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Pression Positive Continue, Coeur et sommeil

Cœur et sommeil
-Une étude coréenne parue dans Nutrition, Metabolism and Cardiovascular diseases (Dis. 2010 Oct;20(8):575-82. Epub 2009 Aug 20) réalisée sur une cohorte de 258 adultes sains entre 40 et 49 ans vient caractériser plus spécifiquement le rôle du syndrome d’apnées obstructives dans le risque de troubles coronariens. Alors qu’il est admis que le SAOS et avec l’obésité est un facteur de risques, cette étude vient évaluer son impact isolément sur les lésions de l’artère coronaire de type calcifications, lésions impliquées dans le trouble coronarien.
 
Respiration
-Une étude rétrospective menée sur deux années parue dans la revue Sleep Medicine (2010 Oct;11(9):837-42. Epub 2010 Aug 16.) vient souligner les effets bénéfiques d’un traitement par pression positive continue sur la pression artérielle chez des patients âgés de 18 ans et plus porteurs d’un syndrome d’apnées du sommeil modéré.
 
Pédiatrie
-Les caractéristiques du sommeil d’enfants atteints du trouble hématologique dits trouble à cellules falciformes est l’objet d’une étude parue dans la revue Pediatric blood &Cancer (2010 Sep;55(3):501-7). A partir d’une étude comparative du sommeil d’enfants sains témoins, cette étude attire l’attention sur la nécessité d’accorder à la qualité du sommeil de ces enfants une attention telle que l’exigence d’un sommeil plus paisible soit intégrée dans une perspective de prise en charge du trouble à cellules falciformes per se et à la fois d’amélioration de la qualité de vie de ces enfants.
 
Neurosciences
-Le rôle de l’hormone corticostérone, en tant qu’elle est produite sous l’effet du stress, est mis en évidence dans les modifications des  transcriptomes du cerveau d’une souris, modifications générées à la suite d’une période de privation de sommeil, modifications jusqu’alors attribuées à l’état de veille. Cette étude est parue dans la revue Sleep (2010 Sep 1;33(9):1147-57).
 
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 Nutr Metab Cardiovasc Dis. 2010 Oct;20(8):575-82. Epub 2009 Aug 20.
 
