminate IPF and CTD-ILD. As secondary aim, the association between the IPF and CTD-ILD discriminating VOC patterns and functional impairment is investigated. METHODS: Fifty-three IPF patients, 53 CTD-ILD patients and 51 controls donated exhaled air, which was analyzed for its VOC content using gas chromatograph- time of flight- mass spectrometry. RESULTS: By applying multivariate analysis, a discriminative profile of 34 VOCs was observed to discriminate between IPF patients and healthy controls whereas 11 VOCs were able to distinguish between CTD-ILD patients and healthy controls. The separation between IPF and CTD-ILD could be made using 16 discriminating VOCs, that also displayed a significant correlation with total lung capacity and the 6 min' walk distance. CONCLUSIONS: This study reports for the first time that specific VOC profiles can be found to differentiate IPF and CTD-ILD from both healthy controls and each other. Moreover, an ILD-specific VOC profile was strongly correlated with functional parameters. Future research applying larger cohorts of patients suffering from a larger variety of ILDs should confirm the potential use of breathomics to facilitate fast, non-invasive and proper differential diagnosis of specific ILDs in the future as first step towards personalized medicine for these complex diseases.
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Aire/análisis , Pruebas Respiratorias/métodos , Espiración , Enfermedades Pulmonares Intersticiales/metabolismo , Capacidad Vital/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades Pulmonares Intersticiales/diagnóstico , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Tomografía Computarizada por Rayos XRESUMEN
Restless legs syndrome, also called Willis-Ekbom disease, is a frequent sensorimotor disease, more often encountered in women than men. It is characterized by an urge to move legs, during the evening or the beginning of the night, increased by rest and relieved by movement. Two forms are classically distinguished: primary restless legs syndrome occurring in young adults with family history and secondary forms occurring in older adults with comorbidities such as iron deficiency, chronic renal failure or neurological diseases (affecting central or peripheral nervous system). The clinical impact of the urge to move the legs may be major, including in particular sleep disorders which can profoundly alter the quality of life. Pathophysiology of restless legs syndrome still remains partially understood and probably relies on dopamine metabolism abnormality secondary to cerebral iron deficiency in genetically susceptible patients. That's why, besides nutritional and sleep hygiene advices, treatment of restless legs syndrome includes iron supplementation if there is an iron deficiency. Pharmacological treatment, for severe to very severe forms, includes use of dopamine agonists, antiepileptic drugs or opioids. These medications have numerous side effects and each prescription has to be individually customized for each patient.
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Síndrome de las Piernas Inquietas , Adulto , Anciano , Anemia Ferropénica/complicaciones , Anemia Ferropénica/diagnóstico , Anemia Ferropénica/epidemiología , Comorbilidad , Predisposición Genética a la Enfermedad , Humanos , Deficiencias de Hierro , Enfermedades del Sistema Nervioso/complicaciones , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/epidemiología , Calidad de Vida , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/terapia , Síndrome de las Piernas Inquietas/diagnóstico , Síndrome de las Piernas Inquietas/epidemiología , Síndrome de las Piernas Inquietas/etiología , Síndrome de las Piernas Inquietas/terapia , Factores de Riesgo , Adulto JovenRESUMEN
The preliminary results of the SERVE-HF study have led to the release of safety information with subsequent contraindication to the use of adaptive servo-ventilation (ASV) for the treatment of central sleep apnoeas in patients with chronic symptomatic systolic heart failure with left ventricular ejection fraction (LVEF) ≤ 45%. The aim of this article is to review these results, and to provide more detailed arguments based on data from the literature advocating the continued use of ASV in different indications, including heart failure with preserved LVEF, complex sleep apnoea syndrome, opioid-induced central sleep apnea syndrome, idiopathic central SAS, and central SAS due to a stroke. Based on these findings, we propose to set up registers dedicated to patients in whom ASV has been stopped and in the context of the next setting up of ASV in these specific indications to ensure patient safety and allow reasoned decisions on the use of ASV.
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Respiración Artificial/métodos , Apnea Central del Sueño/terapia , Testimonio de Experto , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/prevención & control , Humanos , Apnea Central del Sueño/complicacionesRESUMEN
PURPOSE: Respiratory inflammation has been described in patients with obstructive sleep apnea syndrome, but it is unknown whether the increased neutrophil and interleukin (IL)-8 levels observed in induced sputum reflect systemic or local airway inflammation. We assessed the potential role of resident cells in intermittent hypoxia-induced airway inflammation. METHODS: Airway epithelial cells (AEC) and bronchial smooth muscle cells (BSMC) were exposed to intermittent hypoxia (IH) in vitro. Cell supernatants were assessed for matrix metalloproteinase, growth factor, and cytokine expression. The role of IH on neutrophil and BSMC migration capacities was evaluated, and the effect of supernatants from IH-exposed or control AEC was tested. RESULTS: Compared to normoxic conditions, 24 h of exposure to IH induced a significant increase of MMP-9 and MMP-2 expression and pro-MMP-9 activation (p < 0.05), and IL-8 (p < 0.05), platelet-derived growth factor (PDGF)-AA (p < 0.05), and vascular endothelial growth factor (VEGF) (p < 0.05) expression by AEC and VEGF expression (p = 0.04) by BSMC. Neutrophil chemotaxis and BSMC migration were enhanced by IH and supernatants of IH-exposed AEC (112.00 ± 4.80 versus 0.69 ± 0.43 %, p = 0.0053 and 247 ± 76 versus 21 ± 23, p = 0.009 respectively). This enhanced BSMC migration was totally abolished in the presence of an antibody blocking PDGF-AA. CONCLUSIONS: These data suggest a specific inflammatory response of airway cells to IH, independently of systemic events.
