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troubles du sommeil et grossesse

Voici un aperçu des publications liées au sommeil en instance de parution, extraites de la base Pubmed. Résumés et références sont restitués en fin de ce courriel.

-La revue Obstetrics and Gynecology publie une étude visant l’évaluation de la nature et de l’intensité des troubles du sommeil de la femme enceinte, selon les différents épisodes de sa grossesse.

- La douleur et sa prise en charge sont impliquées dans la persistance de troubles du sommeil chez l’enfant prématuré. C’est ce que tend à montrer une étude parue dans la revue European Journal of Pain, à travers, notamment, une analyse des effets de l’oxycodone sur le sommeil.

-La revue Pediatrics interroge la pertinence du questionnaire qualité de vie « OSA 18 » comme alternative aux examens polysomnographiques pour la détection des apnées du sommeil de modérés à sévères chez l’enfant.

-La revue Free Radical Biology and Medicine publie une étude explorant l’existence d’un système de corrélations entre l’isoprostane 15F2t( bio-marqueur de peroxydation lipidique), la sévérité d’un syndrome d’apnées du sommeil  et l’épaisseur intima-média de la carotide chez des patients apnéiques non obèses dans la perspective d’un renforcement de l’hypothèse de l’implication du stress oxydatif dans les processus de l’athérosclérose précoce.

-Sleep Medecine Reviews propose une analyse compréhensive des instruments susceptibles de mesurer l’impression chez le patient d’un sommeil non restaurateur, symptôme décisif dans l’insomnie. Il apparaît que des dispositifs pertinents parmi les instruments existants font défaut, qui permettent l’expression de ce symptôme et l’évaluation de sa sévérité.


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Obstetrics and Gynecology 2010 Jan;115(1):77-83.

Sleep disturbances in pregnancy.

Facco FL, Kramer J, Ho KH, Zee PC, Grobman WA.

From the Department of Obstetrics and Gynecology and Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and the Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Cornell Medical Center, New York, New York.

OBJECTIVE:: To estimate the prevalence and patterns of sleep disturbances during pregnancy among healthy nulliparous women. METHODS:: This was a prospective, cohort study of healthy nulliparous women, recruited between 6 and 20 weeks of gestation, who completed a baseline sleep survey at enrollment with follow-up in the third trimester. The survey was composed of the following validated sleep questionnaires: Berlin Questionnaire for Sleep Disordered Breathing, Epworth Sleepiness Scale, National Institutes of Health/International Restless Legs Syndrome Question Set, Women's Health Initiative Insomnia Rating Scale, and the Pittsburgh Sleep Quality Index. Differences in sleep characteristics between the baseline and third trimester were compared using the paired t test or McNemar test for continuous or categorical data, respectively. RESULTS:: One hundred eighty-nine women completed both baseline and follow-up sleep surveys. The mean gestational age was 13.8 (+/-3.8) and 30.0 (+/-2.2) weeks at the first and second surveys, respectively. Compared with the baseline assessment, mean sleep duration was significantly shorter (7.4 [+/-1.2] hours compared with 7.0 [+/-1.3] hours, P<.001), and the proportion of patients who reported frequent snoring (at least three nights per week) was significantly greater (11% compared with 16.4%, P=.03) in the third trimester. The percentage of patients who met diagnostic criteria for restless leg syndrome increased from 17.5% at recruitment to 31.2% in the third trimester (P=.001). Overall poor sleep quality, as defined by a Pittsburgh Sleep Quality Index score greater than 5, became significantly more common as pregnancy progressed (39.0% compared with 53.5%, P=.001). CONCLUSION:: Sleep disturbances are prevalent among healthy nulliparous women and increase significantly during pregnancy. LEVEL OF EVIDENCE: II.

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European  Journal of Pain. 2009 Dec 15. [Epub ahead of print]

Effects of pain management on sleep in preterm infants.

Axelin A, Kirjavainen J, Salanterä S, Lehtonen L.

Finnish Post-Graduate School in Nursing Science, Department of Nursing Science, University of Turku, Finland.

BACKGROUND: This study was conducted to gain better understanding of the prolonged effects of pain and pain management on preterm infants' sleep. AIM: The hypothesis was that the sleep structure in very preterm infants is different after painful procedures with pain management (facilitated tucking by parents (FTP), oral glucose, and oxycodone) than without pain management (oral water as placebo). METHODS: A prospective randomized placebo-controlled cross-over trial design was used. Thirteen-hour polysomnographic recordings were conducted when the study infants (n=18) were at a post-conceptional age of 28-32weeks. During the recordings, the standardized nursing care periods were carried out with different forms of pain management administered at 3-h intervals. Sleep structure was analyzed before and after the interventions. The main hypothesis was analyzed using mixed models. RESULTS: During the first post-intervention hour, the amount of rapid eye movement (REM) sleep decreased after all interventions regardless of pain management (p<0.001). However, the oxycodone treatment further reduced the amount of REM sleep to 48.0% (SD 14.9) compared to other interventions: oral glucose to 64.4% (SD 12.8), (p<0.001); placebo to 62.9% (SD 16.1), (p<0.001); and FTP to 61.6% (SD 1.9), (p=0.004). In addition, sleep onset comprised non-rapid eye movement (NREM) sleep more frequently after oxycodone (50%) compared to placebo (6%, p=0.006), oral glucose (11%, p=0.019) or FTP (17%, p=0.056). CONCLUSION: Pain management with oxycodone markedly altered the structure of the subsequent sleep period. This reduced amount of REM sleep may have consequences for brain development in preterm infants. Copyright © 2009 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

 

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Pediatrics. 2009 Dec 21. [Epub ahead of print]

Can the OSA-18 Quality-of-Life Questionnaire Detect Obstructive Sleep Apnea in Children?

