Mortality of sleep apnoea patients treated by nasal continuous positive airway pressure registered in the ANTADIR observatory. Association Nationale pour le Traitement A Domicile de l'Insuffisance Respiratoire chronique.

The aim of this study was to examine risk factors for and causes of mortality in patients with obstructive sleep apnoea syndrome (OSAS) treated by nasal continuous positive airway pressure (CPAP). Univariate and multivariate analyses of the data on patients registered in the Association Nationale pour le Traitement A Domicile de l'Insuffisance Respiratoire chronique (ANTADIR) Observatory between January 1, 1985 and December 31, 1993 and followed to January 1, 1996. Survival ratios were compared to those of the French population. A case control study compared patients who died with patients of the same age and sex, in the same Regional Association, who were equipped with CPAP at the same time. Five-thousand-six-hundred-and-sixty-nine patients had CPAP treatment. Two-hundred-and-seventy-six had died. One-hundred-and-twenty-four deaths were examined and compared to 123 control subjects. Overall mortality was the same as the general French population. Independent risk factors for death were age, oxygen tension in arterial blood (Pa,O2) and forced expiratory volume in one second (FEV1) (per cent predicted). In the case-control study independent risk factors for death in the past history were cardiac arrhythmia with an odds ratio (OR) of 2.8 (95% confidence interval (CI) 1.1-7.2), respiratory disorders (OR 2.8; CI 1.6-4.9) ischaemic events (OR 2.2; CI 1.2-4.2), neurological and psychiatric disorders (OR 2.4; CI 1.1-5.4). A significant excess of cardiovascular deaths and an excess of deaths from accidents and poisonings was found. In conclusion, patients die on therapy predominantly from cardiovascular causes but many have a past history of cardiovascular conditions. Compliance with treatment may be important for survival. Continuous positive airway pressure is an effective therapy for obstructive sleep apnoea syndrome but older patients with reduced spirometry and hypoxaemia may need more attention paid to these aspects of their condition.

[Palliative treatment of patients in terminal phase. Experience at the Unité de Soins Palliatifs of the Hôpital International de l'Université de Paris]. / Soins palliatifs des malades en phase terminale. Expérience de l'Unité de Soins Palliatifs de l'Hôpital International de l'Université de Paris.

The development of palliative care is relatively new in France. This study analyzed our observations made in the Palliative Care unit of the Hopital International de l'Université de Paris. The most common complaints were: being bedridden (38%), pain (23%), dyspnea (10%), intestinal irregularities (10%). The importance of being bedridden and the complexity of its handling are emphasized. Dyspnea is common when sought (54%) and hard to alleviate due to a lack of appropriate symptomatic therapies. Reduced survival rates were found for patients with Karnovsky indexes below 30% and taking morphine. Length of survival varied as a function of awareness of the diagnosis and family support.

[Peritoneal sarcoidosis, a rare localization]. / La sarcoïdose péritonéale, une localisation rare.

A case of peritoneal involvement in the course of a mediastino-pulmonary and cutaneous sarcoidosis is reported. This form of the disease is rare (8 cases in the literature) and must be distinguished from peritoneal granulomatous reaction to surgical foreign bodies (e.g. talcum powder) or to particles of starch in food. In the case presented here, the patient's surgical history and the presence of birefringent bodies within peritoneal granulomas raise the problem of the link between local granuloma and sarcoidosis.