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Células Epiteliales/fisiología , Hipoxia/fisiopatología , Mediadores de Inflamación/metabolismo , Mucosa Respiratoria/fisiopatología , Apnea Obstructiva del Sueño/fisiopatología , Adulto , Humanos , Técnicas In Vitro , Miocitos del Músculo Liso/fisiologíaAsunto(s)
Presión de las Vías Aéreas Positiva Contínua/economía , Presión de las Vías Aéreas Positiva Contínua/estadística & datos numéricos , Costos de la Atención en Salud , Comunicación Interdisciplinaria , Telemedicina/estadística & datos numéricos , Presión de las Vías Aéreas Positiva Contínua/instrumentación , Presión de las Vías Aéreas Positiva Contínua/métodos , Costos de la Atención en Salud/tendencias , Humanos , Avance Mandibular/economía , Avance Mandibular/instrumentación , Avance Mandibular/métodos , Obesidad/complicaciones , Obesidad/terapia , Enfermedad Pulmonar Obstructiva Crónica/economía , Enfermedad Pulmonar Obstructiva Crónica/etiología , Enfermedad Pulmonar Obstructiva Crónica/terapia , Mecanismo de Reembolso , Telemedicina/economía , Telemedicina/instrumentación , Telemedicina/métodosAsunto(s)
Trastornos de Somnolencia Excesiva/líquido cefalorraquídeo , Trastornos de Somnolencia Excesiva/epidemiología , Péptidos y Proteínas de Señalización Intracelular/líquido cefalorraquídeo , Neuropéptidos/líquido cefalorraquídeo , Enfermedad de Parkinson/líquido cefalorraquídeo , Enfermedad de Parkinson/epidemiología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Orexinas , Factores de RiesgoAsunto(s)
Apnea Obstructiva del Sueño/diagnóstico , Accidentes , Obstrucción de las Vías Aéreas/diagnóstico , Arritmias Cardíacas/etiología , Aterosclerosis/etiología , Atención/fisiología , Biomarcadores/análisis , Cardiomegalia/etiología , Trastornos del Conocimiento/etiología , Endoscopía , Cardiopatías/etiología , Insuficiencia Cardíaca/etiología , Humanos , Hipertensión/etiología , Resistencia a la Insulina/fisiología , Síndrome de Hipoventilación por Obesidad/diagnóstico , Procedimientos Quirúrgicos Otorrinolaringológicos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Trastornos Respiratorios/diagnóstico , Factores de Riesgo , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/fisiopatología , Fases del Sueño/fisiología , Fumar/fisiopatología , Accidente Cerebrovascular/etiología , Enfermedades Vasculares/diagnóstico , Vigilia/fisiologíaRESUMEN
Obstructive sleep apnea syndrome (OSAS) is a recognized cardiovascular risk factor. Its treatment has been shown to prevent those complications, although in some cases, controversies still remain. However, links between OSAS and cardiovascular and metabolic issues lead to carefully evaluate cardiovascular system when an OSAS is newly diagnosed. Cardiovascular evaluation of a newly diagnosed OSAS will depend on its background. In the case of already known cardiovascular and metabolic mordibities, with a recent evaluation, no additional investigations are needed. By contrast, in the case of a severe OSAS with unknown cardiovascular and metabolic diseases, in addition of a thorough clinical examination, evaluation should include at least fasting glucose, cholesterolemia and triglyceridemia. Ambulatory blood pressure recording should be discussed, together with an EKG and supra aortic vessels echo-doppler.
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Enfermedades Cardiovasculares/etiología , Apnea Obstructiva del Sueño/complicaciones , Técnicas de Diagnóstico Cardiovascular , Humanos , Factores de RiesgoRESUMEN
The aim of the present study was to objectively measure the effect of sleeping alone for one night on sleep quality in female bed partners of male snorers. Females complaining of poor sleep due to snoring by their bed partner and having no known hearing loss or snoring were included in a prospective multicentre cross-sectional study. 23 females underwent one polysomnography recording while sleeping with their bed partner and another while sleeping alone. Their sleep parameters were compared between the two nights. We excluded seven couples because the female partner snored for >10% of the sleep time (n = 6) or had obstructive sleep apnoea syndrome (n = 1). In the remaining 16 females, sleep time, sleep efficiency, arousal index and percentages of deep sleep (stages 3-4) and rapid eye movement (REM) sleep were not significantly different between the two nights. Percentages of light sleep (non-REM stage 2) and awakening index were lower when sleeping alone (p = 0.023 and p = 0.046, respectively). Sleep quality was decreased and sleep fragmentation increased in females sleeping with male snorers. Some females had unrecognised snoring. However, our data do not suggest that objective sleep quality improves substantially in the female nonsnoring partner when she sleeps alone for one night.