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SAOS de l'enfant et marqueurs de risques cardiovasculaires...

Une étude parue dans la revue Chest (IF 6.36) de juillet 2010 intitulée “Leukocyte Telomere Length and Plasma Catestatin and Myeloid-Related Protein 8/14 Concentrations in Children With Obstructive Sleep Apnea”. Elle met en évidence un niveau faible de catestatine plasmatique, une augmentation de la concentration en myéline évoquant une corrélation avec l’index d’apnées hypopnées notamment, biomarqueurs de risques cardiovasculaires chez les enfants souffrant de syndrome d’apnées du sommeil obstructives. Par ailleurs la longueur des leucocytes télomères observée dans ce contexte doit être investiguée plus avant selon les auteurs.
Le résumé de cette étude est en ligne ici :
Par ailleurs, la revue Chest de juin 2010 publie également une série d’articles relatifs aux troubles respiratoires du sommeil. Articles originaux et issus de la rubrique « Postgraduate education corner »
L’une traite de l’insomnie et de ses troubles respiratoires associés ;  un deuxième, des spécificités cliniques du syndrome d’apnées du sommeil en fonction de l’âge chez les personnes âgées ; une étude japonaise vient caractériser la relation entre volume exhalé et pression négative chez les sujets éveillés présentant un syndrome d’apnées du sommeil et enfin une étude présente une hiérarchisation des indices comorbides associés au SAOS.

1. WICKWIRE EM, Collop NA.
Insomnia and sleep-related breathing disorders.
Chest. 2010;137:1449-63.
Chest. 2010 Jun;137(6):1449-63.
Insomnia and sleep-related breathing disorders.
Wickwire EM, Collop NA.
Center for Sleep Disorders, Pulmonary Disease and Critical Care Associates, 10710 Charter Dr, Ste 310, Columbia, MD 21044, USA. ewickwire@pulmdocs.com
Insomnia disorder and obstructive sleep apnea are the two most common sleep disorders among adults. Historically, these conditions have been conceptualized as orthogonal, or insomnia has been considered a symptom of sleep apnea. Insomnia researchers have sought to exclude participants at risk for sleep-related breathing disorders (SRBD), and vice versa. In recent years, however, there has been a growing recognition of co-occurring insomnia disorder and SRBD and interest in the prevalence, consequences, and treatment of the two conditions when they co-occur. Although plagued by inconsistent diagnostic criteria and operational definitions, evidence from clinical and research samples consistently suggests high rates of comorbidity between the two disorders. More important, insomnia disorder and SRBD have additive negative effects. To date, only a few studies have explored the combined or sequential treatment of the conditions. Results support the importance of an integrated, interdisciplinary approach to sleep medicine. This article reviews the empirical literature to date and provides clinical recommendations as well as suggestions for future research.
PMID: 20525657 [PubMed - indexed for MEDLINE]

2.KOBAYASHI M, Namba K, Tsuiki S, Matsuo A, et al.
Clinical characteristics in two subgroups of obstructive sleep apnea syndrome in  the elderly: comparison between cases with elderly and middle-age onset.
Chest. 2010;137:1310-5.

