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Khalifé M, Vergari C, Assi A, Guigui P, Attali V, Valentin R, Vafadar S, Ferrero E, Skalli W. Full-body Postural Alignment Analysis Through Barycentremetry. Spine (Phila Pa 1976) 2024:00007632-990000000-00630. [PMID: 38571297 DOI: 10.1097/brs.0000000000005001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
STUDY DESIGN Multicentric retrospective. OBJECTIVE The study of center of mass (COM) locations (i.e. barycentremetry) can help us understand postural alignment. This study goal was to determine relationships between COM locations and global postural alignment X-ray parameters in healthy subjects. The second objective was to determine the impact on spinopelvic alignment of increased distance between anterior body envelope and spine at lumbar apex level. SUMMARY OF BACKGROUND DATA Unexplored relationship between COM location and spinopelvic parameters. METHODS This study included healthy volunteers with full-body biplanar radiograph including body envelope reconstruction, allowing the estimation of COM location. The following parameters were analyzed: lumbar lordosis (LL), thoracic kyphosis (TK), cervical lordosis (CL), pelvic tilt (PT), Sacro-femoral angle (SFA), Knee flexion angle (KFA), sagittal odontoid-hip axis angle (ODHA). The following COM in the sagittal plane were located: whole body, at thoracolumbar inflexion point, and body segment above TK apex. The body envelope reconstruction also provided the distance between anterior skin and the LL apex vertebral body center ("SV-L distance"). RESULTS This study included 124 volunteers, with a mean age of 44±19.3. Multivariate analysis confirmed posterior translation of COM above TK apex with increasing LL (P=0.002) through its proximal component, and posterior shift of COM at inflexion point with increasing TK (P=0.008). Increased SV-L distance was associated with greater ODHA (r=0.4) and more anterior body COM (r=0.8), caused by increased TK (r=0.2) and decreased proximal and distal LL (both r=0.3), resulting in an augmentation in SFA (r=0.3) (all P<0.01). CONCLUSIONS Barycentremetry showed that greater LL was associated with posterior shift of COM above thoracic apex while greater TK was correlated with more posterior COM at inflexion point. Whole-body COM was strongly correlated with ODHA. This study also exhibited significant alignment disruption associated with increased abdominal volume, with compensatory hip extension. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Marc Khalifé
- Orthopaedic Surgery Department, Spine Unit, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
- Université Paris-Cité, Paris, France
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013 Paris, France
| | - Claudio Vergari
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013 Paris, France
| | - Ayman Assi
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013 Paris, France
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Pierre Guigui
- Orthopaedic Surgery Department, Spine Unit, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
- Université Paris-Cité, Paris, France
| | - Valérie Attali
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013 Paris, France
- Service des Pathologies du Sommeil (Département "R3S"), Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, Paris, France
| | - Rémi Valentin
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013 Paris, France
- Service des Pathologies du Sommeil (Département "R3S"), Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, Paris, France
| | - Saman Vafadar
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013 Paris, France
| | - Emmanuelle Ferrero
- Orthopaedic Surgery Department, Spine Unit, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
- Université Paris-Cité, Paris, France
| | - Wafa Skalli
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013 Paris, France
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Pépin JL, Attali V, Caussé C, Verbraecken J, Hedner J, Lecomte I, Tamisier R, Lévy P, Lehert P, Dauvilliers Y. Long-Term Efficacy and Safety of Pitolisant for Residual Sleepiness Due to OSA. Chest 2024; 165:692-703. [PMID: 37979718 DOI: 10.1016/j.chest.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/05/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND In people with OSA, excessive daytime sleepiness is a prominent symptom and can persist despite adherence to CPAP, the first-line therapy for OSA. Pitolisant was effective in reducing daytime sleepiness in two 12-week randomized controlled trials (RCTs), one in patients adherent to CPAP (BF2.649 in Patients With OSA and Treated by CPAP But Still Complaining of EDS [HAROSA 1]) and the other in patients refusing or not tolerating CPAP (BF2.649 in Patients With OSA, Still Complaining of EDS and Refusing to be Treated by CPAP [HAROSA 2]). RESEARCH QUESTION Does the efficacy and safety of pitolisant persist when these patients take it long-term? STUDY DESIGN AND METHODS All adults included in the HAROSA 1 and HAROSA 2 RCTs (both pitolisant and placebo arms) were offered pitolisant (up to 20 mg/d) after completion of the short-term double-anonymized phase (ie, from week 13) in an open-label cohort study. The primary efficacy outcome was the change in Epworth Sleepiness Scale score between baseline and week 52. Safety outcomes were treatment-emergent adverse event(s) (TEAE[s]), serious TEAEs, and special interest TEAEs. RESULTS Out of 512 adults included in the two RCTs, 376 completed the 1-year follow-up. The pooled mean difference in Epworth Sleepiness Scale score from baseline to 1 year for the intention-to-treat sample was -8.0 (95% CI, -8.3 to -7.5). The overall proportions of TEAEs, serious TEAEs, and TEAEs of special interest were 35.1%, 2.0%, and 11.1%, respectively, without any significant difference between patients in the initial pitolisant and placebo arms. No cardiovascular safety issues were reported. INTERPRETATION Pitolisant is effective in reducing daytime sleepiness over 1 year in adults with OSA, with or without CPAP treatment. Taken for 1 year, it has a good safety profile (including cardiovascular). TRIAL REGISTRATION ClinicalTrials.gov; Nos.: NCT01071876 and NCT01072968; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Jean-Louis Pépin
- HP2 Laboratory, INSERM U1300, University Grenoble Alpes, Grenoble, France; EFCR (Cardiovascular and Respiratory Function) Laboratory, Grenoble Alpes University Hospital, Grenoble, France.
| | - Valérie Attali
- Department of Experimental and Clinical Neurophysiology, UMRS1158, INSERM Sorbonne University, Paris, France; Sleep Disorders Unit (Department R3S, DMU APPROCHES), Groupe Hospitalier Universitaire APHP- Sorbonne, Paris, France
| | | | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium; University of Antwerp, Antwerp, Belgium
| | - Jan Hedner
- Sleep and Vigilance Laboratory, Department of Internal Medicine, Sahlgrenska University Hospital, University of Göteborg, Göteborg, Sweden
| | | | - Renaud Tamisier
- HP2 Laboratory, INSERM U1300, University Grenoble Alpes, Grenoble, France; EFCR (Cardiovascular and Respiratory Function) Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Patrick Lévy
- HP2 Laboratory, INSERM U1300, University Grenoble Alpes, Grenoble, France; EFCR (Cardiovascular and Respiratory Function) Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Philippe Lehert
- Louvain School of Management, Louvain University, Mons, Belgium; Faculty of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
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Valentin R, Niérat M, Wattiez N, Jacq O, Decavèle M, Arnulf I, Similowski T, Attali V. Neurophysiological basis of respiratory discomfort improvement by mandibular advancement in awake OSA patients. Physiol Rep 2024; 12:e15951. [PMID: 38373738 PMCID: PMC10984610 DOI: 10.14814/phy2.15951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/21/2024] Open
Abstract
Patients with obstructive sleep apneas (OSA) do not complain from dyspnea during resting breathing. Placement of a mandibular advancement device (MAD) can lead to a sense of improved respiratory comfort ("pseudo-relief") ascribed to a habituation phenomenon. To substantiate this conjecture, we hypothesized that, in non-dyspneic awake OSA patients, respiratory-related electroencephalographic figures, abnormally present during awake resting breathing, would disappear or change in parallel with MAD-associated pseudo-relief. In 20 patients, we compared natural breathing and breathing with MAD on: breathing discomfort (transitional visual analog scale, VAS-2); upper airway mechanics, assessed in terms of pressure peak/time to peak (TTP) ratio respiratory-related electroencephalography (EEG) signatures, including slow event-related preinspiratory potentials; and a between-state discrimination based on continuous connectivity evaluation. MAD improved breathing and upper airway mechanics. The 8 patients in whom the EEG between-state discrimination was considered effective exhibited higher Peak/TTP improvement and transitional VAS ratings while wearing MAD than the 12 patients where it was not. These results support the notion of habituation to abnormal respiratory-related afferents in OSA patients and fuel the causative nature of the relationship between dyspnea, respiratory-related motor cortical activity and impaired upper airway mechanics in this setting.
