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Syndrome d'apnées du sommeil et Syndrome métabolique

L’apnée complexe du Sommeil pourrait s’avérer être un des extrêmes du spectre évolutif de l’apnée obstructif du sommeil, l’autre extrême étant le syndrome obésité-hypoventilation. Cet article est à paraître dans la revue Medical Hypotheses.

 


Complex sleep apnea and obesity hypoventilation syndrome. Opposite ends of the spectrum of obstructive sleep apnea?

Medical Hypotheses octobre 2009

 

Marrone O. Consiglio Nazionale delle Ricerche, Istituto di Biomedicina e Immunologia Molecolare, Via Ugo La Malfa, 153, 90146 Palermo, Italy. marrone@ibim.cnr.it

 

In most cases, the application of continuous positive airway pressure (CPAP) during sleep in patients affected by obstructive sleep apnea (OSA) eliminates upper airway obstruction and makes breathing stable and regular. However, some OSA patients develop periodic breathing and central apneas during CPAP administration, a finding that has been labelled as "complex sleep apnea" (complex SA). Such breathing disorder may occur only acutely after CPAP treatment initiation or sometimes persist with chronic CPAP treatment. We hypothesize that complex SA may be the consequence of mechanisms analogous to those leading to obesity hypoventilation syndrome (OHS), but operating in an opposite direction. Periodic breathing is one of the factors predisposing to OSA and is an essential factor for the recurrence of central apneas in normo or hypocapnic patients. A high ventilatory responsiveness to chemical stimuli enhances breathing periodicity. In subjects with periodic central apneas chemoresponsiveness is high, while in subjects with OSA it spans throughout a wide range, and is correlated to diurnal blood gas levels. In fact, sleep respiratory disorders may be responsible for either an augmentation in ventilatory responses to chemical stimuli consequent to chronic exposure to intermittent hypoxia, or for a decrease in ventilatory responses when prolonged exposure to hypercapnia is experienced. Among OSA subjects, those with OHS show very depressed hypercapnic responses. After chronic OSA treatment, ventilatory responses to chemical stimuli may either decrease, in previously hyperresponsive subjects, or increase, in previously hyporesponsive subjects. Most patients with OHS decrease daytime PCO(2) levels and increase their ventilatory responses after chronic CPAP treatment. Complex SA could appear in those OSA subjects in whom chronic exposure to nocturnal respiratory disorders leads to the highest responsiveness to chemical stimuli, and could disappear after blunting of ventilatory responses following chronic CPAP treatment. Complex SA may be one extreme of evolutionary spectrum of OSA, the opposite end being represented by OHS.

·         Un autre article à paraître dans Current Opinion in Endocrinology, diabetes and Obesity s’attarde sur le dérèglement de l’axe hypotalamo-hypophyso-surrénalien et son interaction avec l’anxiété chronique,  l’obésité et autres maladies métaboliques apparentées.

 

·         Compte tenu de la prévalence des troubles du sommeil durant l’enfance, de leurs conséquences possibles sur le développement de l’enfant, et des résultats probants des traitements en vigueur, la pertinence des pédiatres comme ressource première et essentielle dans la prise en charge et l’évaluation de ces troubles, est rappelée dans un article à paraître dans la revue European Journal of Pediatrics .

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"Clinical practice: sleep problems during infancy."
Sadeh A, Sivan Y.

European Journal of Pediatrics, octobre 2009

Department of Psychology, Tel Aviv University, The Adler Center for Research in Child Development and Psychopathology, Ramat Aviv, Tel Aviv 69978, Israel. sadeh@post.tau.ac.il

Sleep problems are very prevalent during infancy. The most common problems are those related to night wakings and sleep-disordered breathing (SDB). Most common night waking problems do not have identified physiologic etiology. Their causes appear to be behavioral or developmental by nature, and they usually respond well to behavioral interventions. SDB may result from a variety of anatomic and neurologic factors and is associated with a variety of medical and developmental disorders. Because of the high prevalence of sleep problems during infancy, their persistence, their potential adverse developmental effects, and the positive treatment outcomes, pediatricians should serve as the primary address for screening and referral to proper assessment and treatment.

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 “Stress and obesity: the role of the hypothalamic-pituitary-adrenal axis in metabolic disease.”

Current Opinion in Endocrinology, diabetes and Obesity

Bose M, Oliván B, Laferrère B.

New York Obesity Research Center, St Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York, USA. mb3103@columbia.edu

PURPOSE OF REVIEW: Chronic stress, combined with positive energy balance, may be a contributor to the increased risk for obesity, especially upper body obesity, and other metabolic diseases. This association may be mediated by alterations in the hypothalamic-pituitary-adrenal (HPA) axis. In this review, we summarize the major research that has been conducted on the role of the HPA axis in obesity and metabolic disease. RECENT FINDINGS: Dysregulation in the HPA axis has been associated with upper body obesity, but data are inconsistent, possibly due to methodological differences across studies. In addition to systemic effects, changes in local cortisol metabolism in adipose tissue may also influence the risk for obesity. HPA axis dysregulation may be the causal link between conditions such as maternal malnutrition and sleep deprivation with metabolic disease. SUMMARY: The present review provides evidence for the relationship between chronic stress, alterations in HPA activity, and obesity. Understanding these associations and its interactions with other factors will be important in developing effective treatments for obesity and related metabolic diseases.

 

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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.