Clinical characteristics in two subgroups of obstructive sleep apnea syndrome in the elderly: comparison between cases with elderly and middle-age onset.
Kobayashi M, Namba K, Tsuiki S, Matsuo A, Sugiura T, Inoue Y.
Japan Somnology Center, Neuropsychiatric Research Institute, 1-24-10 Yoyogi, Shibuya-ku, Tokyo 151-0053, Japan. inoue@somnology.com.
BACKGROUND: Morbidity due to obstructive sleep apnea syndrome (OSAS) is increased in the elderly population. However, the clinical characteristics of OSAS in elderly patients have not been characterized conclusively. The aim of this study was to clarify differences in clinical characteristics of OSAS between patients with middle-age onset and elderly onset of OSAS. METHODS: Patients with OSAS aged > or = 65 years were classified into groups according to age at first identification of respiratory pauses during sleep: a middle-age onset group (n = 32) where onset was at age < 50 years and an elderly onset group (n = 31) where onset was at age > or = 60 years. We compared demographic variables; polysomnographic variables; daytime sleepiness measures, including the multiple sleep latency test (MSLT) and the Epworth sleepiness scale (ESS); and adequate level of nasal continuous positive airway pressure (CPAP) between groups. RESULTS: BMI and frequency of underlying cardiovascular disorder were lower in the elderly onset group than in the middle-age onset group. No significant differences in apnea-hypopnea index or percentage of the period showing O(2) desaturation were seen between groups. However, arousal index, maximal negative esophageal pressure value, and adequate nasal CPAP level were significantly smaller in the elderly onset group. Mean sleep latency on MSLT was longer, and ESS score was lower in the elderly onset group. CONCLUSIONS: Compared with the middle-age onset group, the clinical significance of OSAS in the elderly onset group seemed to remain milder. This finding is possibly because of the smaller physiologic response to respiratory events.
PMID: 20363838 [PubMed - indexed for MEDLINE]

3.MONTEMURRO LT, Bettinzoli M, Corda L, Braghini A, et al.
Relationship between critical pressure and volume exhaled during negative pressure in awake subjects with sleep-disordered breathing.
Chest. 2010;137:1304-9.

Relationship between critical pressure and volume exhaled during negative pressure in awake subjects with sleep-disordered breathing.
Montemurro LT, Bettinzoli M, Corda L, Braghini A, Tantucci C.
Cattedra di Malattie dell'Apparato Respiratorio, Spedali Civili, Brescia, Italy.
BACKGROUND: Critical pressure (Pcrit) is considered a reliable parameter to evaluate the mechanical properties of the passive upper airway (UA) and is significantly increased in patients with obstructive sleep apnea-hypopnea (OSAH) compared with normal subjects. The volume exhaled in the first 0.5 s after application at the mouth of 5 cm H(2)O negative pressure at the onset of expiration (V,NEP(0.5)) during wakefulness has been used as a marker of UA collapsibility. The aim of this study was to investigate if there is a significant relationship between V,NEP(0.5) and Pcrit in normal subjects, snorers, and patients with OSAH. METHODS: Thirty men, 10 with OSAH (aged 64 +/- 9.1 years, BMI 32 +/- 4.9 kg/m(2), apnea-hypopnea index [AHI] 43.8 +/- 24, neck circumference 46.6 +/- 3.7 cm), 10 snorers (aged 68 +/- 11 years, BMI 26.6 +/- 4.6 kg/m(2), AHI 3.5 +/- 0.8, snoring time > or = 30% of sleep time, neck circumference 42.2 +/- 3.9 cm), and 10 controls (aged 67 +/- 12 years, BMI 25.4 +/- 2.2 kg/m(2), AHI 1.9 +/- 1.2, neck circumference 41.2 +/- 2.2 cm) underwent V,NEP(0.5) measurement in supine position while awake and Pcrit measurement during sleep. Correlation between V,NEP(0.5) and Pcrit was performed in all subjects. RESULTS: Controls had V,NEP(0.5) of 456 +/- 82 mL and Pcrit of -1.38 +/- 0.6 cm H(2)O, snorers had V,NEP(0.5) of 321 +/- 33 mL and Pcrit -0.55 +/- 0.3 cm H(2)O, and patients with OSAH showed V,NEP(0.5) of 295 +/- 67 mL and Pcrit of 0.99 +/- 1 cm H(2)O (P < .001 vs normal subjects). A strong correlation was found between V,NEP(0.5) and Pcrit (r(2) = 0.61, P < .0001). CONCLUSIONS: In males with neck circumference > 37 cm, V,NEP(0.5) during wakefulness strongly reflects Pcrit in a wide range of values. Our findings suggest that V,NEP(0.5) can be used as valuable substitute for Pcrit to assess UA collapsibility for clinical and research purposes in these subjects.
PMID: 20139226 [PubMed - indexed for MEDLINE]
Hierarchy of comorbidity indicators for obstructive sleep apnea.
Chest. 2010;137:1491-2.

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