Constantin E, Tewfik TL, Brouillette RT.

Departments of Pediatrics and.

Background: Polysomnography is the best tool available for diagnosing obstructive sleep apnea (OSA) in children. However, polysomnography is relatively inaccessible and costly, and studies are needed to evaluate other diagnostic approaches. It has been suggested that the OSA-18 quality-of-life questionnaire (OSA-18) is a useful measure that could replace polysomnography. The purpose of our study was to determine if the OSA-18, is an accurate measure for the detection of moderate-to-severe OSA. Patients and Methods: Children who were referred to our sleep laboratory for evaluation of suspected OSA and who had a nocturnal pulse oximetry study were included in our cross-sectional study. The results of the oximetry study were interpreted by using the McGill oximetry score (MOS). Abnormal scores were consistent with moderate-to-severe OSA. We analyzed demographic and medical data in addition to the OSA-18 results. We estimated sensitivity and negative predictive values for the OSA-18 to detect an abnormal MOS. We also conducted logistic regression analyses with MOS as the dependent variable and the OSA-18 score, age, gender, comorbidities, and race as independent variables. Results: We studied 334 children (mean age: 4.6 years; 58% male). The OSA-18 had a sensitivity of 40% and a negative predictive value of 73% for detecting an abnormal MOS. While controlling for other variables in the regression model, for each unit increase in the OSA-18 score, the odds of having an abnormal MOS were increased by 2%. For each 1-year increase in age, the odds of having an abnormal MOS were decreased by 17%. Conclusions: Among children who are referred to a sleep laboratory, the OSA-18 does not accurately detect which children will have an abnormal MOS and cannot be used to exclude moderate-to-severe OSA. The OSA-18 should not be used in the place of objective testing to identify moderate-to-severe OSA in children.

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Free Radical Biology and Medicine 2009 Dec 15. [Epub ahead of print]

Association of urinary 15-F(2t)-isoprostane level with oxygen desaturation and carotid intima-media thickness in non-obese sleep apnea patients.

Monneret D, Pepin JL, Godin-Ribuot D, Ducros V, Baguet JP, Levy P, Faure P.

INSERM ERI0017, Laboratoire HP2, Université Joseph Fourier, Grenoble, France; Département de Biologie Intégrée, CHU, Grenoble, France; Pôle de Rééducation et physiologie, CHU, Grenoble, France.

Background: Obstructive sleep apnea (OSA) is characterized by recurrent apnea during sleep that may unbalance oxidative stress increasing atherosclerosis. Among oxidative stress markers, 15-F(2t)-isoprostane is considered as one of the most sensible and specific metabolite of lipid peroxidation. Objective: To explore the relationship between urinary 15-F(2t)-isoprostane with sleep apnea severity and carotid modifications in non obese OSA patients. Patients and methods: 31 non-obese sleep apnea patients were studied, along with 10 lean subjects without OSA. Patients were assessed polysomnography, blood pressure measurement and ultrasonography to determine the carotid intima-media thickness (IMT). Urinary 15-F(2t)-isoprostanes were measured by liquid chromatography-tandem mass spectrometry. Results: Urinary 15-F(2t)-isoprostane concentrations were increased in severe OSA patients compared to control subjects (20.2+/-7.3 vs 12.3+/-2.8 ng/mmol creatinine; P=0.020). Mean carotid IMT was correlated to 15-F(2t)-isoprostane (r=0.532; P<0.001) and to the apnea-hypopnea index (r=0.345; P=0.029). 15-F(2t)-isoprostane level was related to the nighttime spent at SaO2<90% (r=0.478; P=0.002), the apnea-hypopnea index (r=0.465; P=0.003), and to the mean nocturnal SaO2 (r=-0.424; P=0.007). Conclusions: These results showed a relationship between lipid peroxidation, carotid intima-media thickness and intermittent hypoxia in non obese OSA patients, thus reinforcing the hypothesis that oxidative stress could be involved in the early atherosclerotic process. Copyright © 2009. Published by Elsevier Inc.

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Sleep Medecine Review. 2009 Dec 15. [Epub ahead of print]

Measurement of non-restorative sleep in insomnia: A review of the literature.

Vernon MK, Dugar A, Revicki D, Treglia M, Buysse D.

United BioSource Corporation, Center for Health Outcomes Research, 7101 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA.

OBJECTIVE: Non-restorative sleep (NRS) is a core symptom of insomnia, typically defined as a subjective feeling of being unrefreshed upon awakening. NRS symptoms have been less consistently studied than other symptoms of insomnia, and there is no consensus regarding measurement of NRS. Given its subjective nature, patient-reported outcome (PRO) instruments are important for evaluating NRS symptom severity and treatment-related changes. The objective of this literature review was to identify PROs used in insomnia populations that purport to measure NRS, and to evaluate their psychometric characteristics. METHODS: A comprehensive review of PRO instruments used in insomnia was conducted; instruments were reviewed for NRS content by two independent reviewers; a total of 26 instruments identified to contain NRS content were retained for further review. RESULTS: Of the 26 instruments reviewed, 23 contained at least one item evaluating subjective nighttime aspects of NRS; 17 contained at least one item evaluating daytime aspects of NRS. Only the Sleep Assessment Questionnaire contained a specific NRS domain score. However, little published evidence was available regarding measurement properties of the NRS domain in insomnia populations. CONCLUSIONS: There is currently no reliable and well-validated PRO instrument available for specifically evaluating NRS symptom severity and response to interventions in insomnia populations. Reliable and valid measurement tools are needed to measure the symptom of NRS in insomnia. Copyright © 2009 Elsevier Ltd. All rights reserved.

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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.