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Geriatrie et sommeil

Gériatrie
Une étude parue dans le Journal of American Geriatrics Society (2010 Sep 14. doi: 10.1111/j.1532-5415.2010.03071.x.) révèle un certain nombre de données probantes sur les rapports entre durée de sommeil et mortalité. L’étude menée sur 7 ans a porté sur une cohorte de 3820 personnes âgées de plus de 60 ans, en Espagne.

Oncologie et sommeil
Les malades du cancer ayant survécu, et réintégrés dans leur environnement professionnel souffrent le plus souvent de fatigue. Une étude parue dans la revue Psychooncology(2010 Sep 5) vise à déterminer les caractéristiques de cette fatigue en croisant les effets relatifs aux troubles résiduels induits par la maladie (troubles du sommeil, la douleur, le symptôme dépressif,…)et la violence symbolique propre à l’environnement professionnel (pression, deadlines, coexistence) ou contraintes physiques (confort, commodités du lieu de travail).

Chronobiologie
L’International Journal of Alzheimer Disease (2010 Sep 2;2010. pii: 716453) envisage dans le cadre d’une revue de la littérature la pertinence d’un examen spécifique des troubles du rythme circadien dans la démence, décrit leur spécificité et évoque les effets bénéfiques de certaines thérapeutiques non invasives susceptibles de réduire ses troubles.

Respiration
La servo-ventilation adaptée peut constituer une alternative intéressante au traitement par pression positive continue en cas de somnolence résiduelle des patients porteurs d’un syndrome d’apnées obstructives du sommeil. C’est ce que soutient une équipe de chercheurs chinois. La réduction de l’index d’apnées centrales et d’apnées/hypopnées est principalement invoquée en faveur de l’efficacité de ce dispositif. L’étude est parue dans Sleep and Breathing (2010 Sep 23.)

Neurosciences
Des chercheurs américains en créant un jet lag artificiel modifiant le cycle lumière-obscurité ont pu observer ses effets sur des souris soumises à un protocole de peur conditionnée. Les données recueillies ont ainsi mis en évidence les effets sensibles de ce jet lag sur les systèmes de mémoire de la peur conditionnée. Ces résultats viennent, selon les auteurs, conforter l’affirmation de l’importance d’une bonne synchronisation du système circadien pour un usage optimal des fonctions cognitives. Par ailleurs, il apparaît ainsi que le processus de consolidation de la mémoire peut être affectée par de tels permutations de la temporalité circadienne. L’étude est publiée dans la revue PLos One (2010 Sep 2;5(9). pii: e12546.)


