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Apnées du sommeil et troubles coronariens: infarctus, angine de poitrine

Voici un  aperçu des publications relatives au sommeil, articles parus récemment ou en instance de parution, annoncés sur Pubmed.

·         La revue Sleep and Breathing publie un article issu d’une étude traitant de l’incidence des apnées obstructives du sommeil en tant que facteurs de risque dans les événements coronariens et le décès par déterminants cardiovasculaires.

 

·         L’étude de l’influence du sommeil sur le conditionnement et la réponse biologique à l’effet placébo-analgésique est l’objet d’un article dans la revue The Journal of Neuroscience.

 

·           La revue Thorax propose un article relatif à l’étude de la progression des apnées obstructives du sommeil de l’enfant. L’hypertrophie des amygdales apparaît notamment comme facteur aggravant tandis que le contrôle de la masse corporelle s’impose comme un réflexe de prévention important.

 

·         Si la mélatonine orale est utilisée en tant qu’elle permet le sommeil de jour, une étude parue dans la revue Clinical Pharmacology and Therapeutics a voulu démontrer que la mélatonine intradermique en ce qu’elle accroit la mélatonine plasmatique et réduit le risque d’éveil post-endormissement, présente une efficacité encore supérieure sur le maintien du sommeil durant les phases circadiennes défavorables.

 

“Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death” in Sleep and Breathing, Septembre 2009

Shah NA, Yaggi HK, Concato J, Mohsenin V.

Yale Center for Sleep Medicine, New Haven, CT, USA.

 

PURPOSE: This study aims to determine whether obstructive sleep apnea independently increases the risk of coronary events, including death from cardiovascular causes. METHODS: We conducted an observational cohort study among consecutive patients >/=50 years of age who were referred during 1997-2001 to the Yale Center for Sleep Medicine for suspected sleep-disordered breathing and were followed longitudinally for subsequent coronary events or cardiovascular death. Each study participant underwent an overnight polysomnography; obstructive sleep apnea was defined as an apnea-hypopnea index >/=5/h. The composite outcome during a mean duration of follow-up of 2.9 years was myocardial infarction, coronary artery revascularization procedures (angioplasty, stent placement, or coronary artery bypass graft surgery), or death from cardiovascular causes. RESULTS: Among 1,436 enrolled patients, 1,024 (71%) had an apnea-hypopnea index >/=5/h. In an unadjusted analysis, obstructive sleep apnea was associated with an increased risk of coronary events or cardiovascular death (hazard ration (HR) 2.57, 95% confidence interval (CI) 1.39-4.72, P = 0.003). After adjustment for traditional cardiovascular risk factors (including body mass index and hypertension), obstructive sleep apnea retained a statistically significant association with this composite outcome (HR 2.06, 95% CI 1.10-3.86, P = 0.024). CONCLUSION: Obstructive sleep apnea increases the risk of coronary events or death from cardiovascular causes.

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“Changes in rapid eye movement sleep associated with placebo-induced expectations and analgesia” in The Journal of Neuroscience, septembre 2009

Laverdure-Dupont D, Rainville P, Montplaisir J, Lavigne G.

Department of Physiology, University of Montréal, Québec, Canada. daniele.laverdure-dupont@umontreal.ca

 

The experience of a sensory event is extensively shaped by past experience and expectations. Placebo analgesia, one of the most studied models of expectation-mediated effects, can be induced by suggestion of analgesia and conditioning. The present study examined the possibility that sleep might contribute to the consolidation of new expectations and consequently influence the generation of expectation-mediated placebo effects. Strong expectations of analgesia were generated before sleep by conditioning manipulations wherein the intensity of thermal pain stimulation was surreptitiously reduced after the application of a topical placebo cream. Expectations and placebo analgesic effects were measured the following morning and compared with those of a control daytime group without sleep. Although placebo effects were observed in both groups, correlation analysis suggests that the mediating effect of expectations on placebo responses was strongest in the overnight group. Moreover, after exposure to a convincing analgesia experience, the relative duration of rapid eye movement (REM) sleep decreased in subjects showing higher analgesic expectations and placebo responses the next morning. In a third group exposed to less consistent analgesic experiences before sleep, expectations reported in the morning were comparable with other groups. However, expectations were positively correlated with REM sleep and did not emerge as a significant mediator of the analgesic effect. Together, these findings show that sleep-related processes may influence the association between expectations and placebo analgesia and that REM sleep can predict placebo-induced expectations of pain relief. However, equivocal previous experience with treatments may significantly alter the relationship between relief expectation, REM sleep, and placebo effects.

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“Natural history and predictors for progression of mild childhood obstructive sleep apnea” in Thorax, septembre 2009.

Li AM, Au CT, Ng SK, Abdullah VJ, Ho C, Fok TF, Ng PC, Wing YK.

The Chinese University of Hong Kong, Hong Kong.

 

AIMS: We examined the natural history of mild childhood obstructive sleep apnoea (OSA) and identified factors that were associated with disease progression. METHODS: Subjects were recruited from an epidemiological study which examined the prevalence of OSA in Chinese children aged 6 to 13-year-old. The first 56 consecutive children identified to have mild OSA (apnoea-hypopnoea index, OAHI, 1-5) were invited for repeat assessment 2 years after the diagnosis. RESULTS: Forty-five children participated in this follow-up study, of whom 13 subjects (29%) were identified to have worsened OSA. When compared to those without worsening of OSA, the worsened OSA group had a greater increase in waist circumference, a higher prevalence of large tonsils (occupied >/=50% of the airway) at both baseline and follow-up, and a higher prevalence of habitual snoring at both baseline and follow-up. The presence of large tonsils had a positive predictive value of 53% and a negative predictive value of 83% for worsening OSA over a 2-year period. Multivariate linear regression analysis showed that the change in OAHI was associated with age at baseline [beta(SE)=-0.92(0.34), p=0.009], gender (male=1; female=0) [beta(SE)=4.69(1.29), p<0.001], presence of large tonsils at baseline [beta(SE)=4.36(1.24), p=0.001], change in waist circumference [beta(SE)=0.30(0.09), p=0.002] and persistently large tonsils [beta(SE)=5.69(1.36), p<0.001] over the 2-year period. CONCLUSIONS: Mild OSA in majority of children did not resolve spontaneously. Cases with tonsillar hypertrophy, especially for boys, should be closely monitored to allow early detection of OSA worsening. Weight control should be stressed in the management of childhood OSA.

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“Use of transdermal melatonin delivery to improve sleep maintenance during daytime” in Clinical Pharmacology and Therapeutics, octobre 2009

Aeschbach D, Lockyer BJ, Dijk DJ, Lockley SW, Nuwayser ES, Nichols LD, Czeisler CA.

Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. daeschbach@hms.harvard.edu

Oral melatonin (MEL) can improve daytime sleep, but the hormone's short elimination half-life limits its use as a hypnotic in shift workers and individuals with jet lag or other sleep problems. Here we show, in healthy subjects, that transdermal delivery of MEL during the daytime can elevate plasma MEL and reduce waking after sleep onset, by promoting sleep in the latter part of an 8-h sleep opportunity. Transdermal MEL may have advantages over fast-release oral MEL in improving sleep maintenance during adverse circadian phases.

 

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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.