[Sleep disorders in connection with somatic symptom disorders]. / Les troubles du sommeil en lien avec les troubles fonctionnels.

Somatic symptom disorders and sleep disorders are very prevalent in the general population. They both have a huge impact on quality of life. These disorders have influences on each other with potential bidirectional exacerbations. It is then very important to look for them and to treat them concomitantly. This article gives a short overview of main sleep disorders in connection with somatic symptom disorders, their respective influences and their treatment.

Les troubles fonctionnels, tout comme les troubles du sommeil, sont des pathologies extrêmement fréquentes dans la population générale avec un impact important sur la qualité de vie. Ces troubles présentent des interactions réciproques pouvant en accentuer les effets. Il est, dès lors, primordial de les rechercher et de les traiter concomitamment pour aider au mieux le patient. Cet article donne un aperçu des principaux troubles du sommeil retrouvés en lien avec des troubles fonctionnels, de leurs influences mutuelles et de leur prise en charge.

Sleep-related head jerks: toward a new movement disorder.

STUDY OBJECTIVES: Sleep-related head jerks (SRHJ) are often considered as a physiological motor phenomenon, occurring mainly during rapid eye movement (REM) sleep. Their clinical relevance and links with other sleep parameters are unclear. We characterized the clinical and polysomnographic features of patients with excessive SRHJ and compare them with healthy controls and patients with isolated REM sleep behavior disorder (iRBD). METHODS: A total of 30 patients (19 males, 27.5 y.o., 16.0-51.0) with a REM-HJ index >30/h were identified over a period of 5 years. All had a video-polysomnographic (PSG) recording to characterize the SRHJ, to assess associations with other sleep parameters and to quantify phasic and tonic electromyographic activity during REM sleep, compared with 30 healthy controls and 30 patients with iRBD. RESULTS: Five among the 30 patients had a primary complaint of involuntary nighttime head movements associated with sleepiness or non-restorative sleep. The mean REM-HJ index was 57.22/h ± 24.42, a nonperiodic pattern, stable across the sleep cycles, and with a low between-test variability (for the nine patients with two PSG assessments in untreated condition). REM-HJs were often associated with arousals (65.2%) and leg movements (38.1%) and less with respiratory events (9.6%), without association with increased phasic and tonic electromyographic activities. SRHJ were also found in 36.7% of controls and 56.7% of iRBD patients, but with a lower index in REM sleep (0.79/h ± 1.59 and 2.76/h ± 4.57). CONCLUSIONS: Although SRHJ are frequent in the general population and with uncertain clinical significance, rare severe symptomatic forms should be individualized and eventually be categorized as a new sleep-related movement disorder, distinct from RBD and periodic leg movements.

Impact of a shift in treatment funding on a multidisciplinary sleep clinic: a cohort study.

Multidisciplinary Sleep Clinics for sleep apnea have long existed, bringing together neurologists, sleep specialists, dentists, orthodontists and surgeons. In Belgium, a shift in funding for obstructive sleep apnea treatment was implemented from January 1st, 2017. Funding was allowed for moderate to severe obstructive sleep apnea and the rules shifted for treatments delivery and monitoring by authorised medical opinion. We aimed to assess whether a shift in treatment funding was associated with a change in the multidisciplinary sleep practice. Sample consisted of all patients discussed in the sleep multidisciplinary team meetings of the University Hospital of Liege from January 2016 to December 2018. Interrupted times series, Mann-Whitney U tests and descriptive statistics were produced. There were no differences in patients age, male sex preponderance, body mass index, clinical presentation and level of obstruction. Baseline obstructive sleep apnea severity was significantly lower (mean apnea-hypopnea index and mean oxygen desaturation index lowered with p = 0.0189 and p = 0.0466, respectively) after the funding rules changed. Oral appliance and ENT surgery were more often offered after the shift in funding. The key changes of the new funding rules for obstructive sleep apnea were reflected in the patient selection and management by sleep multidisciplinary team meeting. Funding terms could influence the care we give, not only in treatment options, but also in patients selection.