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Affiliation(s)
- Rémi Valentin
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Hôpital Pitié‐Salpêtrière, Département R3S, Service des Pathologies du Sommeil (Département R3S)AP‐HP, Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
- Institut de Biomécanique Humaine Georges CharpakÉcole Nationale Supérieure des Arts et MétiersParisFrance
| | - Marie‐Cécile Niérat
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
| | - Nicolas Wattiez
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
| | - Olivier Jacq
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
| | - Maxens Decavèle
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Service de Médecine Intensive et Réanimation (Département R3S)Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
| | - Isabelle Arnulf
- Hôpital Pitié‐Salpêtrière, Département R3S, Service des Pathologies du Sommeil (Département R3S)AP‐HP, Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
- Paris Brain Institute (ICM)Sorbonne UniversitéParisFrance
| | - Thomas Similowski
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Hôpital, Pitié‐Salpêtrière, Département R3SAP‐HP, Groupe Hospitalier APHP‐Sorbonne UniversitéParisFrance
| | - Valérie Attali
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Hôpital Pitié‐Salpêtrière, Département R3S, Service des Pathologies du Sommeil (Département R3S)AP‐HP, Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
- Institut de Biomécanique Humaine Georges CharpakÉcole Nationale Supérieure des Arts et MétiersParisFrance
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Bironneau V, Ingrand P, Pontier S, 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 MF, Gagnadoux F, Meurice JC. Auto-adjusted versus fixed positive airway pressure in patients with severe OSA: A large randomized controlled trial. Respirology 2023; 28:1069-1077. [PMID: 37587548 DOI: 10.1111/resp.14569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/07/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Continuous positive airway pressure (CPAP) in the treatment of severe obstructive sleep apnoea (OSA) can be used in fixed CPAP or auto-adjusted (APAP) mode. The aim of this prospective randomized controlled clinical study was to evaluate the 3 month-efficacy of CPAP used either in fixed CPAP or APAP mode. METHODS Eight hundred one patients with severe OSA were included in twenty-two French centres. After 7 days during which all patients were treated with APAP to determine the effective pressure level and its variability, 353 and 351 patients were respectively randomized in the fixed CPAP group and APAP group. After 3 months of treatment, 308 patients in each group were analysed. RESULTS There was no difference between the two groups in terms of efficacy whatever the level of efficient pressure and pressure variability (p = 0.41). Exactly, 219 of 308 patients (71.1%) in the fixed CPAP group and 212 of 308 (68.8%) in the APAP group (p = 0.49) demonstrated residual apnoea hypopnoea index (AHI) <10/h and Epworth Score <11. Tolerance and adherence were also identical with a similar effect on quality of life and blood pressure evaluation. CONCLUSION The two CPAP modes, fixed CPAP and APAP, were equally effective and tolerated in severe OSA patients.
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Affiliation(s)
- Vanessa Bironneau
- INSERM CIC 1402, IS-ALIVE Research Group, University of Poitiers, Poitiers, France
- Pneumologie, CHU de Poitiers, Poitiers, France
| | | | | | | | | | | | | | | | | | | | | | - Renaud Tamisier
- Université Grenoble Alpes, Inserm U1300, CHU Grenoble Alpes, Grenoble, France
| | | | | | | | - Guy Auregan
- Pneumologie, Polyclinique de Poitiers, Poitiers, France
| | | | - Valérie Attali
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Département R3S, Service des Pathologies du Sommeil, AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | | | | | - Didier Recart
- Pneumologie, Cabinet Médical Arnasa, Biarritz, France
| | | | - Frédéric Gagnadoux
- Département de Pneumologie et Médecine du sommeil, CHU d'Angers, Angers, France
| | - Jean-Claude Meurice
- INSERM CIC 1402, IS-ALIVE Research Group, University of Poitiers, Poitiers, France
- Pneumologie, CHU de Poitiers, Poitiers, France
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Rossi J, Gales A, Attali V, Leu-Smenescu S, Dodet P, Groos E, Arnulf I. Do the EEG and behavioral criteria of NREM arousal disorders apply to sexsomnia? Sleep 2023:7068072. [PMID: 36866491 DOI: 10.1093/sleep/zsad056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/20/2022] [Indexed: 03/04/2023] Open
Abstract
STUDY OBJECTIVES To establish whether the recent EEG and behavioral criteria of arousal disorders apply to sexsomnia. METHODS EEG and behavioral markers upon N3 sleep interruptions in videopolysomnography were retrospectively compared in 24 participants with sexsomnia, 41 participants with arousals disorders, and 40 healthy controls. The specificity and sensitivity of previously suggested EEG and behavioral cutoffs for supporting arousal disorders diagnosis were measured in the sexsomnia vs. control groups. RESULTS Participants with sexsomnia and arousals disorders showed a higher N3 fragmentation index, slow/mixed N3 arousal index, and number of eye openings during N3 interruptions than healthy controls. Ten (41.7%) participants with sexsomnia (vs. one sleepwalker and no control) displayed an apparently sexual behavior (masturbation, sexual vocalization, pelvic thrusting, and hand within the pajama) during N3 arousal. An N3 sleep fragmentation index ≥ 6.8/h of N3 sleep and two or more N3 arousals associated with eye opening was 95% specific but poorly (46% and 42%) sensitive for diagnosing sexsomnia. An index of slow/mixed N3 arousals ≥ 2.5/h of N3 sleep was 73% specific and 67% sensitive. An N3 arousal with trunk raising, sitting, speaking, showing an expression of fear/surprise, shouting, or exhibiting sexual behavior was 100% specific for a diagnosis of sexsomnia. CONCLUSION In patients with sexsomnia, videopolysomnography based markers of arousal disorders are intermediate between healthy individuals and patients with other arousal disorders, supporting the concept of sexsomnia as a specialized, but less neurophysiologically severe, NREM parasomnia. Previously validated criteria for arousal disorders partially fit in patients with sexsomnia.
