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Pression intraoculaire, SAS et ventilation nasale par PPC / dépression et SAS / cancer et durée de sommeil / troubles métabolique et exposition nocturne à la lumière

 
Chronobiologie et métabolisme
 
-Une étude à paraître dans la revue Proceedings of the National Academic Sciences of the United States of America (2010 Oct 11) met en évidence, sur des modèles animaux, une corrélation entre une exposition prolongée à la lumière la nuit et l’apparition de troubles du métabolisme voire d’obésité. Il apparaît en effet que les souris exposées à une source lumineuse la nuit développent une masse corporelle supérieure, une intolérance au glucose et une prise de nourriture plus importante, phénomènes non observés chez les souris connaissant un rythme circadien jour / nuit conforme.
 
Sommeil et cancer
 
-Une étude parue dans la revue Cancer attire l’attention sur l’existence d’une corrélation entre la durée de sommeil et la survenue d’une néoplasie du côlon et du rectum.  Une analyse multi-variée de régression  a permis d’isoler la durée de sommeil (- de 6 heures par nuit) comme un facteur de risque ayant une incidence significative sur la formation d’adénomes colorectaux.
 
Respiration
 
-La perte du rythme nycthéméral normal de la pression intraoculaire est fréquente chez les patients porteurs d’un syndrome d’apnées du sommeil. Dans ce contexte, une étude parue dans la revue Archives of Ophtalmology (2010 Oct;128(10):1257-63) est venue montrer qu’un traitement par ventilation nasale par pression positive continue permet aux patients apnéiques, dans la plupart des cas, de retrouver un rythme nycthéméral IP ur 24 heures normal.
 
-La revue Laryngoscope (2010 Oct 11) explore les rapports entre dépression, somnolence en fonction de la sévérité des symptômes chez 53 patients porteurs d’un syndrome d’apnées du sommeil. Tests de sommeil, questionnaire d’évaluation des états dépressifs et polysomnographies sont venus établir une corrélation entre SAS avec somnolence excessive et risque dépressif sans qu’une incidence directe entre SAS et dépression puisse être établie, quant à elle.
 
Pédiatrie
 
-L’American Journal of respiratory and critical care medicine (2010 Oct 8) publie une étude relative aux mécanismes qui conduisent les jeunes patients souffrant d’obésité à contracter un syndrome d’apnées du sommeil. Ont été considérés et évalués, dans cette perspective de compréhension, les facteurs de risque de type anatomiques tels la composition corporelle en termes de répartition de la masse grasse et la structure des voies aériennes supérieures.
 

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Laryngoscope. 2010 Oct 11. [Epub ahead of print]
Depression, sleepiness, and disease severity in patients with obstructive sleep apnea.
Ishman SL, Cavey RM, Mettel TL, Gourin CG.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A.
 
Abstract
 
OBJECTIVES/HYPOTHESIS: To determine if a relationship exists between depression, disease severity, and sleepiness in patients with obstructive sleep apnea (OSA).
STUDY DESIGN: Case control study.
METHODS: Fifty-three consecutive patients with suspected OSA were evaluated before treatment and compared with controls by using the Beck Depression Inventory (BDI), Epworth Sleepiness Scale (ESS), and polysomnography.
RESULTS: OSA was associated with an increased risk of depression in the study group compared to the control group (odds ratio = 6.3, 95% confidence interval: 1.9-20.6, P = .002); depression was seen in 35% of OSA patients and 8% of controls (P < .001). There was a significant correlation between BDI and ESS scores (r = 0.342, P = .012). In addition, ESS was significantly associated (P = .039) with depression in a linear regression model that controlled for race, sex, age, and respiratory disturbance index (RDI). RDI and depression were weakly associated (P = .056) in this model, and there was no correlation found between BDI scores and OSA disease severity (RDI)(r = 0.446).
CONCLUSIONS: Patients with OSA and daytime sleepiness are more likely to have depressive symptoms as compared with controls. OSA disease severity, as measured with the RDI score, is a weak predictor of BDI score, and no correlation was seen between the severity of OSA and BDI scores after controlling for other factors. However, there was a strong correlation between sleepiness (ESS) and disease severity (BDI). These data suggest that OSA patients with symptoms of excessive sleepiness have the highest risk of associated depressive symptoms and may benefit most from depression screening. Laryngoscope, 2010.
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Arch Ophthalmol. 2010 Oct;128(10):1257-63.
 
