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Le sommeil en cardiologie

Voici un aperçu des publications parues ou en instance de parution liées au sommeil annoncées sur la base Pubmed.
Références et résumés sont restitués à la fin de ce courriel.
·         Une étude du Deutsche Medizinische Wochenschrift s’interroge sur la pratique des cardiologues libéraux et hospitaliers confrontés à la prévalence d’une pathologie respiratoire du sommeil chez leurs patients. Elle estime important le hiatus entre la prise en compte réel de ces troubles par les cardiologues et les infrastructures in situ à leur disposition pour une prise en charge optimale de ces pathologies (matériel de polysomnographie, moniteurs portables pour les apnées) pouvant entraîner des accidents cardiovasculaires graves.
·         Une étude parue dans le Journal of Rehabilitation Research and Development évalue dans quelle mesure les patients atteints de lésions traumatiques cérébrales et porteurs de l’apoliprotéine epsilon 4 sont plus vulnérables aux effet néfastes des apnées du sommeil sur le fonctionnement cognitif. Une compréhension de ces mécanismes pourrait conduire à des avancées significatives dans la prévention du risque de démence liée aux lésions traumatiques cérébrales.
·         Le Journal of geriatric psychiatry and neurology propose une revue de la littérature relative à la prévalence des troubles du sommeil dans la maladie de Parkinson, estimant leur prise en considération encore insuffisante. L’auteur attire l’attention également en ce sens sur la nécessité d’une attention spécifique à la signification de l’hétérogénéité des dysfonctionnements qui caractérisent la maladie de Parkinson. 
·         La revue Journal of family practice consacre une série d’articles évoquant les conséquences du travail posté sur la santé des individus et notamment sur leur sommeil. Ils traitent tour à tour  des effets délétères du travail posté sur le rythme circadien, de la nécessité d’aménager des solutions de prise en charge d’urgence spécifiques pour cette population plus vulnérable, du diagnostic différentiel et de la nature des traitements applicables.
Bien cordialement et pardon pour le mail précédent, issu d'une erreur de manipulation,
Cécile Cornibert
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Deutsche Medizinische Wochenschrift 2010 Feb;135(5):178-183. Epub 2010 Jan 26.
Management of sleep-related abnormal breathing by cardiologists and hospital departments of cardiology.
Fietze I, Penzel T, Baumann G, Bönner G, Kamke W, Podszus T; für die AG35 „Kardiovaskuläre Erkrankungen und schlafbezogene Atmungsstörungen” der Deutschen Gesellschaft für Kardiologie (DGK).
Interdisziplinäres Schlafmedizinisches Zentrum, Klinik für Kardiologie und Angiologie, Charité Universitätsmedizin Berlin.
BACKGROUND AND OBJECTIVES: In the general population there is a high prevalence of sleep-related disorders of breathing (sleep apnea). In addition to being leading symptom of excessive day-time sleepiness they are also important predictors are cardiovascular disease such as arterial hypertension, heart failure, cardiac arrhythmias and stroke. Are the cardiologists the specialists who recognize such patients and refer them to diagnostic procedures and treatment? METHODS: We sent out a questionnaires to cardiologists in private practice, to hospitals with cardiology departments and to cardiology rehabilitation units in Germany in order to assess the knowledge about sleep apnea and of the current diagnostic and therapeutic procedures in patients with suspected sleep apnea. All cardiology rehabilitation units and every other practice and cardiology department listed in the reference book 'Medführer' were approached. RESULTS: 98 % of 388 cardiologists with private practice were found to know about the disorder sleep apnea. 94.3 % routinely asked their patients about any sleep disorder and specifically about excessive day-time sleepiness. More than half of the cardiologists (59.3 %) questioned patients about possible sleep apnea as part of their interview, but only 32.7 % carried out tests with a portable sleep apnea monitor. Most patients were referred to a sleep center. In 60 % of the cardiology departments a portable sleep apnea monitor was used. Further diagnostic investigation followed in collaborating sleep centers (66.4 %), because only 22.4 % of the departments had a sleep laboratories. The main focus was on the diagnosis of abnormal sleep due to central or obstructive disorders of breathing. More than two thirds of the cardiology departments initiate nocturnal ventilation treatment. CONCLUSION: Cardiologists in private practice and cardiologists in hospital departments know about sleep-related abnormal breathing. The use of portable sleep apnea monitors and of polysomnography in special as parts of sleep centers within cardiology departments should be improved. © Georg Thieme Verlag KG Stuttgart · New York.
PMID: 20104437 [PubMed - as supplied by publisher]
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Journal of Rehabilitation Research and Developpement 2009;46(6):837-50
Sleep apnea, apolipoprotein epsilon 4 allele, and TBI: Mechanism for cognitive dysfunction and development of dementia.
O'Hara R, Luzon A, Hubbard J, Zeitzer JM.
Associate Director, Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), 151-Y, 3801 Miranda Avenue, Palo Alto, CA 94304. roh@stanford.edu.