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Affiliation(s)
- Jessica Rossi
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Ana Gales
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
| | - Valérie Attali
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France.,INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Smaranda Leu-Smenescu
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France.,Paris Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Pauline Dodet
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France.,Sorbonne University, Paris, France
| | - Elisabeth Groos
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
| | - Isabelle Arnulf
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France.,Paris Brain Institute (ICM), INSERM, CNRS, Paris, France.,Sorbonne University, Paris, France
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Attali V, Weber M, Rivals I, Similowski T, Arnulf I, Gatignol P. Moderate-to-severe obstructive sleep apnea syndrome is associated with altered tongue motion during wakefulness. Eur Arch Otorhinolaryngol 2023; 280:2551-2560. [PMID: 36707431 DOI: 10.1007/s00405-023-07854-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/11/2022] [Accepted: 01/18/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Impairment of genioglossus control is a frequent "non-anatomical" cause of obstructive sleep apnea syndrome (OSAS) in non- or mildly obese patients. Although wake-related compensatory mechanisms prevent the occurrence of obstructive events, the genioglossus control is often impaired during wakefulness. We hypothesized that the lingual motion would be altered during wakefulness in this population in patients with moderate-to-severe OSAS. METHODS We included non- or mildly obese participants with suspected OSAS. They underwent a Bucco-Linguo-Facial Motor Skills assessment using the MBLF ("Motricité Bucco-Linguo-Faciale"), which includes an evaluation of 13 movements of the tongue. This was followed by a night-attended polysomnography. We compared patients with moderate-to-severe OSAS (apnea-hypopnea index (AHI) ≥ 15/h; n = 15) to patients without or with mild OSAS (AHI < 15/h; n = 24). RESULTS MBLF total and "tongue" sub-scores were lower in patients with moderate-to-severe OSAS: total z-score - 0.78 [- 1.31; 0.103] versus 0.20 [- 0.26; 0.31], p = 0.0011; "tongue" z-sub-score (- 0.63 [- 1.83; 0.41] versus 0.35 [0.26; 0.48], p = 0.014). There was a significant age-adjusted correlation between the "tongue" sub-score and AHI. The logistic regression model for the prediction of moderate-to-severe OSAS gave area under the curve ratio of 88.2% for MBLF score plus age. CONCLUSIONS Myofunctional activity of the tongue is impaired during wakefulness in non- or mildly obese patients with moderate-to-severe OSAS. This study supports the lingual myofunctional assessment using the MBLF in screening of moderate-to-severe OSAS. This simple tool could help clinicians to select patients with suspected moderate-to-severe OSAS for polysomnography.
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Affiliation(s)
- Valérie Attali
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France. .,Département R3S, Service des Pathologies du Sommeil, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013, Paris, France.
| | - Mathilde Weber
- Département d'Orthophonie, Faculté de Médecine UFR 967, Sorbonne Université, 75013, Paris, France
| | - Isabelle Rivals
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, Paris, France
| | - Thomas Similowski
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Département R3S, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
| | - Isabelle Arnulf
- Département R3S, Service des Pathologies du Sommeil, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institut du Cerveau, Paris Brain Institute-ICM, INSERM, CNRS, Sorbonne Université, 75013, Paris, France
| | - Peggy Gatignol
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Département d'Orthophonie, Faculté de Médecine UFR 967, Sorbonne Université, 75013, Paris, France.,Service d'Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
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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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Khalifé M, Vergari C, Ferrero E, Attali V, Heidsieck C, Assi A, Skalli W. The rib cage: a new element in the spinopelvic chain. Eur Spine J 2022; 31:1457-1467. [PMID: 35501578 DOI: 10.1007/s00586-022-07216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 03/03/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION This study analyzes anatomical variations of the thoracic cage (TC) according to spinopelvic alignment, age and gender using stereoradiography in erect position. METHODS This retrospective multicentric study analyzed computed parameters collected from free-standing position bi-planar radiographs, among healthy subjects. Collected data were: age, gender, pelvic parameters (Pelvic Incidence, Pelvic Tilt (PT) and Sacral Slope), T1-T12 Kyphosis (TK), L1-S1 Lordosis (LL), curvilinear spinal length, global TC parameters (maximum thickness and width, rib cage volume, mean Spinal Penetration Index (SPI)), 1st-10th rib parameters (absolute and relative (to the corresponding vertebra) sagittal angles). RESULTS Totally, 256 subjects were included (140 females). Mean age was 34 (range: 8-83). Significant correlations were found between TK and TC thickness (0.3, p < 0.001) and with TC Volume (0.3, p = 0.04), as well as rib absolute sagittal angle for upper and middle ribs (0.2, p = 0.02). Conversely, a -0.3 correlation has been exhibited between SPI and TK. Similar correlations were found with LL. PT significantly correlated with TC thickness (0.4, p = 0.003), SPI (-0.3, p = 0.03), and all rib relative sagittal angles. Among global TC parameters, only thickness and SPI significantly changed after 20 years (respectively, 0.39 and -0.52, p < 0.001). Ribs relative sagittal angle showed negative correlation with age in skeletally mature subjects (p < 0.001). CONCLUSION This study demonstrates the correlation between TC anatomy and spinopelvic parameters, confirming its part of the spinopelvic chain of balance. Indeed, higher spinal curvatures were associated with lower SPI and higher TC thickness, TC volume and rib absolute sagittal angles.
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Affiliation(s)
- Marc Khalifé
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015, Paris, France. .,Université Paris Cité, Paris, France. .,Arts Et Métiers Institute of Technology, Université Sorbonne Paris Nord, Villetaneuse, France. .,IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France.
| | - Claudio Vergari
- Arts Et Métiers Institute of Technology, Université Sorbonne Paris Nord, Villetaneuse, France.,IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France
| | - Emmanuelle Ferrero
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015, Paris, France.,Université Paris Cité, Paris, France
| | - Valérie Attali
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Sorbonne Université, Paris, France.,Service Des Pathologies du Sommeil (Département "R3S"), Assistance Publique Hôpitaux de Paris (APHP), Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Cécile Heidsieck
- Arts Et Métiers Institute of Technology, Université Sorbonne Paris Nord, Villetaneuse, France.,IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France
| | - Ayman Assi
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Wafa Skalli
- Arts Et Métiers Institute of Technology, Université Sorbonne Paris Nord, Villetaneuse, France.,IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France
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10
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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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11
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Vergari C, Skalli W, Clavel L, Demuynck M, Valentin R, Sandoz B, Similowski T, Attali V. Functional analysis of the human rib cage over the vital capacity range in standing position using biplanar X-ray imaging. Comput Biol Med 2022; 144:105343. [DOI: 10.1016/j.compbiomed.2022.105343] [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] [Received: 01/20/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022]
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Kerbrat A, Rivals I, Dupuy P, Dot G, Berg BI, Attali V, Schouman T. Biplanar Low-Dose Radiograph Is Suitable for Cephalometric Analysis in Patients Requiring 3D Evaluation of the Whole Skeleton. J Clin Med 2021; 10:5477. [PMID: 34884179 PMCID: PMC8658104 DOI: 10.3390/jcm10235477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The biplanar 2D/3D X-ray technology (BPXR) is a 2D/3D imaging system allowing simultaneous stereo-corresponding posteroanterior (PA) and lateral 2D views of the whole body. The aim of our study was to assess the feasibility of cephalometric analysis based on the BPXR lateral skull view to accurately characterize facial morphology. METHOD A total of 17 landmarks and 11 angles were placed and/or calculated on lateral BPXR and lateral cephalograms of 13 patients by three investigators. Five methods of angle identification were performed: the direct construction of straight lines on lateral cephalograms (LC-A) and on BPXR (BPXR-A), as well as the calculation of angles based on landmark identification on lateral cephalograms (LA-L) and on BPXR with the PA image (BPXR-LPA) or without (BPXR-L). Intra- and interoperator reliability of landmark identification and angle measurement of each method were calculated. To determine the most reliable method among the BPXR-based methods, their concordance with the reference method, LC-A, was evaluated. RESULTS Both imaging techniques had excellent intra- and interoperator reliability for landmark identification. On lateral BPXR, BPXR-A presented the best concordance with the reference method and a good intra- and interoperator reliability. CONCLUSION BPXR provides a lateral view of the skull suitable for cephalometric analysis with good reliability.
