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Caussé C, Pépin JL, Dauvilliers Y, Attali V, Lehert P. Pitolisant efficacy in excessive daytime sleepiness for patients with obstructive sleep apnea. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pépin JL, Georgiev O, Tiholov R, Attali V, Verbraecken J, Buyse B, Partinen M, Fietze I, Belev G, Dokic D, Tamisier R, Lévy P, Lecomte I, Lecomte JM, Schwartz JC, Dauvilliers Y. Pitolisant long term effect in sleepy obstructive sleep apnea patients with CPAP. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Georges M, Perez T, Rabec C, Jacquin L, Finet-Monnier A, Ramos C, Patout M, Attali V, Amador M, Gonzalez-Bermejo J, Salachas F, Morelot-Panzini C. Proposals from a French expert panel for respiratory care in ALS patients. Respir Med Res 2022; 81:100901. [PMID: 35378353 DOI: 10.1016/j.resmer.2022.100901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive diaphragm weakness and deteriorating lung function. Bulbar involvement and cough weakness contribute to respiratory morbidity and mortality. ALS-related respiratory failure significantly affects quality of life and is the leading cause of death. Non-invasive ventilation (NIV), which is the main recognized treatment for alleviating the symptoms of respiratory failure, prolongs survival and improves quality of life. However, the optimal timing for the initiation of NIV is still a matter of debate. NIV is a complex intervention. Multiple factors influence the efficacy of NIV and patient adherence. The aim of this work was to develop practical evidence-based advices to standardize the respiratory care of ALS patients in French tertiary care centres. METHODS For each proposal, a French expert panel systematically searched an indexed bibliography and prepared a written literature review that was then shared and discussed. A combined draft was prepared by the chairman for further discussion. All of the proposals were unanimously approved by the expert panel. RESULTS The French expert panel updated the criteria for initiating NIV in ALS patients. The most recent criteria were established in 2005. Practical advice for NIV initiation were included and the value of each tool available for NIV monitoring was reviewed. A strategy to optimize NIV parameters was suggested. Revisions were also suggested for the use of mechanically assisted cough devices in ALS patients. CONCLUSION Our French expert panel proposes an evidence-based review to update the respiratory care recommendations for ALS patients in daily practice.
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Affiliation(s)
- M Georges
- Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon France; Centre des Sciences du Goût et de l'Alimentation, UMR 6265 CNRS 1234 INRA, University of Bourgogne Franche-Comté, Dijon, France.
| | - T Perez
- Department of Respiratory Diseases, University Hospital of Lille, Lille, France; Centre for Infection and Immunity of Lille, INSERM U1019-UMR9017, University of Lille Nord de France, Lille, France
| | - C Rabec
- Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon France
| | - L Jacquin
- Clinical Training Manager for ResMed SAS company, Saint-Priest, France
| | - A Finet-Monnier
- Department of Neuromuscular Disorders and ALS, University Hospital of Timone, Marseille, France
| | - C Ramos
- CRMR SLA-MNM, Hôpital Pasteur 2, University Hospital of Nice, Nice, France
| | - M Patout
- Service des Pathologies du Sommeil (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France
| | - V Attali
- Service des Pathologies du Sommeil (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France
| | - M Amador
- Neurology Department, Paris ALS center, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - J Gonzalez-Bermejo
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France; Service de Pneumologie (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - F Salachas
- Neurology Department, Paris ALS center, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - C Morelot-Panzini
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France; Service de Pneumologie (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
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Kerbrat A, Schouman T, Decressain D, Rouch P, Attali V. Interaction between posture and maxillomandibular deformity: a systematic review. Int J Oral Maxillofac Surg 2021; 51:104-112. [PMID: 34120792 DOI: 10.1016/j.ijom.2021.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/05/2021] [Accepted: 05/07/2021] [Indexed: 11/24/2022]
Abstract
Maxillomandibular deformity (MMD) and body posture appear to be correlated. However, no systematic literature review of the available evidence to support this correlation has been performed to date. The aim of this study was to conduct a systematic literature review on posture and MMD. This systematic literature review was registered in the PROSPERO database. Systematic searches of the MEDLINE, Scopus, Cochrane Library, and Web of Science databases were performed. In total, 13 clinical studies were included. Nine found a significant association between MMD and body posture or body balance: two studies showed a correlation between increased cervical lordosis and skeletal class III MMD, two studies showed an interaction between mandibular deviation and scoliosis, four studies demonstrated a significant association between lumbar column and pelvis anatomy and MMD, and one study found a correlation between displacement of the centre of mass and MMD. However, the level of evidence is low; the methods used to evaluate body posture and MMD were inconsistent. Orthognathic surgery could modify body posture. Although there seems to be an interaction between body posture and facial deformity, the number of studies is too small and the level of evidence too low to strongly support this association.
