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Apnées du sommeil de l'enfant

Voici des publications scientifiques récentes liées au sommeil parues ou en instance de parution.

 -Le European Spine Journal publie une étude explorant l’hypothèse d’une corrélation entre l’apparition de douleurs musculo-squelettiques et un sommeil de moindre qualité, chez les adolescents.

-La revue Indian Journal of Pediatrics propose une revue de la littérature consacrée à l’apnée obstructive de l’enfant. Les articles les plus pertinents traitant de l’épidémiologie, de la pathogenèse, des facteurs de risque et nouveautés diagnostiques et de prise en charge de cette pathologie y sont convoqués.

-Une étude parue dans la revue Circulation. Heart failure tend à montrer que la ventilation servo-adaptée est plus efficace pour les patients porteurs d’une insuffisance cardiaque chronique et présentant un syndrome d’apnées obstructives du sommeil, des apnées centrales et une respiration de Cheyne-Stokes, que le traitement par pression positive continue.

-Sleep Medecine Reviews propose une revue de la littérature sur la corrélation entre durée de sommeil et mortalité et propose des pistes de recherche autour de cette thématique et des mécanismes impliqués.

Les résumés et références de ces publications extraits de la base pubmed.com sont restitués ci-dessous.

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European Spine Journal. 2009 Nov 20.

Is insufficient quantity and quality of sleep a risk factor for neck, shoulder and low back pain? A longitudinal study among adolescents.

Auvinen JP, Tammelin TH, Taimela SP, Zitting PJ, Järvelin MR, Taanila AM, Karppinen JI.

Finnish Institute of Occupational Health, Aapistie 1, 90220, Oulu, Finland, juhaauvi@mail.student.oulu.fi.

The quantity and quality of adolescents' sleep may have changed due to new technologies. At the same time, the prevalence of neck, shoulder and low back pain has increased. However, only a few studies have investigated insufficient quantity and quality of sleep as possible risk factors for musculoskeletal pain among adolescents. The aim of the study was to assess whether insufficient quantity and quality of sleep are risk factors for neck (NP), shoulder (SP) and low back pain (LBP). A 2-year follow-up survey among adolescents aged 15-19 years was (2001-2003) carried out in a subcohort of the Northern Finland Birth Cohort 1986 (n = 1,773). The outcome measures were 6-month period prevalences of NP, SP and LBP. The quantity and quality of sleep were categorized into sufficient, intermediate or insufficient, based on average hours spent sleeping, and whether or not the subject suffered from nightmares, tiredness and sleeping problems. The odds ratios (OR) and 95% confidence intervals (CI) for having musculoskeletal pain were obtained through logistic regression analysis, adjusted for previously suggested risk factors and finally adjusted for specific pain status at 16 years. The 6-month period prevalences of neck, shoulder and low back pain were higher at the age of 18 than at 16 years. Insufficient quantity or quality of sleep at 16 years predicted NP in both girls (OR 4.4; CI 2.2-9.0) and boys (2.2; 1.2-4.1). Similarly, insufficient sleep at 16 years predicted LBP in both girls (2.9; 1.7-5.2) and boys (2.4; 1.3-4.5), but SP only in girls (2.3; 1.2-4.4). After adjustment for pain status, insufficient sleep at 16 years predicted significantly only NP (3.2; 1.5-6.7) and LBP (2.4; 1.3-4.3) in girls. Insufficient sleep quantity or quality was an independent risk factor for NP and LBP among girls. Future studies should test whether interventions aimed at improving sleep characteristics are effective in the prevention and treatment of musculoskeletal pain.

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Indian Journal of Pediatrics 2009 Nov 20.

Pediatric obstructive sleep apnea.

Chhangani BS, Melgar T, Patel D.

 

For over 100 years obstructive sleep apnea has been recognized as a clinical entity in adults and more recently in children. A comprehensive review of the literature of pediatric obstructive sleep apnea was conducted using a PubMed search for original research articles. Bibliographies of these articles were reviewed for additional relevant articles not identified by the initial PubMed search. This article reviews the epidemiology, pathogenesis and risk factors, clinical features, diagnostic evaluation and treatment of obstructive sleep apnea in children. All physicians who provide care for children should be aware of the unique features of obstructive sleep apnea in children and the appropriate management.

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Circulation. Heart Failure 2009 Nov 20.

Effect of Flow-triggered Adaptive Servo-ventilation Compared with Continuous Positive Airway Pressure in Chronic Heart Failure Patients with Coexisting Obstructive Sleep Apnea and Cheyne-Stokes Respiration.

Kasai T, Usui Y, Yoshioka T, Yanagisawa N, Takata Y, Narui K, Yamaguchi T, Yamashina A, Momomura SI.

1 Toranomon Hospital, Tokyo, Japan;

 

BACKGROUND: -In patients with chronic heart failure (CHF), the presence of sleep-disordered breathing (SDB), including either obstructive sleep apnea (OSA) or Cheyne-Stokes respiration-central sleep apnea (CSR-CSA), is associated with a poor prognosis. A large-scale clinical trial showed that continuous positive airway pressure (CPAP) did not improve the prognosis of such CHF patients, probably due to insufficient SDB suppression. Recently, it was reported that adaptive servo-ventilation (ASV) can effectively treat SDB. However, there are no specific data about the efficacy of flow-triggered ASV for cardiac function in CHF patients with SDB. The aim of the present study was to compare the efficacy of flow-triggered ASV to CPAP in CHF patients with coexisting OSA and CSR-CSA. METHODS AND RESULTS: -Thirty-one patients with CHF, defined as left ventricular ejection fraction (LVEF) <50% and New York Heart Association (NYHA) class >/=II, with coexisting OSA and CSR-CSA, were randomly assigned to either CPAP or flow-triggered ASV. The suppression of respiratory events, changes in cardiac function, and compliance with the devices during the 3-month study period were compared. Although both devices decreased respiratory events, ASV more effectively suppressed respiratory events (DeltaAHI: -35.4+/-19.5 with ASV, -23.2+/-12.0 with CPAP, P<0.05). Compliance was significantly greater with ASV than with CPAP (5.2+/-0.9 versus 4.4+/-1.1 h/night, P<0.05). The improvements in quality of life and LVEF were greater in the ASV group (DeltaLVEF: +9.1%+/-4.7% versus +1.9%+/-10.9%). CONCLUSIONS: -These results suggest that patients with coexisting OSA and CSR-CSA may receive greater benefit from treatment with ASV than with CPAP.

 

Sleep Medecine Reviews. 2009 Nov 23.

 

Mortality associated with short sleep duration: The evidence, the possible mechanisms, and the future.

Grandner MA, Hale L, Moore M, Patel NP.

 

Center for Sleep and Respiratory Neurobiology, Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, 125 South 31st Street, Philadelphia, PA 19104, USA.

 

This review of the scientific literature examines the widely observed relationship between sleep duration and mortality. As early as 1964, data have shown that 7-h sleepers experience the lowest risks for all-cause mortality, whereas those at the shortest and longest sleep durations have significantly higher mortality risks. Numerous follow-up studies from around the world (e.g., Japan, Israel, Sweden, Finland, the United Kingdom) show similar relationships. We discuss possible mechanisms, including cardiovascular disease, obesity, physiologic stress, immunity, and socioeconomic status. We put forth a social-ecological framework to explore five possible pathways for the relationship between sleep duration and mortality, and we conclude with a four-point agenda for future research.

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Groupe Santé Sommeil

Le groupe médical Santé Sommeil a pour vocation de diagnostiquer et traiter les troubles du sommeil et de la veille chez l’adulte et l’enfant.