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Affiliation(s)
- Adeline Kerbrat
- Service de Chirurgie Maxillo-Faciale, Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, 75013 Paris, France; (P.D.); (T.S.)
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 75013 Paris, France; (G.D.); (V.A.)
- Sorbonne Université, Inserm, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005 Paris, France;
| | - Isabelle Rivals
- Sorbonne Université, Inserm, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005 Paris, France;
- Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, 75231 Paris, France
| | - Pauline Dupuy
- Service de Chirurgie Maxillo-Faciale, Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, 75013 Paris, France; (P.D.); (T.S.)
| | - Gauthier Dot
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 75013 Paris, France; (G.D.); (V.A.)
| | - Britt-Isabelle Berg
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland;
| | - Valérie Attali
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 75013 Paris, France; (G.D.); (V.A.)
- Sorbonne Université, Inserm, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005 Paris, France;
- Service des Pathologies du Sommeil, Département R3S, Hôpital Pitié-Salpêtrière, AP-HP. Sorbonne Université, 75013 Paris, France
| | - Thomas Schouman
- Service de Chirurgie Maxillo-Faciale, Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, 75013 Paris, France; (P.D.); (T.S.)
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 75013 Paris, France; (G.D.); (V.A.)
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13
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Vecchierini MF, Attali V, Collet JM, d'Ortho MP, Goutorbe F, Kerbrat JB, Leger D, Lavergne F, Monaca C, Monteyrol PJ, Mullens E, Pigearias B, Martin F, Khemliche H, Lerousseau L, Meurice JC. Mandibular advancement device use in obstructive sleep apnea: ORCADES study 5-year follow-up data. J Clin Sleep Med 2021; 17:1695-1705. [PMID: 34165074 DOI: 10.5664/jcsm.9308] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVES Mandibular advancement devices (MADs) are an alternative to continuous positive airway pressure for the management of obstructive sleep apnea (OSA). The ORthèse d'avanCée mAndibulaire dans le traitement en DEuxième intention du SAHOS sévère (ORCADES) study is investigating the long-term effectiveness of MAD therapy in patients with OSA who refused or were intolerant of continuous positive airway pressure. Five-year follow-up data are presented. METHODS Data were available in 172 of 331 patients treated with a custom-made computer-aided design/computer-aided manufacturing biblock MAD (Narval CC; ResMed, Saint-Priest, France). The primary end point was treatment success (≥50% decrease in apnea-hypopnea index from baseline). RESULTS Five-year treatment success rates were 52% overall and 25%, 52%, and 63%, respectively, in patients with mild, moderate, or severe OSA. This reflects a decline over time vs 3-6 months (79% overall) and 2 years (68%). Rates declined in all patient subgroups but to the greatest extent in patients with mild OSA. The slight worsening of respiratory parameters over time was not associated with any relevant changes in sleepiness and symptoms. Moderate or severe OSA at baseline, treatment success at 3-6 months, and no previous continuous positive airway pressure use were significant independent predictors of 5-year treatment success on multivariate analysis. No new safety signals emerged during long-term follow-up. The proportion of patients using their MAD for ≥4 h/night on ≥4 days/wk was 93.3%; 91.3% of patients reported device use of ≥6 h/night at 5 years. At 5-year follow-up, 96.5% of patients reported that they wanted to continue MAD therapy. CONCLUSIONS Long-term MAD therapy remained effective after 5 years in >50% of patients, with good levels of patient satisfaction and adherence. CITATION Vecchierini MF, Attali V, Collet JM, et al. Mandibular advancement device use in obstructive sleep apnea: ORCADES study 5-year follow-up data. J Clin Sleep Med. 2021;17(8):1695-1705.
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Affiliation(s)
- Marie-Françoise Vecchierini
- AP-HP, Hôpital Hôtel Dieu, Centre du Sommeil et de la Vigilance, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Valérie Attali
- AP-HP Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Jean-Marc Collet
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Stomatologie et Chirurgie Maxillo-Faciale, Paris, France
| | - Marie-Pia d'Ortho
- Physiologie Clinique- Explorations Fonctionnelles et Centre du Sommeil, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France.,Université de Paris, INSERM, UMR 1141 NeuroDiderot, Paris, France
| | - Frederic Goutorbe
- Centre Médecine du Sommeil, Centre Hospitalier de Béziers, Béziers, France
| | - Jean-Baptiste Kerbrat
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Stomatologie et Chirurgie Maxillo-Faciale, Paris, France.,Hôpital Charles Nicolle, Stomatologie et Chirurgie Maxillo-Faciale, Rouen, France
| | - Damien Leger
- AP-HP, Hôpital Hôtel Dieu, Centre du Sommeil et de la Vigilance, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | | | | | - Eric Mullens
- Fondation Bon Sauveur, Laboratoire du Sommeil, Albi, France
| | | | - Francis Martin
- AP-HP Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France
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14
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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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15
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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 for Residual Excessive Daytime Sleepiness in OSA Patients Adhering to CPAP: A Randomized Trial. Chest 2020; 159:1598-1609. [PMID: 33121980 DOI: 10.1016/j.chest.2020.09.281] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 05/08/2020] [Revised: 08/11/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) in individuals with OSA syndrome persisting despite good adherence to CPAP is a disabling condition. Pitolisant is a selective histamine H3-receptor antagonist with wake-promoting effects. RESEARCH QUESTION Is pitolisant effective and safe for reducing daytime sleepiness in individuals with moderate to severe OSA adhering to CPAP treatment but experiencing residual EDS? STUDY DESIGN AND METHODS In a multicenter, double-blind, randomized (3:1), placebo-controlled, parallel-design trial, pitolisant was titrated individually at up to 20 mg/day and taken over 12 weeks. The primary end point was change in the Epworth Sleepiness Scale (ESS) score in the intention-to-treat population. Key secondary end points were maintenance of wakefulness assessed by the Oxford Sleep Resistance Test, Clinical Global Impressions scale of severity, the patient's global opinion, EuroQoL quality-of-life questionnaire score, Pichot fatigue questionnaire score, and safety. RESULTS Two hundred forty-four OSA participants (82.8% men; mean age, 53.1 years; mean Apnea Hypopnea Index with CPAP, 4.2/h; baseline ESS score, 14.7) were randomized to pitolisant (n = 183) or placebo (n = 61). ESS significantly decreased with pitolisant compared with placebo (-2.6; 95% CI, -3.9 to -1.4; P < .001), and the rate of responders to therapy (ESS ≤ 10 or change in ESS ≥ 3) was significantly higher with pitolisant (71.0% vs 54.1%; P = .013). Adverse event occurrence (mainly headache and insomnia) was higher in the pitolisant group compared with the placebo group (47.0% and 32.8%, respectively; P = .03). No cardiovascular or other significant safety concerns were reported. INTERPRETATION Pitolisant used as adjunct to CPAP therapy for OSA with residual sleepiness despite good CPAP adherence significantly reduced subjective and objective sleepiness and improved participant-reported outcomes and physician-reported disease severity. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01071876; URL: www.clinicaltrials.gov; EudraCT N°: 2009-017248-14; URL: eudract.ema.europa.eu.