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Affiliation(s)
- A Kerbrat
- Service de Chirurgie Maxillo-Faciale, Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Paris, France; Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, Paris, France.
| | - T Schouman
- Service de Chirurgie Maxillo-Faciale, Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Paris, France; Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - D Decressain
- Service de Chirurgie Maxillo-Faciale, Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - P Rouch
- Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - V Attali
- Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, Paris, France; Groupe Hospitalier Universitaire APHP - Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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Chadefaux D, Valdes-Tamayo L, Moreno Flores R, Poulet Y, Herrera Altamira G, Hybois S, Coursimault M, Sauret C, Attali V, Thoreux P. A preliminary study of stability in elite and novice 10 meter air pistol shooters. Comput Methods Biomech Biomed Engin 2020. [DOI: 10.1080/10255842.2020.1812160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- D. Chadefaux
- Université Sorbonne Paris Nord, Institut de Biomécanique Humaine Georges Charpak, IBHGC, Arts et Métiers Institute of Technology, Paris, France
- Département STAPS, Université Sorbonne Paris Nord, Bobigny, France
| | - L. Valdes-Tamayo
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, IBHGC, Université Sorbonne Paris Nord, Bobigny, France
| | | | - Y. Poulet
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, IBHGC, Université Sorbonne Paris Nord, Bobigny, France
| | - G. Herrera Altamira
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, IBHGC, Université Sorbonne Paris Nord, Bobigny, France
| | - S. Hybois
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, IBHGC, Université Sorbonne Paris Nord, Bobigny, France
| | | | - C. Sauret
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, IBHGC, Université Sorbonne Paris Nord, Bobigny, France
| | - V. Attali
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - P. Thoreux
- Université Sorbonne Paris Nord, Institut de Biomécanique Humaine Georges Charpak, IBHGC, Arts et Métiers Institute of Technology, Paris, France
- Hôpital Avicenne, Université Paris 13, Sorbonne Paris-Cité, AP-HP, Bobigny, France
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Lespert Y, Attali V, Similowski T, Sandoz B, Ing R. Airborne ultrasound measurement of posturo-respiratory interaction. Comput Methods Biomech Biomed Engin 2020. [DOI: 10.1080/10255842.2020.1813419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Y. Lespert
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Institut de Biomécanique Humaine Georges Charpak, Paris, France
- Institut Langevin, CNRS, ESPCI Paris, PSL ResearchUniversity, Paris, France
| | - V. Attali
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Institut de Biomécanique Humaine Georges Charpak, Paris, France
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - T. Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Médecine Intensive et Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Paris, France
| | - B. Sandoz
- Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - R.K. Ing
- Institut Langevin, CNRS, ESPCI Paris, PSL ResearchUniversity, Paris, France
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Eastwood PR, Barnes M, MacKay SG, Wheatley JR, Lewis R, Campbell MC, Jones AC, Palme CE, Petelle B, Meslier N, Bertolus C, Denoncin K, Attali V, Gagnadoux F, Launois SH. 0665 Bilateral Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Hypoglossal Nerve Stimulation (HGNS) decreases obstructive sleep apnea (OSA) severity by contracting the tongue and decreasing upper airway collapsibility. This study assessed the safety and effectiveness of a new implantable device that delivers bilateral HGNS: the Genio™ system.
Methods
The BLAST OSA study (BiLAteral Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea), was a prospective, open-label, non-randomized, single arm treatment study conducted at eight centres in three countries (Australia, France, UK). Primary outcomes were the incidence of device-related Serious Adverse Events (SAEs) and change in the Apnea-Hypopnea Index (AHI). The secondary outcome was change in the 4% Oxygen Desaturation Index (ODI). Additional outcomes included measures of sleepiness, quality of life, snoring, and device use. Participants were eligible if: 21-75 years old; BMI ≤ 32 kg/m2; obstructive AHI 20-60 events/hr and combined central and mixed AHI < 10 events/hr; no positional OSA; no Complete Concentric Collapse of the soft palate during Drug Induced Sleep Endoscopy; and failed to tolerate or accept Positive Airway Pressure treatments.
Results
27 participants were implanted (63% male, aged 55.9±12.0 years, BMI 27.4±3.0 kg/m2). 22 completed the protocol. At 6 months, AHI decreased from 23.7±12.2 to 12.9±10.1 events/hr [p<0.001]; and ODI decreased from 19.1±11.2 to 9.8±6.9 events/hr [p<0.001]. Daytime sleepiness (ESS, p=0.011) and sleep-related quality of life (FOSQ-10, p=0.016) both significantly improved. 91% of participants reported using their device >5 days per week, and 77% used it >5 hours per night. The number of bed partners reporting disruptive snoring decreased from 96% to 35%. No device-related SAE occurred.
Conclusion
In a targeted population of individuals with moderate-to-severe OSA, the Genio system reduced OSA severity and sleepiness, improved quality of life, and was associated with high adherence and an acceptable safety profile.
Support
This study trial was funded by Nyxoah S.A. This trial was registered with ClinicalTrials.gov, number NCT03048604.