Frequent Loss of Nyctohemeral Rhythm of Intraocular Pressure Restored by nCPAP Treatment in Patients With Severe Apnea.
 
Pépin JL, Chiquet C, Tamisier R, Lévy P, Almanjoumi A, Romanet JP.
Clinique Universitaire d'Ophtalmologie, CHU de Grenoble, 38043 Grenoble CEDEX 09, France. cchiquet@chu-grenoble.fr.
Abstract
OBJECTIVE: To assess 24-hour intraocular pressure (IOP) and ocular perfusion pressure rhythms in newly diagnosed apneic patients before and after nasal continuous positive airway pressure (nCPAP) treatment.
METHODS: Intraocular pressure (using a Tonopen XL) and ambulatory blood pressure, measured hourly for 24 hours, were analyzed in 18 consecutive patients with obstructive sleep apnea for nyctohemeral rhythmicity (cosinor model). Twelve of 18 patients were reassessed after nCPAP use.
RESULTS: Before treatment, 28% of the patients with obstructive sleep apnea demonstrated a nocturnal acrophase, 22% a diurnal acrophase, and 50% absence of 24-hour rhythm of IOP. The ocular perfusion pressure rhythm was nocturnal in 78% of cases and absent in 22%. Using nCPAP, the mean (standard error of the mean) nocturnal IOP increased from 14.8 (0.8) to 18.3 (1.2) mm Hg (P < .03). Among patients with initial abnormal IOP rhythm (ie, rhythm with diurnal acrophase or absence of rhythm), 67% shifted to a normal 24-hour IOP profile after treatment.
CONCLUSIONS: Normal IOP nyctohemeral rhythm is lost in most patients with severe apnea. Nasal continuous positive airway pressure use restored a normal 24-hour IOP profile in most cases.
 
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Proc Natl Acad Sci U S A. 2010 Oct 11. [Epub ahead of print]
Light at night increases body mass by shifting the time of food intake.
Fonken LK, Workman JL, Walton JC, Weil ZM, Morris JS, Haim A, Nelson RJ.
Departments of Neuroscience and Psychology, Ohio State University, Columbus, OH 43210.
Abstract
The global increase in the prevalence of obesity and metabolic disorders coincides with the increase of exposure to light at night (LAN) and shift work. Circadian regulation of energy homeostasis is controlled by an endogenous biological clock that is synchronized by light information. To promote optimal adaptive functioning, the circadian clock prepares individuals for predictable events such as food availability and sleep, and disruption of clock function causes circadian and metabolic disturbances. To determine whether a causal relationship exists between nighttime light exposure and obesity, we examined the effects of LAN on body mass in male mice. Mice housed in either bright (LL) or dim (DM) LAN have significantly increased body mass and reduced glucose tolerance compared with mice in a standard (LD) light/dark cycle, despite equivalent levels of caloric intake and total daily activity output. Furthermore, the timing of food consumption by DM and LL mice differs from that in LD mice. Nocturnal rodents typically eat substantially more food at night; however, DM mice consume 55.5% of their food during the light phase, as compared with 36.5% in LD mice. Restricting food consumption to the active phase in DM mice prevents body mass gain. These results suggest that low levels of light at night disrupt the timing of food intake and other metabolic signals, leading to excess weight gain. These data are relevant to the coincidence between increasing use of light at night and obesity in humans.
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Cancer. 2010 Oct 8. [Epub ahead of print]
Short duration of sleep increases risk of colorectal adenoma.
Thompson CL, Larkin EK, Patel S, Berger NA, Redline S, Li L.
 
Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio.
Abstract
BACKGROUND: Short duration and poor quality of sleep have been associated with increased risks of obesity, cardiovascular disease, diabetes mellitus, and total mortality. However, few studies have investigated their associations with risk of colorectal neoplasia.
METHODS: In a screening colonoscopy-based case-control study, the Pittsburg Sleep Quality Index (PSQI) was administered to 1240 study participants before colonoscopy.
RESULTS: Three hundred thirty-eight (27.3%) of the participants were diagnosed with incident colorectal adenomas. Although there was no appreciable difference in the overall PSQI score between cases and adenoma-free controls (5.32 vs 5.11; P = .37), the authors found a statistically significant association of colorectal adenoma with the PSQI component 3, which corresponds to sleep duration (P = .02). Cases were more likely to average less than 6 hours of sleep per night (28.9% vs 22.1% in controls, P = .01). In multivariate regression analysis adjusted for age, gender, race, smoking, family history of colorectal cancer, and waist-to-hip ratio, individuals averaging less than 6 hours per night had an almost 50% increase in risk of colorectal adenomas (OR = 1.47; CI = 1.05-2.06, P for trend = .02) as compared with individuals sleeping at least 7 hours per night. Cases were also more likely to report being diagnosed with sleep apnea (9.8% vs 6.5%, P = .05) and more likely to have worked alternate shifts (54.0% vs 46.1%, P = .01), although these differences were not significant in multivariate models.
CONCLUSIONS: Shorter duration of sleep significantly increases risk of colorectal adenomas. The authors' results suggest sleep duration as a novel risk factor for colorectal neoplasia. Cancer 2010. © 2010 American Cancer Society.
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Am J Respir Crit Care Med. 2010 Oct 8. [Epub ahead of print]
Upper Airway Structure and Body Fat Composition in Obese Children with Obstructive Sleep Apnea Syndrome.
Arens R, Sin S, Nandalike K, Rieder J, Khan UI, Freeman K, Wylie-Rosett J, Lipton ML, Wootton DM, McDonough JM, Shifteh K.
Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Montefiore Medical Center, and Albert Einstein College of Medicine, Bronx, New York, United States.
Abstract
RATIONALE: Mechanisms leading to OSAS in obese children are not well understood. The aim of the study was to determine anatomical risk factors associated with OSAS in obese children as compared to non-OSAS obese controls.
METHODS: MRI was used to determine the size of upper airway structure, and body-fat composition. Paired analysis was used to compare between groups. Mixed effects regression models and conditional multiple logistic regression models were used to determine whether BMI Z-score was an effect modifier of each anatomic characteristic as it relates to OSAS.
RESULTS: We studied 22 obese OSAS subjects (12.5±2.8 yrs, BMI Z-score: 2.4±0.4) and 22 obese controls (12.3±2.9 yrs, BMI Z-score: 2.3±0.3). As compared to controls, OSAS subjects had a smaller oropharynx (p<0.05), and larger adenoid (p<0.01), tonsils (p<0.05) and retropharyngeal nodes (p<0.05). The size of lymphoid tissues correlated with severity of OSAS while BMI Z-score did not have a modifier effect on these tissues. OSAS subjects demonstrated increased size of parapharyngeal fat-pads (p<0.05), and abdominal visceral fat (p<0.05). The size of these tissues did not correlate with severity of OSAS and BMI Z-score did not have a modifier effect on these tissues.
CONCLUSIONS: Upper airway lymphoid hypertrophy is significant in obese children with OSAS. The lack of correlation of lymphoid tissue size with obesity suggests that this hypertrophy is caused by other mechanisms. Though the parapharyngeal fat-pads and abdominal visceral fat are larger in obese children with OSAS we could not find a direct association with severity of OSAS or with obesity.

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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.