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Affiliation(s)
- Jean-Louis Pépin
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, and EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France.
| | - Ognian Georgiev
- Department of Internal Medicine, Pulmonology, Alexandrovska Hospital Medical University, Sofia, Bulgaria
| | - Rumen Tiholov
- Department of Internal Diseases, Sv. Ivan Rilski Multiprofile Hospital for Active Treatment, Kozloduy, Bulgaria
| | - Valérie Attali
- Neurophysiologie Respiratoire Expérimentale et Clinique UMRS1158, Sorbonne Université, INSERM, and Service des Pathologies du Sommeil (Departement R3S, DMU APPROCHES), Groupe Hospitalier Universitaire APHP-Sorbonne Université, Paris, France
| | - Johan Verbraecken
- Universitair Multidisciplinair Slaap Centrum, Edegem-Antwerp, Belgium
| | - Bertien Buyse
- Leuvens Universitair Centrum voor Slaap-en waakstoornissen, Department of Respiratory Diseases, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Center, Department of Clinical Neurosciences, University of Helsinki, Finland
| | - Ingo Fietze
- Interdisziplinares Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Georgi Belev
- Pulmonology Division, Department of Internal Medicine, St. George Hospital Medical University, Plovdiv, Bulgaria
| | - Dejan Dokic
- Department of Pulmology and Allergy, Mother Teresa Medical University, Skopje, Macedonia
| | - Renaud Tamisier
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, and EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Patrick Lévy
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, and EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Isabelle Lecomte
- Bioprojet, Paris, France; Department of Pulmology and Allergy, Mother Teresa Medical University, Skopje, Macedonia
| | | | | | - Yves Dauvilliers
- Centre National de Référence Narcolepsie, Unité du Sommeil, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Université de Montpellier, INSERM U1061, Montpellier, France
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Straus C, Teulier M, Morel S, Wattiez N, Hajage D, Giboin C, Charbit B, Dasque E, Bodineau L, Chenuel B, Straus N, Attali V, Similowski T. Baclofen destabilises breathing during sleep in healthy humans: A randomised, controlled, double-blind crossover trial. Br J Clin Pharmacol 2020; 87:1814-1823. [PMID: 32986891 DOI: 10.1111/bcp.14569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/28/2020] [Revised: 08/31/2020] [Accepted: 09/13/2020] [Indexed: 11/29/2022] Open
Abstract
AIMS Periodic breathing is frequent in patients with severe heart failure. Apart from being an indicator of severity, periodic breathing has its own deleterious consequences (sleep-related oxygen desaturations, sleep fragmentation), which justifies attempts to correct it irrespective of the underlying disease. Animal models and human data suggest that baclofen can reconfigure respiratory central pattern generators. We hypothesised that baclofen, a GABAB agonist, may thus be able to correct periodic breathing in humans. METHODS Healthy volunteers were exposed to hypoxia during sleep. Participants who developed periodic breathing (n = 14 [53 screened]) were randomly assigned to double-blind oral baclofen (progressively increased to 60 mg/d) or placebo. The primary outcome was the coefficient of variation (CoVar) of respiratory cycle total time considered as an indicator of breathing irregularity. Secondary outcomes included the CoVar of tidal volume, apnoea-hypopnoea index, sleep fragmentation index and ventilatory complexity (noise limit). RESULTS The analysis was conducted in 9 subjects after exclusion of incomplete datasets. CoVar of respiratory cycle total time significantly increased with baclofen during non-rapid eye movement sleep (median with placebo 56.00% [37.63-78.95]; baclofen 85.42% [68.37-86.40], P = .020; significant difference during the N1-N2 phases of sleep but not during the N3 phase). CoVar of tidal volume significantly increased during N1-N2 sleep. The apnoea-hypopnoea index, sleep fragmentation index and ventilatory complexity were not significantly different between placebo and baclofen. CONCLUSION Baclofen did not stabilise breathing in our model. On the contrary, it increased respiratory variability. Baclofen should probably not be used in patients with or at risk of periodic breathing.
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Affiliation(s)
- Christian Straus
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3S, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, Paris, France
| | - Marion Teulier
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Sébastien Morel
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Nicolas Wattiez
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - David Hajage
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Unité de Recherche Clinique Salpêtrière-Charles Foix, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, Paris, France
| | - Caroline Giboin
- AP-HP, Groupe Hospitalier APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Unité de Recherche Clinique Salpêtrière-Charles Foix, Paris, France
| | - Beny Charbit
- INSERM and AP-HP, CIC-1901 module Paris-Est, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France.,Department of Anesthesiology and Intensive Care, CHU Reims, Hôpital Robert Debré, Reims, France
| | - Eric Dasque
- INSERM and AP-HP, CIC-1901 module Paris-Est, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Laurence Bodineau
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Bruno Chenuel
- CHRU de Nancy, Service des Explorations Fonctionnelles Respiratoires et Centre Universitaire de Médecine du Sport et Activité Physique Adaptée, Vandoeuvre-lès-Nancy, France.,Faculté de Médecine de Nancy, EA DevAH - Universié de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Nicolas Straus
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Valérie Attali
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Hôpital Pitié-Salpêtrière, Département R3S, Service des Pathologies du Sommeil, Paris, France
| | - Thomas Similowski
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Hôpital Pitié-Salpêtrière, Département R3S, Service de Pneumologie, Médecine Intensive et Réanimation, Paris, France
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17
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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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18
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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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19
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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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20
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Clavel L, Attali V, Rivals I, Niérat MC, Laveneziana P, Rouch P, Similowski T, Sandoz B. Decreased respiratory-related postural perturbations at the cervical level under cognitive load. Eur J Appl Physiol 2020; 120:1063-1074. [PMID: 32185476 DOI: 10.1007/s00421-020-04345-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/23/2019] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE In healthy humans, postural and respiratory dynamics are intimately linked and a breathing-related postural perturbation is evident in joint kinematics. A cognitive dual-task paradigm that is known to induce both postural and ventilatory disturbances can be used to modulate this multijoint posturo-ventilatory (PV) interaction, particularly in the cervical spine, which supports the head. The objective of this study was to assess this modulation. METHODS With the use of optoelectronic sensors, the breathing profile, articular joint motions of the cervical spine, hip, knees and ankles, and centre of pressure (CoP) displacement were measured in 20 healthy subjects (37 years old [29; 49], 10 females) during natural breathing (NB), a cognitive dual task (COG), and eyes-closed and increased-tidal-volume conditions. The PV interaction in the CoP and joint motions were evaluated by calculating the respiratory emergence (REm). RESULTS Only the COG condition induced a decrease in the cervical REm (NB: 17.2% [7.8; 37.2]; COG: 4.2% [1.8; 10.0] p = 0.0020) concurrent with no changes in the cervical motion. The CoP REm (NB: 6.2% [3.8; 10.3]; COG: 12.9% [5.8; 20.7] p = 0.0696) and breathing frequency (NB: 16.6 min-1 [13.3; 18.7]; COG: 18.6 min-1 [16.3; 19.4] p = 0.0731) tended to increase, while the CoP (p = 0.0072) and lower joint motion displacements (p < 0.05) increased. CONCLUSION This study shows stable cervical spine motion during a cognitive dual task, as well as increased postural perturbations globally and in other joints. The concurrent reduction in the PV interaction at the cervical spine suggests that this "stabilization strategy" is centrally controlled and is achieved by a reduction in the breathing-related postural perturbations at this level. Whether this strategy is a goal for maintaining balance remains to be studied.