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Affiliation(s)
- P R Eastwood
- University of Western Australia, Centre for Sleep Science, Perth, AUSTRALIA
| | - M Barnes
- Institute for Breathing and Sleep, Austin Hospital, Melbourne, AUSTRALIA
| | - S G MacKay
- Illawara ENT Head & Neck Clinic, Woollongong, AUSTRALIA
| | - J R Wheatley
- Depatment of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, AUSTRALIA
| | - R Lewis
- Department of Otolaryngology, Head & Neck Surgery, Royal Perth Hosptital, Perth, AUSTRALIA
| | - M C Campbell
- Institute for Breathing and Sleep, Austin Hospital, Melbourne, AUSTRALIA
| | - A C Jones
- Illawarra ENG Head & Neck Clinic, Woollongong, AUSTRALIA
| | - C E Palme
- University of Sydney at Westmead Hospital, Sydney, AUSTRALIA
| | - B Petelle
- Service ORL Chirurgie de la Face et du Cou, Hopital Tenon, Paris, FRANCE
| | - N Meslier
- Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, FRANCE
| | - C Bertolus
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, FRANCE
| | - K Denoncin
- Nyxoah, S.A., Mont-Saint-Guibert, BELGIUM
| | - V Attali
- Sorbonne Universite, INSERM, UMRS 1158, Neurophysiologie Respiratoire Experimentale et Clinique, Paris, FRANCE
| | - F Gagnadoux
- Department of Respiratory and Sleep Medicine, University of Angers, Angers, FRANCE
| | - S H Launois
- Unite de Somnologie et Fonction Respiratoire, Hospital St Antoine, Paris, FRANCE
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Eastwood P, Barnes M, Mackay S, Wheatley J, Hillman D, Nguyen XL, Lewis R, Campbell M, Petelle B, Walsh J, Jones A, Palme C, Bizon A, Meslier N, Bertolus C, Maddison K, Laccourreye L, Raux G, Denoncin K, Attali V, Gagnadoux F, Launois S. Bilateral hypoglossal nerve stimulation for treatment of obstructive sleep apnea. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vigié du Cayla G, Collet JM, Attali V, Kerbrat JB, Benslama L, Goudot P. Long-term effectiveness and side effects of mandibular advancement devices on dental and skeletal parameters. J Stomatol Oral Maxillofac Surg 2018; 120:7-10. [PMID: 30739641 DOI: 10.1016/j.jormas.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/09/2018] [Accepted: 09/22/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Continuous positive airways pressure, generally used to treat obstructive sleep apnea-hypopnea syndrome (OSAHS), is not tolerated well by many patients. An alternative is to treat OSAHS with mandibular advancement devices (MAD). This research assesses the long term (> 2 years) effectiveness and the side effects on dental and skeletal parameters of these devices. MATERIAL AND METHODS We selected 24 patients with moderate to severe OSAHS. All were treated with MADs for at least 2 years. We gathered cephalometric teleradiographs in centric relation and sleep recordings before and after the patients were treated. We evaluated the patients' apnea-hypopnea indexes (AHI) as well as their Epworth sleepiness scale (ESS) scores. We measured the inclination of the central incisors and the positions of the upper and lower jaws. RESULTS Mandibular advancement devices were used for more than 2 years (3.9 ± 1.9 years). We observed a statistically significant decrease of the patients' AHI and their ESS scores. We also observed a modification of the inclination of the lower central incisors (+0.521; P = 0.047) and of the position of the maxilla (-0.287; P = 0.039). DISCUSSION We demonstrated the clinical effectiveness of mandibular advancement devices for treating OSAHS, with a very low rate of side effects on dental and skeletal positions.
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Affiliation(s)
- G Vigié du Cayla
- Service de stomatologie et chirurgie maxillo-faciale, AP-HP, DHU FAST, GH Pitié - Salpêtrière - Charles-Foix, 75013, Paris, France; Sorbonne Universités, UPMC université Paris 06, UMR 8256 B2A, 75005, Paris, France
| | - J M Collet
- Service de stomatologie et chirurgie maxillo-faciale, AP-HP, DHU FAST, GH Pitié - Salpêtrière - Charles-Foix, 75013, Paris, France; Sorbonne Universités, UPMC université Paris 06, UMR 8256 B2A, 75005, Paris, France
| | - V Attali
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Service des pathologies du Sommeil (Département ''R3S''), AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles-Foix, 75013 Paris, France
| | - J B Kerbrat
- Service de stomatologie et chirurgie maxillo-faciale, AP-HP, DHU FAST, GH Pitié - Salpêtrière - Charles-Foix, 75013, Paris, France; Sorbonne Universités, UPMC université Paris 06, UMR 8256 B2A, 75005, Paris, France
| | - L Benslama
- Service de stomatologie et chirurgie maxillo-faciale, AP-HP, DHU FAST, GH Pitié - Salpêtrière - Charles-Foix, 75013, Paris, France; Sorbonne Universités, UPMC université Paris 06, UMR 8256 B2A, 75005, Paris, France.
