[The set-up of obstructive sleep apnea treatment]. / Mise en place du traitement du SAHOS.

The therapeutic strategy of obstructive sleep apnea syndrome (OSAS) is dependent on the illness severity, which is influenced by several factors as the presence of comorbidities (particularly cardiovascular comorbidities), the importance of diurnal drowsiness and the number of abnormal respiratory events. Whereas the treatment is most often palliative and uncomfortable, its success is closely dependent on its compliance. The way of starting the treatment of OSAS is therefore an essential topic, which will condition its long-term acceptance.

[Adolescent obstructive sleep apnoea syndrome: Characteristics and treatment]. / Syndrome d'apnées obstructives du sommeil de l'adolescent : particularités et prise en charge.

Although the prevalence of the obstructive sleep apnoea syndrome (OSAS) is high in adolescents, studies pertaining to adolescent OSAS are less numerous than childhood studies. Cases of adolescent OSAS may consist of residual OSAS after adenotonsillectomy, but most often are de novo cases. Major pathophysiological factors are weight excess or even high-grade obesity, and the association of upper airway narrowing and tonsillar hypertrophy (pharyngeal, palatal or even lingual). ENT and systematic orthodontic assessments are the main points. In case of predisposing factors such as dental, occlusal or dento-facial abnormalities, a specific orthodontic treatment can be discussed. First line treatment is surgical adenotonsillectomy; surgical reduction of the lingual tonsils is seldom required. CPAP treatment may be indicated in the case of severe comorbidities (craniofacial malformations, neuromuscular diseases…) or in obese adolescents with severe residual OSAS. Treatment of adolescent OSAS has to be comprehensive and multidisciplinary, taking into account the specific treatments of obesity and abnormal sleep/wake rhythms.

Wrist-actigraphic estimation of sleep time under nCPAP treatment in sleep apnoea patients.

The aim of this study was to correlate daily use of nasal continuous positive airway pressure (nCPAP) with total sleep time (TST) evaluated by home actigraphy. Actigraphy was validated by comparing TST determined by actigraphy (aTST) and polysomnography (pTST) in 24 untreated patients with suspected sleep apnoea. The % sleep time spent under nCPAP was estimated on 3 consecutive days in 28 patients receiving long-term nCPAP, by comparing machine-use periods with sleep periods identified by home actigraphy. The mean difference between pTST and aTST was 2.5 min. The correlation coefficient between aTST and pTST was 0.90. Daily use of nCPAP over the 3 study days was 388 +/- 114 min. nCPAP was used 41-100% (82 +/- 17% (mean +/- sD)) of sleep time detected by actigraphy. Some patients used nCPAP during nonsleep periods. In conclusion, comparison of nasal continuous positive airway pressure use with sleep time estimated by home actigraphy shows marked individual differences in the % sleep time under nasal continuous positive airway pressure. These results suggest that actigraphic estimation of sleep time under nasal continuous positive airway pressure could provide a better index than simple daily use of the device to evaluate the impact of treatment in sleep apnoea.