Sleep apnea is prevalent among patients with traumatic brain injuries (TBIs), and initial studies suggest it is associated with cognitive impairments in these patients. Recent studies found that the apolipoprotein epsilon 4 (APOE epsilon 4) allele increases the risk for sleep disordered breathing, particularly sleep apnea. The APOE epsilon 4 allele is associated with cognitive decline and the development of dementia in the general population as well as in patients with TBI. These findings raise the question of whether patients with TBI who are APOE epsilon 4 allele carriers are more vulnerable to the negative effects of sleep apnea on their cognitive functioning. While few treatments are available for cognitive impairment, highly effective treatments are available for sleep apnea. Here we review these different lines of evidence, making a case that the interactive effects of sleep apnea and the APOE epsilon 4 allele represent an important mechanism by which patients with TBI may develop a range of cognitive and neurobehavioral impairments. Increased understanding of the relationships among sleep apnea, the APOE epsilon 4 allele, and cognition could improve our ability to ameliorate one significant source of cognitive impairment and risk for dementia associated with TBI.
PMID: 20104407 [PubMed - in process]
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Journal of geriatric psychiatry and neurology 2010 Jan 25. [Epub ahead of print]
Sleep Disturbances in Parkinson Disease and Their Potential Role in Heterogeneity.
Gunn DG, Naismith SL, Lewis SJ.
Parkinson disease (PD) is commonly conceptualized as a movement disorder. Most previous attempts to define the heterogeneity of the condition have used prospective methods based on arbitrary features such as motor symptoms or age of disease onset. However, nonmotor symptoms including neuropsychological, neuropsychiatric, and behavioral impairments have received less attention. Sleep disturbances are extremely common in PD and appear to be associated with cognitive and psychiatric problems. Recent research has begun to elucidate the links between these variables, but the origin and extent of these relationships are not clearly understood. This review outlines the importance of sleep for healthy cognition and mood, highlighting the possible implications that disturbed sleep may have with regard to patients with PD. It also emphasizes the need for further studies that explore the heterogeneity of all disease features in PD.
PMID: 20101072 [PubMed - as supplied by publisher]
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Journal of Family Practice 2010 Jan;59(1 Suppl):S3-S11.
The social and economic burden of shift-work disorder.
Culpepper L.
Department of Family Medicine, Boston University Medical Center, Boston, MA, USA.
Shift-wrk disorder (SWD) and its defining symptoms can negatively affect health, quality of life, and work performance. The gravity of these consequences necessitates vigilance for the symptoms of SWD by primary care physicians. The threshold for treatment intervention for emergency service workers, such as firefighters, who make crucial decisions under shift-work conditions and who are experiencing SWD should be lower than for shift workers in general. The economic costs of untreated SWD are likely to be high. Early diagnosis and treatment of SWD may reduce these costs in addition to reducing the human burden of this circadian rhythm sleep disorder.
PMID: 20074508 [PubMed - in process]
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Journal of Familial Practice. 2010 Jan;59(1 Suppl):S24-31.
Managing the patient with shift-work disorder.
Thorpy MJ.
Sleep-Wake Disorders Center, Montefiore Medical Center, Bronx, NY, USA.
Behavioral measures, eg, exercise and improved sleep hygiene, can enhance sleep quality and combat insomnia and excessive sleepiness (ES) in shift workers and individuals with shift-work disorder (SWD). Napping before a shift followed by consumption of a caffeinated drink and, if appropriate, scheduled naps at work, may improve ES in patients with SWD. Use of bright light therapy to partially re-entrain the circadian clock should be explored for all night-shift workers-particularly those with SWD. The wakefulness-promoting agents armodafinil and modafinil are FDA approved for the treatment of ES in patients with SWD. Alongside nonpharmacologic interventions, they can be included in a comprehensive management plan for SWD. Melatonin or other sleep-promoting agents may help shift workers achieve sleep during required rest periods and when adjusting to night-shift work; studies are needed in patients with SWD to better evaluate the utility of these agents in this population.
PMID: 20074507 [PubMed - in process]
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Journal of Familial Practice 2010 Jan;59(1 Suppl):S18-23.
Recognition of shift-work disorder in primary care.
Schwartz JR.
University of Oklahoma Health Sciences Center, INTEGRIS Sleep Disorders Center of Oklahoma, Oklahoma City, OK, USA.
To recognize shift-work disorder (SWD), primary care physicians can screen for persistent excessive sleepiness (ES) and insomnia in patients who work night or rotating shifts. If SWD is suspected, a differential diagnosis should be generated, as ES and insomnia are commonly associated with other morbidities. Ask patients about symptoms of other common sleep/wake disorders, such as obstructive sleep apnea and periodic limb movement disorder. The Epworth Sleepiness Scale is a useful tool for subjectively evaluating ES.
PMID: 20074506 [PubMed - in process]

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