| | - P Goudot
- Service de stomatologie et chirurgie maxillo-faciale, AP-HP, DHU FAST, GH Pitié - Salpêtrière - Charles-Foix, 75013, Paris, France; Sorbonne Universités, UPMC université Paris 06, UMR 8256 B2A, 75005, Paris, France
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Clavel L, Attali V, Jacq O, Nierat MC, Similowski T, Rouch P, Sandoz B. Breathing through a spirometer perturbs balance. Comput Methods Biomech Biomed Engin 2017; 20:41-42. [DOI: 10.1080/10255842.2017.1382851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- L. Clavel
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris France
- UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Sorbonne Universités, INSERM, UPMS Univ Paris 6, France
| | - V. Attali
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris France
- Département “RS3”, F-75013, Groupe Hospitalier Pitié-Salpêtrière Charles Fois, Paris France
- UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Sorbonne Universités, INSERM, UPMS Univ Paris 6, France
| | - O. Jacq
- Département “RS3”, F-75013, Groupe Hospitalier Pitié-Salpêtrière Charles Fois, Paris France
- UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Sorbonne Universités, INSERM, UPMS Univ Paris 6, France
| | - MC. Nierat
- UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Sorbonne Universités, INSERM, UPMS Univ Paris 6, France
| | - T. Similowski
- Département “RS3”, F-75013, Groupe Hospitalier Pitié-Salpêtrière Charles Fois, Paris France
- UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Sorbonne Universités, INSERM, UPMS Univ Paris 6, France
| | - P. Rouch
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris France
| | - B. Sandoz
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris France
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Meurice J, Ingrand P, Sedkaoui K, Iamandi C, Portel L, Martin F, Lerousseau L, Alfandary D, Levrat V, Portier F, Tamisier R, Goutorbe F, Georges M, Codron F, Auregan G, Mercy M, Attali V, Soyez F, Launois C, Recart D, Vecchierini M, Gagnadoux F. Évaluation comparative de l’efficacité de la PPC constante et de l’auto-PPC dans le traitement du SAHOS en fonction du profil de variabilité de la pression et du niveau de pression efficace individuelle. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Meurice J, Attali V, Collet J, D’ortho M, Goutorbe F, Kerbrat J, Khemliche H, Leger D, Lerousseau L, Martin F, Monaca C, Monteyrol P, Morin L, Mullens E, Pigearias B, Vecchierini M. Résultats à 2 ans de suivi de l’étude ORCADES : orthèse d’avancée mandibulaire (OAM) sur mesure CAD/CAM chez les patients traités pour un syndrome d’apnées hypopnées obstructives du sommeil (SAHOS). Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Meurice J, Attali V, D’ortho M, Goutorbe F, Leger D, Lerousseau L, Martin F, Monaca C, Monteyrol P, Morin L, Pigearias B, Vecchierini M. Bénéfices cliniques d’une orthèse d’avancée mandibulaire (OAM) sur mesure CAD/CAM sur la pression artérielle dans le syndrome d’apnées hypopnées obstructives du sommeil (SAHOS). Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bironneau V, Loustonneau E, Pontier S, Gagnadoux F, Iamandi C, Portel L, Martin F, Mallart A, Lerousseau L, Alfandary D, Levrat V, Portier F, Tamisier R, Goutorbe F, Rabec C, Codron F, Auregan G, Mercy M, Attali V, Soyez F, Launois C, Recart D, Vecchierini F, Meurice J. Et s’il était possible de prédire le type d’appareil de PPC (constant ou autopiloté) à utiliser dans le traitement du SAHOS ? Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jacq O, Souchet S, Similowski T, Attali V. Effets physiologiques de la compression ostéopathique du ganglion ptérygo-palatin chez des patients atteints du syndrome d’apnées obstructives du sommeil, étude prospective, randomisée, croisée, contrôlée, contre manœuvre factice et en simple insu. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2015.02.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jacq O, Souchet S, Arnulf I, Similowski T, Attali V. Compression ostéopathique du ganglion ptérygo-palatin dans le syndrome d’apnées obstructives du sommeil (SAOS), étude prospective, randomisée, contrôlée, croisée, contre manœuvre factice, en simple aveugle. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2014.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Attali V, Chaumereuil C, Arnulf I, Morin L, Goudot P, Collet JM. QUOVADIS : étude monocentrique en vie réelle évaluant à long terme le traitement par orthèse d’avancée mandibulaire (OAM) sur mesure dans le syndrome d’apnées obstructives du sommeil (SAOS). Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2014.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Van Den Broecke S, Jobard O, Montalescot G, Bruyneel M, Ninane V, Arnulf I, Similowski T, Attali V. La polysomnographie très précoce dans les syndromes coronariens aigus est faisable : résultats d’étude pilote. Rev Mal Respir 2014. [DOI: 10.1016/j.rmr.2013.10.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martin F, Leu S, Attali V, Arnulf I. Traitement par aide ventilatoire du stridor nocturne dans l’atrophie multisystématisée. Rev Mal Respir 2013. [DOI: 10.1016/j.rmr.2012.10.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Redolfi S, Attali V, Poitou C, Coupaye M, Lloret Linares C, Leu-Semenescu S, Orvoen-Frija E, Arnulf I. Narcolepsie et hypersomnie centrale au cours du syndrome de Prader-Willi adulte. Neurophysiol Clin 2012. [DOI: 10.1016/j.neucli.2012.02.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Redolfi S, Arnulf I, Pottier M, Attali V, Lajou J, Koskas I, Bradley T, Similowski T. Traitement du syndrome d’apnées obstructives du sommeil par bas de contention. Neurophysiol Clin 2012. [DOI: 10.1016/j.neucli.2012.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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22
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Vernet C, Redolfi S, Attali V, Konofal E, Brion A, Frija-Orvoen E, Pottier M, Similowski T, Arnulf I. Why excessive sleepiness may persist in OSA patients receiving adequate CPAP treatment. Eur Respir J 2011. [DOI: 10.1183/09031936.00153311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Vernet C, Redolfi S, Attali V, Konofal E, Brion A, Frija-Orvoen E, Pottier M, Similowski T, Arnulf I. Residual sleepiness in obstructive sleep apnoea: phenotype and related symptoms. Eur Respir J 2011; 38:98-105. [PMID: 21406511 DOI: 10.1183/09031936.00040410] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The characteristics of residual excessive sleepiness (RES), defined by an Epworth score >10 in adequately treated apnoeic patients, are unknown. 40 apnoeic patients, with (n = 20) and without (n = 20) RES, and 20 healthy controls underwent clinical interviews, cognitive and biological tests, polysomnography, a multiple sleep latency test, and 24-h sleep monitoring. The marked subjective sleepiness in the RES group (mean ± sd score 16.4 ± 3) contrasted with moderately abnormal objective measures of sleepiness (90% of patients with RES had daytime sleep latencies >8 min). Compared with patients without RES, the patients with RES had more fatigue, lower stage N3 percentages, more periodic leg movements (without arousals), lower mean sleep latencies and longer daytime sleep periods. Most neuropsychological dimensions (morning headaches, memory complaints, spatial memory, inattention, apathy, depression, anxiety and lack of self-confidence) were not different between patients with and without RES, but gradually altered from controls to apnoeic patients without and then with RES. RES in apnoeic patients differs markedly from sleepiness in central hypersomnia. The association between RES, periodic leg movements, apathy and depressive mood parallels the post-hypoxic lesions in noradrenaline, dopamine and serotonin systems in animals exposed to intermittent hypoxia.