Association of coronary artery calcification with obstructive sleep apnea and obesity in middle-aged men.
Kim SH, Cho GY, Baik I, Kim J, Kim SJ, Lee JB, Lim HE, Lim SY, Park J, Shin C.
Division of Cardiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea.
Abstract
BACKGROUND AND AIMS: Obstructive sleep apnea (OSA) and obesity are closely associated, and both have been reported to increase the risk of coronary heart disease. Although obesity is known to be associated with coronary artery calcification (CAC), there is limited information on whether OSA is associated with CAC independent of obesity.
METHODS AND RESULTS: A cross-sectional study examined the association between OSA and CAC among 258 healthy men, ages 40-49 years old, randomly selected from a population-based cohort. All individuals underwent overnight polysomnography and electron-beam computed tomography to measure their apnea-hypopnea index (AHI) and degree of CAC. A logistic regression model including potential cardiovascular risk factors excluding body mass index (BMI) showed that the presence of CAC was significantly greater in the fourth quartile versus the first quartile of AHI severity (odds ratio [OR] 2.21, 95% confidence interval [CI] 1.01-4.86). A multivariate linear regression model excluding BMI also showed that AHI was significantly associated with CAC (P = 0.004). However, this association was no longer significant after adjusting for BMI.
CONCLUSIONS: In our cross-sectional study, even though both OSA and obesity were positively associated with the presence and extent of CAC, only obesity remained a significant independent contributor after an adjustment for potential cardiovascular risk factors, irrespective of OSA.
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Sleep Med. 2010 Oct;11(9):837-42. Epub 2010 Aug 16.
Does CPAP treatment in mild obstructive sleep apnea affect blood pressure?
Jaimchariyatam N, Rodriguez CL, Budur K.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand. drboy48@yahoo.com
Abstract
OBJECTIVES: Obstructive sleep apnea (OSA) is associated with significant cardiovascular (CV) morbidity. Continuous positive airway pressure (CPAP) is the standard treatment for moderate to severe OSA, resulting in a reduction in CV morbidity. No studies have compared CV outcomes between CPAP and no CPAP in mild OSA (5>or=AHI<15).
METHODS: Retrospective cohort study of subjects (age>or=18) with mild OSA diagnosed between 2004 and 2006. Subjects with a history of hypertension, angina, stroke and smoking were excluded. Subjects were stratified into two groups: CPAP (n=93) or no CPAP (n=162). The mean blood pressures (MBP) were compared 2 years after the diagnosis of OSA was established.
RESULTS: Unmatched for covariates (age, sex, BMI, neck circumference, AHI, arousal index and family h/o CV disorders), subjects with mild OSA on CPAP had a 1.97 point reduction, and no CPAP resulted in a 9.61 point elevation (p<0.0001) in MBP. With propensity score matching for covariates, the mean difference in MBP was -1.97 (95% CI: -14.03, -9.92; p<0.0001) with a sensitivity analysis of 2.646.
CONCLUSION: This study shows an elevation of the MBP in mild OSA patients who were not treated with CPAP. CPAP treatment in mild OSA patients decreased the MBP over a 2-year period.
PMID: 20719563 [PubMed - in process]
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Sleep. 2010 Sep 1;33(9):1147-57.
Separating the contribution of glucocorticoids and wakefulness to the molecular and electrophysiological correlates of sleep homeostasis.
Mongrain V, Hernandez SA, Pradervand S, Dorsaz S, Curie T, Hagiwara G, Gip P, Heller HC, Franken P.
Center for Integrative Genomics, University of Lausanne, CH 1015 Lausanne, Switzerland.
Sleep. 2010 Sep 1;33(9):1131-2.
Abstract
STUDY OBJECTIVES: The sleep-deprivation-induced changes in delta power, an electroencephalographical correlate of sleep need, and brain transcriptome profiles have importantly contributed to current hypotheses on sleep function. Because sleep deprivation also induces stress, we here determined the contribution of the corticosterone component of the stress response to the electrophysiological and molecular markers of sleep need in mice.
DESIGN: N/A
SETTINGS: Mouse sleep facility.
PARTICIPANTS: C57BL/6J, AKR/J, DBA/2J mice.
INTERVENTIONS: Sleep deprivation, adrenalectomy (ADX).
MEASUREMENTS AND RESULTS: Sleep deprivation elevated corticosterone levels in 3 inbred strains, but this increase was larger in DBA/2J mice; i.e., the strain for which the rebound in delta power after sleep deprivation failed to reach significance. Elimination of the sleep-deprivation-associated corticosterone surge through ADX in DBA/2J mice did not, however, rescue the delta power rebound but did greatly reduce the number of transcripts affected by sleep deprivation. Genes no longer affected by sleep deprivation cover pathways previously implicated in sleep homeostasis, such as lipid, cholesterol (e.g., Ldlr, Hmgcs1, Dhcr7, -24, Fkbp5), energy and carbohydrate metabolism (e.g., Eno3, G6pc3, Mpdu1, Ugdh, Man1b1), protein biosynthesis (e.g., Sgk1, Alad, Fads3, Eif2c2, -3, Mat2a), and some circadian genes (Per1, -3), whereas others, such as Homer1a, remained unchanged. Moreover, several microRNAs were affected both by sleep deprivation and ADX.
CONCLUSIONS: Our findings indicate that corticosterone contributes to the sleep-deprivation-induced changes in brain transcriptome that have been attributed to wakefulness per se. The study identified 78 transcripts that respond to sleep loss independent of corticosterone and time of day, among which genes involved in neuroprotection prominently feature, pointing to a molecular pathway directly relevant for sleep function.
PMID: 20857860 [PubMed - in process]PMCID: PMC2938796 [Available on 2011/3/1]
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Pediatr Blood Cancer. 2010 Sep;55(3):501-7.
Sleep patterns in pediatric sickle cell disease.
Daniel LC, Grant M, Kothare SV, Dampier C, Barakat LP.
Department of Psychology, Drexel University, Philadelphia, Pennsylvania 19104, USA. lcd34@drexel.edu
Abstract
BACKGROUND: Research examining sleep in children with sickle cell disease (SCD) has focused on the increased occurrence of specific sleep disorders (i.e., sleep-disordered breathing, hypoxemia, nocturnal enuresis), but no research exists describing general sleep behaviors of children with SCD. The purpose of the current study was to compare sleep patterns and sleep behaviors in children with SCD and healthy controls and examine the associations of demographic and disease factors with sleep in the SCD group.
PROCEDURE: The Children's Sleep Habits Questionnaire was completed by parents of 4- to 10-year-old children with SCD (n = 54) and children attending well-care clinics in the same urban hospital (n = 52). Within the SCD group, demographic and disease factors [i.e., genotype, healthcare utilization, SCD complications, and socioeconomic status (SES)] were determined by medical chart review.
RESULTS: Parents of children with SCD reported significantly more behaviors associated with night waking and sleep-disordered breathing than the control group. Within the SCD group, parasomnias were related to SES, enuresis, more severe genotypes, SCD complications, and healthcare utilization. Sleep-disordered breathing was also related to SES, enuresis, and SCD complications.
CONCLUSIONS: Results indicate the importance of routinely assessing sleep in children with SCD as they are more likely to exhibit disrupted sleep than children with similar demographic backgrounds. Given significantly higher rates of parent reported sleep-disordered breathing and night waking in this population, it is important to consider interventions to minimize disruptions to overnight sleep and improve daytime functioning for quality of life in children with SCD.
PMID: 20658622 [PubMed - indexed for MEDLINE]

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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.