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Affiliation(s)
- Louis Clavel
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France. .,Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'Hopital, 75013, Paris, France.
| | - Valérie Attali
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'Hopital, 75013, Paris, France.,Service des Pathologies du Sommeil (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
| | - Isabelle Rivals
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, 75005, Paris, France
| | - Marie-Cécile Niérat
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France
| | - Pierantonio Laveneziana
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, Département "R3S", Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 75013, Paris, France
| | - Philippe Rouch
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'Hopital, 75013, Paris, France
| | - Thomas Similowski
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
| | - Baptiste Sandoz
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'Hopital, 75013, Paris, France
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21
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Clavel L, Rémy-Neris S, Skalli W, Rouch P, Lespert Y, Similowski T, Sandoz B, Attali V. Cervical Spine Hyperextension and Altered Posturo-Respiratory Coupling in Patients With Obstructive Sleep Apnea Syndrome. Front Med (Lausanne) 2020; 7:30. [PMID: 32118015 PMCID: PMC7020015 DOI: 10.3389/fmed.2020.00030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/21/2020] [Indexed: 12/26/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is associated with postural dysfunction characterized by abnormal spinal curvature and disturbance of balance and walking, whose pathophysiology is poorly understood. We hypothesized that it may be the result of a pathological interaction between postural and ventilatory functions. Twelve patients with OSAS (4 women, age 53 years [51–63] (median [quartiles]), apnea hypopnea index 31/h [24–41]) were compared with 12 healthy matched controls. Low dose biplanar X-rays (EOS® system) were acquired and personalized three-dimensional models of the spine and pelvis were reconstructed. We also estimated posturo-respiratory coupling by measurement of respiratory emergence, obtaining synchronized center of pressure data from a stabilometric platform and ventilation data recorded by an optico-electronic system of movement analysis. Compared with controls, OSAS patients, had cervical hyperextension with anterior projection of the head (angle OD-C7 12° [8; 14] vs. 5° [4; 8]; p = 0.002), and thoracic hyperkyphosis (angle T1–T12 65° [51; 71] vs. 49° [42; 59]; p = 0.039). Along the mediolateral axis: (1) center of pressure displacement was greater in OSAS patients, whose balance was poorer (19.2 mm [14.2; 31.5] vs. 8.5 [1.4; 17.8]; p = 0.008); (2) respiratory emergence was greater in OSAS patients, who showed increased postural disturbance of respiratory origin (19.2% [9.9; 24.0] vs. 8.1% [6.4; 10.4]; p = 0.028). These results are evidence for the centrally-mediated and primarily respiratory origin of the postural dysfunction in OSAS. It is characterized by an hyperextension of the cervical spine with a compensatory hyperkyphosis, and an alteration in posturo-respiratory coupling, apparently secondary to upper airway instability.
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Affiliation(s)
- Louis Clavel
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France
| | - Ségolène Rémy-Neris
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Wafa Skalli
- Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France
| | - Philippe Rouch
- Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France
| | - Yoann Lespert
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), Paris, France
| | - Baptiste Sandoz
- Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France
| | - Valérie Attali
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France
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22
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Eastwood PR, Barnes M, MacKay SG, Wheatley JR, Hillman DR, Nguyên XL, Lewis R, Campbell MC, Pételle B, Walsh JH, Jones AC, Palme CE, Bizon A, Meslier N, Bertolus C, Maddison KJ, Laccourreye L, Raux G, Denoncin K, Attali V, Gagnadoux F, Launois SH. Bilateral hypoglossal nerve stimulation for treatment of adult obstructive sleep apnoea. Eur Respir J 2020; 55:13993003.01320-2019. [PMID: 31601716 PMCID: PMC6949509 DOI: 10.1183/13993003.01320-2019] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/21/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIM Hypoglossal nerve stimulation (HNS) decreases obstructive sleep apnoea (OSA) severity via genioglossus muscle activation and decreased upper airway collapsibility. This study assessed the safety and effectiveness at 6 months post-implantation of a novel device delivering bilateral HNS via a small implanted electrode activated by a unit worn externally, to treat OSA: the Genio™ system. METHODS This prospective, open-label, non-randomised, single-arm treatment study was conducted at eight centres in three countries (Australia, France and the UK). Primary outcomes were incidence of device-related serious adverse events and change in the apnoea-hypopnoea index (AHI). The secondary outcome was the change in the 4% oxygen desaturation index (ODI). Additional outcomes included measures of sleepiness, quality of life, snoring and device use. This trial was registered with ClinicalTrials.gov, number NCT03048604. RESULTS 22 out of 27 implanted participants (63% male, aged 55.9±12.0 years, body mass index (BMI) 27.4±3.0 kg·m-2) completed the protocol. At 6 months BMI was unchanged (p=0.85); AHI decreased from 23.7±12.2 to 12.9±10.1 events·h-1, a mean change of 10.8 events·h-1 (p<0.001); and ODI decreased from 19.1±11.2 to 9.8±6.9 events·h-1, a mean change of 9.3 events·h-1 (p<0.001). Daytime sleepiness (Epworth Sleepiness Scale; p=0.01) and sleep-related quality of life (Functional Outcomes of Sleep Questionnaire-10; p=0.02) both improved significantly. The number of bed partners reporting loud, very intense snoring, or leaving the bedroom due to participant snoring decreased from 96% to 35%. 91% of participants reported device use >5 days per week, and 77% reported use for >5 h per night. No device-related serious adverse events occurred during the 6-month post-implantation period. CONCLUSIONS Bilateral HNS using the Genio™ system reduces OSA severity and improves quality of life without device-related complications. The results are comparable with previously published HNS systems despite minimal implanted components and a simple stimulation algorithm.