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Affiliation(s)
- C Vernet
- Sleep Disorders Unit, UMR 975, National Reference Centre for Narcolepsy and Hypersomnia, Paris, France
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Jankowski R, Klossek JM, Attali V, Coste A, Serrano E. Long-term study of fluticasone propionate aqueous nasal spray in acute and maintenance therapy of nasal polyposis. Allergy 2009; 64:944-50. [PMID: 19298572 DOI: 10.1111/j.1398-9995.2009.01938.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Topical steroids are first-line medication to control nasal polyposis (NP), a disease with long-term clinical course. OBJECTIVE The aim of this study was to evaluate the efficacy and safety of fluticasone propionate aqueous nasal spray (FPANS) 200 microg twice a day (bd) after 1 month of treatment, and to compare FPANS 200 microg bd and FPANS 200 microg once a day (od) in maintenance and long-term treatment. METHODS Double-blind, placebo-controlled, 8-month study with three treatment periods (1-month acute period followed with 1-month maintenance period and 6-month follow-up period) was carried out. Group 1 received FPANS 200 microg bd, during acute, maintenance and follow-up periods, Group 2 received FPANS 200 microg bd during acute period and FPANS 200 microg od during maintenance and follow-up periods, and Group 3 received placebo during acute and maintenance periods and FPANS 200 microg bd during follow-up period. Endpoints were change from baseline in clinic peak nasal inspiratory flow (PNIF), domiciliary evening PNIF, intensity of symptoms and polyposis grade. RESULTS After acute period and maintenance periods, FPANS 200 microg bd was significantly more effective than placebo on all endpoints and more effective than FPANS 200 microg od after 1-month maintenance period on clinic PNIF, evening PNIF, obstruction, percentage of days with no sense of smell and percentage of nights with no disturbances. The two doses were similar on other endpoints. After the 6-month follow-up period, there was no difference between the two doses of FPANS at all efficacy endpoints. The safety profile of FPANS did not highlight any new or unanticipated adverse events. CONCLUSION The study demonstrated the efficacy of FPANS 200 microg bd in acute treatment and FPANS 200 microg od as a sufficient dose to maintain a long-term efficacy in the treatment for NP.
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Affiliation(s)
- R Jankowski
- Hôpital Central de Nancy, Service ORL, Nancy, France
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25
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Chabot F, Devillier P, Drugeon H, Dusser D, Fournier M, Gaillard J, Grouin JM, Housset B, Huchon G, Léophonte P, Muir JF, Raffy O, Tonnel AB, Tremolieres F, Zück P, Attali V, Boucot I, Chemali-Hudry J, Daniloski M. Prévention des exacerbations dans la BPCO. Rev Mal Respir 2004; 21:685-8. [PMID: 15536368 DOI: 10.1016/s0761-8425(04)71408-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Respiratory manifestations of systemic lupus erythematosus (SLE) are frequent. They include respiratory muscle abnormalities, which have been implicated in the pathogenesis of the "shrinking lung syndrome" (SLS). We report the case of a patient with this syndrome, in whom diaphragmatic paralysis due to demyelinating phrenic lesions was diagnosed at the same time as SLE. Follow-up studies showed a favorable clinical and diaphragmatic outcome with corticosteroid therapy, but little change in spirometry. It is concluded that severe diaphragm palsy is possibly due to phrenic nerve lesions in SLE, and that the link between diaphragm dysfunction and the SLS is probably not a straightforward one.
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Affiliation(s)
- K Hardy
- Service de Pneumologie, Centre Hospitalier le Raincy-Montfermeil, France
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Sériès F, Straus C, Demoule A, Attali V, Arnulf I, Derenne JP, Similowski T. Assessment of upper airway dynamics in awake patients with sleep apnea using phrenic nerve stimulation. Am J Respir Crit Care Med 2000; 162:795-800. [PMID: 10988085 DOI: 10.1164/ajrccm.162.3.9906135] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Phrenic nerve stimulation can reproduce during wakefulness the dissociation between upper airway and inspiratory muscles that is associated with obstructive sleep-related breathing disorders. This could provide a useful management tool in the study of passive upper airway (UA) dynamics during wakefulness in patients with the obstructive sleep apnea-hypopnea syndrome (OSAHS). To assess the feasibility of the technique in this setting, we studied the dynamics of diaphragm twitch-associated inspiratory flow in eight patients with OSAHS. Cervical magnetic stimulation (CMS) and bilateral anterior magnetic phrenic stimulation (BAMPS) were applied at end-expiration during exclusive nasal breathing. Electrical phrenic nerve stimulation (ES) proved not feasible. The driving pressure and the respiratory resistance at peak twitch esophageal pressure obtained at maximal stimulation intensity were significantly higher with BAMPS than with CMS. A twitch-flow limitation pattern was observed in seven of eight subjects; VI(max) values of flow-limited twitches obtained at 100% stimulation intensity was 0.81 +/- 0.5 L/s with BAMPS and 0.87 +/- 0.5 L/s with CMS (p = 0.4). The number of flow-limited BAMPS twitches dropped from an average 77.5% to 18.4% with nasal continuous positive airway pressure (CPAP) levels corresponding to the patient's home treatment. We conclude that (1) BAMPS is potentially a useful tool to evaluate the dynamics of flow through the passive UA in awake OSAHS patients, (2) BAMPS may be superior to CMS in evaluating UA properties in OSAHS.