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J Am Geriatr Soc. 2010 Sep 14. doi: 10.1111/j.1532-5415.2010.03071.x. [Epub ahead of print]
Sleep Duration and Mortality According to Health Status in Older Adults.
Mesas AE, López-García E, León-Muñoz LM, Guallar-Castillón P, Rodríguez-Artalejo F.
From the Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ-Biomedical Research Centre Network for Epidemiology and Public Health, Madrid, Spain.
Abstract
OBJECTIVES: To examine the association between usual sleep duration and mortality according to physical and mental health status in older adults.
DESIGN: Prospective study conducted from 2001 to 2008.
SETTING: Community-based study.
PARTICIPANTS: Cohort study of 3,820 persons representative of the noninstitutionalized population aged 60 and older in Spain.
MEASUREMENTS: Sleep duration was self-reported at baseline. Analyses were performed using Cox regression and adjusted for the main confounders. The analyses were then stratified according to numerous indicators of health status.
RESULTS: During follow-up, 897 persons died. Mortality was higher in those who slept 8 hours (relative risk (RR)=1.34, 95% confidence interval (CI)=1.02-1.76), 9 hours (RR 1.48, 95% CI=1.12-1.96), 10 hours (RR 1.73, 95% CI=1.30-2.29) and 11 hours or more (RR 1.66, 95% CI=1.23-2.24) than in those who slept 7 hours (P for trend <.001). The association between long sleep duration (≥10 vs 7 hours) and mortality was observed even in persons with good health status: optimal perceived health, good cognitive function (Mini-Mental State Examination score >27), no depression, quality of life better than the cohort median (Medical Outcomes Study 36-item Short Form Survey Physical Component Summary score ≥46 and Mental Component Summary score ≥52), and without disability in instrumental activities of daily living. Sleeping 6 hours or less was not associated with higher mortality than sleeping 7 hours in persons with good health status.
CONCLUSION: Self-reported sleep duration was associated with 7-year mortality in this cohort of older adults, even when adjusted for health status. Further research is needed to determine the mechanisms and clinical implications of these findings.
PMID: 20840460 [PubMed - as supplied by publisher]
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Psychooncology. 2010 Sep 5. [Epub ahead of print]
Fatigue and its correlates in cancer patients who had returned to work-a cohort study.
Taskila T, de Boer AG, van Dijk FJ, Verbeek JH.
Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands.
Abstract
Objectives: Fatigue and other symptoms in cancer patients often interfere with social and occupational activities. Only a few studies, however, have examined relationship between fatigue and work-related outcomes. The aim of this study was to investigate which disease-related factors (treatment, diagnosis, cognitive dysfunction, depression, pain, and sleep disturbance) and work-related factors (work-load, work pressure, relationship to supervisor and colleagues, size of the company, and workplace accommodations) were related to fatigue in employed cancer survivors.Methods: Data was collected by questionnaire at 6 months (baseline) and 18 months (end of the follow-up) after cancer diagnosis from 135 people with different types of cancer who had returned to work at follow-up. Fatigue was measured with a four-item sub-scale of MFI. Scores ranged from 4 to 20, with higher scores indicating more fatigue.Results: The mean rate of general fatigue was 11.9 at baseline decreasing to 10.4 at the end of the follow-up (p<0.0001). At 6 months, higher work pressure (p = 0.02), physical workload (p<0.05) and less workplace accommodations (p = 0.03) were related to higher levels of fatigue. From disease-related factors, depression was associated with fatigue (p<0.0001) at baseline. Lack of workplace accommodations was the only factor affecting higher levels of fatigue at 18 months (p<0.001) and was also related to higher levels of depression at 6 months (p = 0.02) and at 18 months (p<0.001).Conclusions: Lack of workplace accommodations was significantly related to fatigue at the end of the follow-up, which suggests that accommodations for illness can help to reduce fatigue and depression. Copyright (c) 2010 John Wiley & Sons, Ltd.
PMID: 20821375 [PubMed - as supplied by publisher]
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Sleep Breath. 2010 Sep 23. [Epub ahead of print]
Adaptive pressure support servoventilation: a novel treatment for residual sleepiness associated with central sleep apnea events.
Mei S, Xilong Z, Mao H, Ning D.
Department of Respiratory Medicine, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
Abstract
OBJECTIVE: Nasal continuous positive airway pressure (nCPAP) usually reduces sleepiness in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). However, even with regular use of nCPAP, some OSAHS patients experience residual sleepiness (RS). The aim of this study was to evaluate the efficacy of adaptive servoventilation (ASV) on RS in OSAHS patients.
PATIENTS AND METHODS: The Epworth Sleepiness Scale (ESS) score was used for assessment of RS. Following correct application of 1-month auto-CPAP (APAP) treatment and exclusion for other sleepiness-associated disorders, 42 RS patients with severe OSAS were recruited. All of them received 1-week ASV treatment with auto-CS2 ventilator. Comparisons between APAP and ASV treatments were made for the following data: polysomnographic parameters including apnea hypopnea index (AHI), central sleep apnea index (CSAI), micro-arousal index (MAI), minimal pulse oxygen saturation, etc.; daytime ESS score.
RESULTS: Compared with the parameters on day 30 of APAP treatment, there was a further significant decrease in AHI, CSAI, MAI, and daytime ESS score (P < 0.01) on day 7 of ASV treatment. ESS score before ASV treatment (10.89 ± 0.40) reduced to normal range (3.98 ± 1.26) on day 7 of ASV treatment (P < 0.01).
CONCLUSION: ASV treatment could significantly improved RS in OSAS patients; the mechanism of such an efficacy might be associated with further declined levels of AHI, CSAI, and arousal index.
PMID: 20862555 [PubMed - as supplied by publisher]
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PLoS One. 2010 Sep 2;5(9). pii: e12546.
Rapid changes in the light/dark cycle disrupt memory of conditioned fear in mice.
Loh DH, Navarro J, Hagopian A, Wang LM, Deboer T, Colwell CS.
Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California, United States of America.
Abstract
BACKGROUND: Circadian rhythms govern many aspects of physiology and behavior including cognitive processes. Components of neural circuits involved in learning and memory, e.g., the amygdala and the hippocampus, exhibit circadian rhythms in gene expression and signaling pathways. The functional significance of these rhythms is still not understood. In the present study, we sought to determine the impact of transiently disrupting the circadian system by shifting the light/dark (LD) cycle. Such "jet lag" treatments alter daily rhythms of gene expression that underlie circadian oscillations as well as disrupt the synchrony between the multiple oscillators found within the body.
METHODOLOGY/PRINCIPAL FINDINGS: We subjected adult male C57Bl/6 mice to a contextual fear conditioning protocol either before or after acute phase shifts of the LD cycle. As part of this study, we examined the impact of phase advances and phase delays, and the effects of different magnitudes of phase shifts. Under all conditions tested, we found that recall of fear conditioned behavior was specifically affected by the jet lag. We found that phase shifts potentiated the stress-evoked corticosterone response without altering baseline levels of this hormone. The jet lag treatment did not result in overall sleep deprivation, but altered the temporal distribution of sleep. Finally, we found that prior experience of jet lag helps to compensate for the reduced recall due to acute phase shifts.
CONCLUSIONS/SIGNIFICANCE: Acute changes to the LD cycle affect the recall of fear-conditioned behavior. This suggests that a synchronized circadian system may be broadly important for normal cognition and that the consolidation of memories may be particularly sensitive to disruptions of circadian timing.
PMID: 20824058 [PubMed - in process]

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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.