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Affiliation(s)
- Peter R Eastwood
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Australia .,West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Australia.,University of Melbourne, Parkville, Australia
| | - Stuart G MacKay
- Illawarra ENT Head and Neck Clinic, Wollongong, Australia.,Wollongong Hospital, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, Australia.,Graduate School of Medicine, University of Wollongong, Wollongong, Australia.,Woolcock Institute of Medical Research, Glebe, Australia
| | - John R Wheatley
- Dept of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Australia.,University of Sydney at Westmead Hospital, Westmead, Australia.,Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, Australia
| | - David R Hillman
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Australia.,West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, Australia
| | - Xuân-Lan Nguyên
- Unité de Somnologie et Fonction Respiratoire, Hopital St Antoine, Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Richard Lewis
- Dept Otolaryngology, Head and Neck Surgery, Royal Perth Hospital, Perth, Australia.,Hollywood Private Hospital, Perth, Australia
| | - Matthew C Campbell
- Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Australia.,University of Melbourne, Parkville, Australia
| | - Boris Pételle
- Service ORL Chirurgie de la Face et du Cou, Hôpital Tenon, AP-HP, Paris, Sorbonne Université, Paris, France
| | - Jennifer H Walsh
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Australia.,West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, Australia
| | - Andrew C Jones
- Illawarra ENT Head and Neck Clinic, Wollongong, Australia.,Wollongong Hospital, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, Australia.,Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Carsten E Palme
- University of Sydney at Westmead Hospital, Westmead, Australia.,The Dept of Otolaryngology Head Neck Surgery, Westmead Hospital, Westmead, Australia
| | - Alain Bizon
- Dept Otolaryngology, Head and Neck Surgery, University Hospital of Angers, Angers, France
| | - Nicole Meslier
- Dept of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France.,INSERM UMR 1063 "SOPAM", University of Angers, Angers, France
| | - Chloé Bertolus
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Stomatologie et Chirurgie Maxillo-faciale, Paris, France
| | - Kathleen J Maddison
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Australia.,West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, Australia
| | - Laurent Laccourreye
- Dept Otolaryngology, Head and Neck Surgery, University Hospital of Angers, Angers, France
| | | | | | - Valérie Attali
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France
| | - Frédéric Gagnadoux
- Dept of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France.,INSERM UMR 1063 "SOPAM", University of Angers, Angers, France
| | - Sandrine H Launois
- Unité de Somnologie et Fonction Respiratoire, Hopital St Antoine, Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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23
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Launois C, Nierat M, Attali V, Raux M, Arnulf I, Similowski T, Redolfi S. Postural preinspiratory cortical activity, genioglossus activity and fluid shift in awake obstructive sleep apnoea patients. Exp Physiol 2019; 105:370-378. [DOI: 10.1113/ep087804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 11/12/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Claire Launois
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Marie‐Cécile Nierat
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Valérie Attali
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du Sommeil Département R3S Paris France
| | - Mathieu Raux
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixDépartement d'Anesthésie Réanimation Paris France
| | - Isabelle Arnulf
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du Sommeil Département R3S Paris France
| | - Thomas Similowski
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de PneumologieMédecine Intensive et Réanimation Département R3S Paris France
| | - Stefania Redolfi
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du Sommeil Département R3S 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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25
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Baum DM, Morales Rodriguez B, Attali V, Cauhapé M, Arnulf I, Cardot P, Bodineau L, Fiamma MN. New Zealand Obese Mice as a Translational Model of Obesity-related Obstructive Sleep Apnea Syndrome. Am J Respir Crit Care Med 2019; 198:1336-1339. [PMID: 30019912 DOI: 10.1164/rccm.201801-0162le] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Valérie Attali
- 1 Sorbonne Université/Inserm UMR_S1158 Paris, France and.,2 Groupe Hospitalier Pitié-Salpêtrière Charles Foix Paris, France
| | | | - Isabelle Arnulf
- 2 Groupe Hospitalier Pitié-Salpêtrière Charles Foix Paris, France
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26
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Attali V, Vecchierini MF, Collet JM, d'Ortho MP, Goutorbe F, Kerbrat JB, Leger D, Lavergne F, Monaca C, Monteyrol PJ, Morin L, Mullens E, Pigearias B, Martin F, Tordjman F, Khemliche H, Lerousseau L, Meurice JC. Efficacy and tolerability of a custom-made Narval mandibular repositioning device for the treatment of obstructive sleep apnea: ORCADES study 2-year follow-up data. Sleep Med 2019; 63:64-74. [PMID: 31606651 DOI: 10.1016/j.sleep.2019.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/22/2019] [Accepted: 04/24/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE/BACKGROUND Mandibular repositioning device (MRD) therapy is an alternative to continuous positive airway pressure (CPAP). The Orkney Complex Disease Study-ORCADES study is assessing the long-term efficacy and tolerability of MRD therapy in obstructive sleep apnoea syndrome (OSAS); two-year follow-up data are presented. PATIENTS/METHODS OSAS patients who refused or were noncompliant with CPAP were fitted with a custom-made computer-aided design/computer-aided manufacturing (CAD/CAM) bi-block MRD (ResMed, Narval CC™); mandibular advancement was individually titrated. Sleep and respiratory parameters were determined at baseline, 3-6 months, and two years. The primary endpoint was treatment success (percentage of patients achieving a ≥50% reduction in the apnoea-hypopnoea index [AHI]). RESULTS Of 315 enrolled patients, 237 remained on MRD treatment at two years, and 197 had follow-up data. The treatment success rate at two years was 67%; AHI <5/h, <10/h and <15/h was achieved in 30%, 56% and 72% of patients, respectively. On multivariate analysis, ≥50% decrease in AHI at 3-6 months and absence of nocturia at 3-6 months were significant predictors of MRD treatment continuation. Adverse events were generally mild, and the majority occurred in the first year of treatment. CONCLUSIONS Two years' treatment with an MRD was effective and well tolerated in patients with mild to severe OSAS who refused or were intolerant of CPAP.
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Affiliation(s)
- Valérie Attali
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France.
| | - Marie-Françoise Vecchierini
- AP-HP, Hôpital Hôtel Dieu, Centre du Sommeil et de la Vigilance, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean-Marc Collet
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Stomatologie et Chirurgie Maxillo-Faciale, Paris, France
| | - Marie-Pia d'Ortho
- AP-HP, DHU FIRE, Hôpital Bichat-Claude Bernard, Physiologie et Explorations Fonctionnelles, Paris, France; UFR de Médecine, Université Denis Diderot Paris 7, Paris, France
| | - Frederic Goutorbe
- Centre Médecine du Sommeil, Centre Hospitalier de Béziers, Béziers, France
| | - Jean-Baptiste Kerbrat
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Stomatologie et Chirurgie Maxillo-Faciale, Paris, France; Hôpital Charles Nicolle, Stomatologie et Chirurgie Maxillo-Faciale, Rouen, France
| | - Damien Leger
- AP-HP, Hôpital Hôtel Dieu, Centre du Sommeil et de la Vigilance, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | | | | | | | - Eric Mullens
- Fondation Bon Sauveur, Laboratoire du Sommeil, Albi, France
| | | | - Francis Martin
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France
| | - Fabienne Tordjman
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France
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27
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Attali V, Clavel L, Rouch P, Rivals I, Rémy-Néris S, Skalli W, Sandoz B, Similowski T. Compensation of Respiratory-Related Postural Perturbation Is Achieved by Maintenance of Head-to-Pelvis Alignment in Healthy Humans. Front Physiol 2019; 10:441. [PMID: 31068832 PMCID: PMC6491726 DOI: 10.3389/fphys.2019.00441] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/01/2019] [Indexed: 11/17/2022] Open
Abstract
The maintenance of upright balance in healthy humans requires the preservation of a horizontal gaze, best achieved through dynamical adjustments of spinal curvatures and a pelvic tilt that keeps the head-to-pelvis alignment close to vertical. It is currently unknown whether the spinal and pelvic compensations of respiratory-related postural perturbations are associated with preservation of the head-to-pelvis vertical alignment. We tested this hypothesis by comparing postural alignment variables at extreme lung volume (total lung capacity, TLC; residual volume, RV) with their reference value at functional residual capacity (FRC). Forty-eight healthy subjects [22 women; median age of 34 (26; 48) years] were studied using low dose biplanar X-rays (BPXR; EOS®system). Personalized three-dimensional models of the spine and pelvis were reconstructed at the three lung volumes. Extreme lung volumes were associated with changes of thoracic curvature bringing it outside the normal range. Maximal inspiration reduced thoracic kyphosis [T1–T12 angle = 47° (37; 56), -4° variation (-9; 1), p = 0.0007] while maximal expiration induced hyperkyphosis [T1–T12 angle = 63° (55; 68); +10° variation (5; 12), p = 9 × 10-12]. Statistically significant (all p < 0.01) cervical and pelvic compensatory changes occurred [C3–C7 angle: +4° (-2; 11) and pelvic tilt +1° (0; 3) during maximal inspiration; C3–C7 angle: -7° (-18; -1) and pelvic tilt +5° (1; 8) during maximal expiration], resulting in preserved head-to-pelvis alignment (no change in the angle between the vertical plane and the line connecting the odontoid process and the midpoint of the line connecting the center of the two femoral heads ODHA). Lung volume related postural perturbations were more marked as a function of age, but age did not affect the head-to-pelvis alignment. These findings should help understand balance alterations in patients with chronic respiratory diseases that modify lung volume and rib cage geometry.