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Affiliation(s)
- F Sériès
- Centre de recherche de l'Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Québec, Canada.
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Arnulf I, Similowski T, Salachas F, Garma L, Mehiri S, Attali V, Behin-Bellhesen V, Meininger V, Derenne JP. Sleep disorders and diaphragmatic function in patients with amyotrophic lateral sclerosis. Am J Respir Crit Care Med 2000; 161:849-56. [PMID: 10712332 DOI: 10.1164/ajrccm.161.3.9805008] [Citation(s) in RCA: 174] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In amyotrophic lateral sclerosis (ALS), the progressive loss of upper and lower motor neurons leads to respiratory failure, often with predominant diaphragm dysfunction, and death. Because the diaphragm is the only active inspiratory muscle during rapid eye movement (REM) sleep, there is a high theoretical risk of respiratory disorders during REM sleep in patients with ALS. To assess this hypothesis, we studied sleep characteristics (polysomnography) in 21 patients with ALS, stratified according to the presence or absence of diaphragmatic dysfunction. Diaphragmatic dysfunction was defined as an absent or delayed diaphragm response to cervical or cortical magnetic stimulation, abdominal paradox, or respiratory pulse (Group 1, 13 patients). These patients did not differ in age, clinical course, or form (bulbar or spinal) from the eight others, who did not have diaphragmatic dysfunction (Group 2). REM sleep was reduced in Group 1 (7 +/- 7% of total sleep time; mean +/- SD) and normal in Group 2 (18 +/- 6%, p = 0.004). Apneas or hypopneas were rare in both groups. In Group 1, REM sleep was absent or minimal (less than 3 min) in five patients. An unusual and remarkable preservation of phasic inspiratory sternomastoid activation during REM was associated with longer REM sleep duration in six of the other patients with diaphragmatic dysfunction. Median survival time was dramatically shorter (217 d) in Group 1 than in Group 2 (619 d, p = 0.015).
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Affiliation(s)
- I Arnulf
- Service de Pneumologie, UPRES EA 2397, Explorations Fonctionnelles Respiratoires, Neurologie et Explorations Fonctionnelles du Systeme Nerveux, Groupe Hospitalier Pitie-Salpetriere, Paris, France.
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Similowski T, Attali V, Bensimon G, Salachas F, Mehiri S, Arnulf I, Lacomblez L, Zelter M, Meininger V, Derenne JP. Diaphragmatic dysfunction and dyspnoea in amyotrophic lateral sclerosis. Eur Respir J 2000; 15:332-7. [PMID: 10706501 DOI: 10.1034/j.1399-3003.2000.15b19.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive disorder of unknown origin. Respiratory involvement is the principal cause of death, and dyspnoea is a major source of discomfort. In this study, diaphragm function is described and its relationship with dyspnoea examined in 48 ALS patients (32 male, age 26-80 yrs). The detailed neurological and respiratory evaluation (clinical examination, pulmonary function tests, static pressures, mouth twitch pressures (Pm,t), electromyographic responses to phrenic nerve stimulation and cortical magnetic stimulation were analysed after stratification according to dyspnoea. Dyspnoeic (group I) and nondyspnoeic (group II) patients were similar, bulbar signs being more frequent in group I. Vital capacity was lower in group I (mean+/-SD 67.9+/-22.7 versus 87.9+/-15.6% of the predicted value, p=0.0028), as were maximal static inspiratory pressure (41+/-24 versus 60+/-27% pred, p=0.0242) maximal static inspiratory pressure (18+/-11 versus 32+/-14% pred, p=0.0042), and Pm,t (3.71+/-2.5 versus 7.26+/-3.45 cmH2O, p=0.0011). Abdominal (Abd) paradox and respiratory pulse were frequent in group I (15 of 25 and 14 of 25) but absent or rare in group II (0 of 23 and four of 23) (p<0.05). The electromyographic responses to phrenic and cortical stimulation were generally abnormal in group I but subnormal in group II. Multivariate analysis selected only signs of diaphragm dysfunction (namely, Abd paradox and abnormal electromyographic responses) as significant predictors of dyspnoea. It is concluded that dyspnoea in amyotrophic lateral sclerosis patients should prompt diaphragm function tests.