Validation of midsagittal jaw movements to measure sleep in healthy adults by comparison with actigraphy and polysomnography.

OBJECTIVE: In a device based on midsagittal jaw movements analysis, we assessed a sleep-wake automatic detector as an objective method to measure sleep in healthy adults by comparison with wrist actigraphy against polysomnography (PSG). METHODS: Simultaneous and synchronized in-lab PSG, wrist actigraphy and jaw movements were carried out in 38 healthy participants. Epoch by epoch analysis was realized to assess the ability to sleep-wake distinction. Sleep parameters as measured by the three devices were compared. This included three regularly reported parameters: total sleep time, sleep onset latency, and wake after sleep onset. Also, two supplementary parameters, wake during sleep period and latency time, were added to measure quiet wakefulness state. RESULTS: The jaw movements showed sensitivity level equal to actigraphy 96% and higher specificity level (64% and 48% respectively). The level of agreement between the two devices was high (87%). The analysis of their disagreement by discrepant resolution analysis used PSG as resolver revealed that jaw movements was right (58.9%) more often than actigraphy (41%). In sleep parameters comparison, the coefficient correlation of jaw movements was higher than actigraphy in all parameters. Moreover, its ability to distinct sleep-wake state allowed for a more effective estimation of the parameters that measured the quiet wakefulness state. CONCLUSIONS: Midsagittal jaw movements analysis is a reliable method to measure sleep. In healthy adults, this device proved to be superior to actigraphy in terms of estimation of all sleep parameters and distinction of sleep-wake status.

Upper airway imaging in sleep-disordered breathing.

Our understanding of sleep-disordered breathing has evolved considerably over the past three decades, and clinical techniques of evaluation have progressed tremendously. Myriad imaging techniques are now available for the physician to approach the dynamic features resulting in turbulent airflow, upper airway narrowing or collapse at different levels. Controversy exists in the choice of investigations, probably because the best evaluation should be a combination of different techniques. Physical, radiographic, endoscopic and acoustic evaluations could be integrated to understand the degree and the levels of airway reduction and/or obstruction in a given patient. This review focuses on cost-effective and easily implemented techniques in daily practice, allowing quality assessment of the dynamic anatomy of sleep-disordered breathing: cephalometry, (sleep-)endoscopy and acoustic reflectometry of the upper airway.

Involvement of placental growth factor in Wallerian degeneration.

Wallerian degeneration (WD) is an inflammatory process of nerve degeneration, which occurs more rapidly in the peripheral nervous system compared with the central nervous system, resulting, respectively in successful and aborted axon regeneration. In the peripheral nervous system, Schwann cells (SCs) and macrophages, under the control of a network of cytokines and chemokines, represent the main cell types involved in this process. Within this network, the role of placental growth factor (PlGF) remains totally unknown. However, properties like monocyte activation/attraction, ability to increase expression of pro-inflammatory molecules, as well as neuroprotective effects, make it a candidate likely implicated in this process. Also, nothing is described about the expression and localization of this molecule in the peripheral nervous system. To address these original questions, we decided to study PlGF expression under physiological and degenerative conditions and to explore its role in WD, using a model of sciatic nerve transection in wild-type and Pgf(-/-) mice. Our data show dynamic changes of PlGF expression, from periaxonal in normal nerve to SCs 24h postinjury, in parallel with a p65/NF-κB recruitment on Pgf promoter. After injury, SC proliferation is reduced by 30% in absence of PlGF. Macrophage invasion is significantly delayed in Pgf(-/-) mice compared with wild-type mice, which results in worse functional recovery. MCP-1 and proMMP-9 exhibit a 3-fold reduction of their relative expressions in Pgf(-/-) injured nerves, as demonstrated by cytokine array. In conclusion, this work originally describes PlGF as a novel member of the cytokine network of WD.