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Affiliation(s)
- T Similowski
- Laboratoire de Physiopathologie Respiratoire, Groupe Hospitalier Pitié-Salpetrière, Paris, France
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30
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Lévy-Soussan M, Chérin P, Demoule A, Straus C, Attali V, Payan C, Zelter M, Derenne J, Similowski T, Herson S. Dysfonction diaphragmatique au cours des affections inflammatoires du muscle. Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(00)87607-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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31
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Similowski T, Straus C, Attali V, Duguet A, Derenne JP. Cervical magnetic stimulation as a method to discriminate between diaphragm and rib cage muscle fatigue. J Appl Physiol (1985) 1998; 84:1692-700. [PMID: 9572819 DOI: 10.1152/jappl.1998.84.5.1692] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Inspiratory muscle fatigue can probably determine hypercapnic respiratory failure. Diaphragm fatigue is detected by electrical phrenic stimulation (ELS), but there is no simple tool to assess rib cage muscle (RCM) fatigue. Cervical magnetic stimulation (CMS) costimulates the phrenic nerves and RCM. We reasoned that changes in transdiaphragmatic pressure twitch (Pdi,tw) with CMS and ELS should be different after selective diaphragm vs. RCM fatigue. Five volunteers performed inspiratory resistive tasks while voluntarily uncoupling diaphragm and RCM. Baseline Pdi,twELS and Pdi,twCMS were 28.57 +/- 1.68 and 32.83 +/- 2.92 cmH2O. After selective diaphragm loading, Pdi,twELS and Pdi,twCMS were reduced by 39 and 26%, with comparable decreases in gastric pressure twitch (Pga,tw). Esophageal pressure twitch (Pes,tw) was better preserved with CMS. Therefore Pes,tw/Pga,tw was lower with ELS than CMS (-1.24 +/- 0.16 vs. -1.73 +/- 0.11, P = 0.05). After selective RCM loading, there was no diaphragm fatigue, but Pes,twCMS was significantly reduced (-30%). These findings support the role of rib cage stiffening by CMS-related RCM contraction in the ELS-CMS differences and suggest that CMS can be used to assess RCM fatigue.
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Affiliation(s)
- T Similowski
- Laboratoire de Physiopathologie Respiratoire,Service de Physiopatholog ie Respiratoire, Paris, France
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32
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Attali V, Mehiri S, Straus C, Salachas F, Arnulf I, Meininger V, Derenne JP, Similowski T. Influence of neck muscles on mouth pressure response to cervical magnetic stimulation. Am J Respir Crit Care Med 1997; 156:509-14. [PMID: 9279232 DOI: 10.1164/ajrccm.156.2.9612053] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Measurement of mouth pressure (Pm) in response to electrical phrenic nerve stimulation (Es) provides a simple noninvasive means to assess diaphragm function. An even simpler measure would be to use the Pm twitch response (Pm,t) to cervical magnetic stimulation (CMS) rather than to Es. Because CMS coactivates the diaphragm and inspiratory neck muscles (INM), CMS-Pm,t accurately reflects diaphragm function only if the corresponding INM contraction does not produce inspiratory pressures by itself. In patients with recent-onset bilateral diaphragm paralysis, it has been demonstrated that CMS-Pm,t was indeed zero; however, INM hypertrophy could change this situation and lead CMS-Pm,t to overestimate the performance of the diaphragm. To address this issue, we studied nine patients with amyotrophic lateral sclerosis (ALS) who had evidence of diaphragmatic paralysis and compensatory hypertrophy and hyperactivity of inspiratory neck muscles. The response to CMS was described in terms of diaphragm electromyogram (EMG), Pm, and abdominal (AB) and rib cage (RC) motion. No EMG response to CMS could be observed in most cases, and CMS was always associated with AB paradox. Nevertheless, a negative Pm,t swing was recorded with an amplitude of -2.6 +/- 1.0 cm H2O (mean +/- SD). We conclude that inspiratory neck muscle hypertrophy can significantly influence the Pm response to CMS. This should be taken into account when using the CMS-Pm combination in patients with possible chronic diaphragm dysfunction.
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Affiliation(s)
- V Attali
- Laboratoire de Physiopathologie Respiratoire, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Similowski T, Straus C, Attali V, Girard F, Philippe F, Deray G, Thomas D, Derenne JP. Neuromuscular blockade with acute respiratory failure in a patient receiving cibenzoline. Thorax 1997; 52:582-4. [PMID: 9227733 PMCID: PMC1758590 DOI: 10.1136/thx.52.6.582] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cibenzoline is a class Ic antiarrhythmic agent that can be used to treat supraventricular arrhythmias. A case is reported of cibenzoline overdose in a patient with impaired renal function, leading not only to the usual cardiac and metabolic symptoms (bradycardia and hypoglycaemia), but also to a myastheniform syndrome with acute respiratory failure. Neuromuscular blockade was demonstrated by repetitive supramaximal stimulation of the median nerve, and diaphragmatic involvement was evidenced by applying the same protocol to the phrenic nerve. Muscle strength recovered as serum cibenzoline levels decreased, allowing the patient to be weaned from the ventilator. This observation suggests that cibenzoline, like other antiarrhythmic agents, can be responsible for neuromuscular blockade, and should therefore be used with caution in patients with neuromuscular and respiratory diseases or with impaired renal function.
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Affiliation(s)
- T Similowski
- Service de Pneumologie et Réanimation, Groupe Hospitalier Pitié-Salpêtrière, France
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Similowski T, Mehiri S, Duguet A, Attali V, Straus C, Derenne JP. Comparison of magnetic and electrical phrenic nerve stimulation in assessment of phrenic nerve conduction time. J Appl Physiol (1985) 1997; 82:1190-9. [PMID: 9104856 DOI: 10.1152/jappl.1997.82.4.1190] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Cervical magnetic stimulation (CMS), a nonvolitional test of diaphragm function, is an easy means for measuring the latency of the diaphragm motor response to phrenic nerve stimulation, namely, phrenic nerve conduction time (PNCT). In this application, CMS has some practical advantages over electrical stimulation of the phrenic nerve in the neck (ES). Although normal ES-PNCTs have been consistently reported between 7 and 8 ms, data are less homogeneous for CMS-PNCTs, with some reports suggesting lower values. This study systematically compares ES- and CMS-PNCTs for the same subjects. Surface recordings of diaphragmatic electromyographic activity were obtained for seven healthy volunteers during ES and CMS of varying intensities. On average, ES-PNCTs amounted to 6.41 +/- 0.84 ms and were little influenced by stimulation intensity. With CMS, PNCTs were significantly lower (average difference 1.05 ms), showing a marked increase as CMS intensity lessened. ES and CMS values became comparable for a CMS intensity 65% of the maximal possible intensity of 2.5 Tesla. These findings may be the result of phrenic nerve depolarization occurring more distally than expected with CMS, which may have clinical implications regarding the diagnosis and follow-up of phrenic nerve lesions.
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Affiliation(s)
- T Similowski
- Service de Pneumologie et Réanimation and Laboratoire de Physiopathologie Respiratoire, Groupe Hospitalier Pitié-Salpêtrière,Paris, France.
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35
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Similowski T, Straus C, Attali V, Duguet A, Jourdain B, Derenne JP. Assessment of the motor pathway to the diaphragm using cortical and cervical magnetic stimulation in the decision-making process of phrenic pacing. Chest 1996; 110:1551-7. [PMID: 8989076 DOI: 10.1378/chest.110.6.1551] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Phrenic nerve pacing is a recognized substitute to positive pressure ventilation via tracheotomy in patients with high cervical cord lesions or central hypoventilation. Although its indications are infrequent, reliable strategies need to be used in the determinations of patients who may benefit from this treatment; contraindications should be carefully respected. STUDY OBJECTIVES To determine whether modern and noninvasive means to study the motor pathway to the diaphragm, namely cortical magnetic stimulation (CxMS) and cervical magnetic stimulation (CMS), can contribute to the selection of patients who may benefit from phrenic pacing. DESIGN AND SETTING Prospective study (18 months), on a consecutive basis, of patients referred for possible phrenic pacing to a 10-bed ICU associated with a respiratory neurophysiology laboratory. PATIENTS Seven patients (high cervical cord injury, n = 5; central hypoventilation following neurosurgery, n = 1; idiopathic acquired central hypoventilation, n = 1). INTERVENTION, MEASUREMENTS, AND RESULTS: Electromyography of the diaphragm and transdiaphragmatic pressure were assessed in response to CxMS and CMS. In three cases, no interruption of the corticodiaphragmatic pathway was evidenced, the decision of pacing was postponed, and the patients eventually recovered a spontaneous breathing activity. In two cases, the diagnosis of irreversible peripheral phrenic dysfunction was reached and pacing was denied. In two cases, complete interruption of the corticodiaphragmatic pathway and integrity of peripheral conduction led to the decision of phrenic pacemaker implantation. CONCLUSION CxMS and CMS can be used to refine the assessment of patients proposed for phrenic pacing. CxMS can possibly identify those in whom there is a possibility for eventual recovery, and therefore substantiate a decision to postpone the pacing.
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Affiliation(s)
- T Similowski
- Unité de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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36
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Similowski T, Duguet A, Straus C, Attali V, Boisteanu D, Derenne JP. Assessment of the voluntary activation of the diaphragm using cervical and cortical magnetic stimulation. Eur Respir J 1996; 9:1224-31. [PMID: 8804942 DOI: 10.1183/09031936.96.09061224] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The twitch occlusion technique is a promising tool for use in accessing central drive to the diaphragm and determining maximal transdiaphragmatic pressure (Pdi) from submaximal efforts. It clinical use is limited by difficulties inherent to bilateral electrical stimulation (BES) of the phrenic nerves. This study was designed to revisit the technique using cervical magnetic stimulation (CMS). In addition, the effects of a voluntary contraction on diaphragm response to magnetic stimulation of the cortex (CxMS) were studied. Seven volunteers aged 23-33 yrs were studied. Pdi was determined at relaxed functional residual capacity (FRC) in response to BES (Pdi,P-ES) and CMS (Pdi,p-CMS), and the effects of an increasing voluntary contraction (Pdi, vol) were assessed, The same procedure was applied to CxMS. Pdi,p-CMS at relaxed FRC was 27.5 +/- 2.2 cmH2O (mean+/-SEM), about 20% higher than Pdi,p-ES, and reported previously. Pd,p-CMS linearly decreased with Pdi, vol, and six out of seven subjects were capable of producing voluntary contractions sufficient to extinguish the twitch. More complex patterns were observed with CxMS. Cervical magnetic stimulation provides diaphragmatic twitch occlusion data very similar to bilateral electrical phrenic stimulation. Magnetic stimulation, be it cervical or cortical, could probably be helpful for the assessment of central and peripheral mechanisms of diaphragmatic dysfunction in the clinical setting.
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Affiliation(s)
- T Similowski
- Laboratoire de Physiopathologie Respiratoire, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Arnulf I, Garma L, Mehiri S, Attali V, Similowski T, Salachas F, Meininger V, Derenne JP. Sommeil au cours de la sclérose latérale amyotrophique. Neurophysiol Clin 1996. [DOI: 10.1016/s0987-7053(97)89155-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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