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Affiliation(s)
- Valérie Attali
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France.,Service des Pathologies du Sommeil (Département "R3S"), Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Assistance Publique Hôpitaux de Paris (APHP), Paris, France.,Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France
| | - Louis Clavel
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France.,Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France
| | - Philippe Rouch
- Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France
| | - Isabelle Rivals
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France.,Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, Paris, France
| | - Ségolène Rémy-Néris
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Wafa Skalli
- Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France
| | - Baptiste Sandoz
- Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France
| | - Thomas Similowski
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France.,Médecine Intensive et Réanimation (Département "R3S"), Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, APHP, Paris, France
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Launois C, Perger E, Attali V, Nierat M, Raux M, Arnulf I, Similowski T, Redolfi S. Postural respiratory‐related cortical activation and rostral fluid shift in awake healthy humans. Exp Physiol 2019; 104:887-895. [DOI: 10.1113/ep087468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/27/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Claire Launois
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Elisa Perger
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
| | - Valérie Attali
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
| | - Marie‐Cécile Nierat
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Mathieu Raux
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixDépartement d'Anesthésie Réanimation Paris France
| | - Isabelle Arnulf
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
| | - Thomas Similowski
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de PneumologieMédecine Intensive et RéanimationDépartement R3S Paris France
| | - Stefania Redolfi
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
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29
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Attali V, Collet JM, Jacq O, Souchet S, Arnulf I, Rivals I, Kerbrat JB, Goudot P, Morelot-Panzini C, Similowski T. Mandibular advancement reveals long-term suppression of breathing discomfort in patients with obstructive sleep apnea syndrome. Respir Physiol Neurobiol 2019; 263:47-54. [PMID: 30872167 DOI: 10.1016/j.resp.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/12/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 02/07/2023]
Abstract
Obstructive sleep apnoea syndrome (OSAS) patients do not report breathing discomfort in spite of abnormal upper airway mechanics. We studied respiratory sensations in OSAS patients without and with mandibular advancement device (MAD). Fifty-seven moderate to severe non obese OSAS patients were asked about breathing discomfort using visual analogue scales (VAS) in the sitting position (VAS-1), after lying down (VAS-2), then with MAD (VAS-3). Awake critical closing pressure (awake Pcrit) was measured in 15 patients without then with MAD. None of the patients reported breathing discomfort when sitting but 19 patients (33%) did when lying (VAS-2: -20% or less). A feeling of "easier breathing" with MAD was observed and was more marked in patients reporting breathing discomfort when supine (VAS-3: +66.0% [49.0; 89.0]) than in those not doing so (VAS-3: +28.5% [1.0; 56.5], p = 0.007). MAD-induced change in awake Pcrit was correlated to VAS-3. In conclusion, MAD revealed "latent dyspnea" related to the severity of upper airways mechanics abnormalities in OSAS patients.
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Affiliation(s)
- Valérie Attali
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France.
| | - Jean-Marc Collet
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Stomatologie et Chirurgie Maxillo-faciale, F-75013, Paris, France.
| | - Olivier Jacq
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France.
| | - Sandie Souchet
- Université Paris I - Panthéon-Sorbonne, laboratoire SAMM (Statistique, Analyse, Modélisation Multidisciplinaire -EA4543), F-75005, Paris, France.
| | - Isabelle Arnulf
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France.
| | - Isabelle Rivals
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University F-75005, Paris, France.
| | - Jean-Baptiste Kerbrat
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Stomatologie et Chirurgie Maxillo-faciale, F-75013, Paris, France; Sorbonne Université, UMR, 8256 B2A, F-75005, Paris, France.
| | - Patrick Goudot
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Stomatologie et Chirurgie Maxillo-faciale, F-75013, Paris, France; Sorbonne Université, UMR, 8256 B2A, F-75005, Paris, France.
| | - Capucine Morelot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département "R3S"), F-75013, Paris, France.
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département "R3S"), F-75013, Paris, France.
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30
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Ghergan A, Coupaye M, Leu-Semenescu S, Attali V, Oppert JM, Arnulf I, Poitou C, Redolfi S. Prevalence and Phenotype of Sleep Disorders in 60 Adults With Prader-Willi Syndrome. Sleep 2018; 40:4384753. [PMID: 29294134 DOI: 10.1093/sleep/zsx162] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Study Objectives Excessive sleepiness is a common symptom in Prader-Willi syndrome (PWS), and it negatively impacts the quality of life. Obstructive sleep apnea and narcolepsy phenotypes have been reported in PWS. We characterized sleep disorders in a large cohort of adults with PWS. Methods All consecutive patients with genetically confirmed PWS unselected for sleep-related symptoms, underwent a clinical interview, polysomnography, and multiple sleep latency tests (MSLT, n = 60), followed by long-term (24 hours) polysomnography (n = 22/60). Results Among 60 adults evaluated (57% female, aged 25 ± 10 years, body mass index: 39 ± 12 kg/m2), 67% reported excessive sleepiness. According to the sleep study results, 43% had a previously unrecognized hypersomnia disorder, 15% had an isolated sleep breathing disorder, 12% had combined hypersomnia disorder and untreated breathing sleep disorder, and only 30% had normal sleep. Isolated hypersomnia disorder included narcolepsy in 35% (type 1, n = 1, and type 2, n = 8), hypersomnia in 12% (total sleep time >11 hours, n = 2, and MSLT <8 minutes, n = 1), and borderline phenotype in 53% (≥2 sleep onset in REM periods and MSLT >8 minutes, n = 10, and 8 minutes < MSLT < 10 minutes, n = 4). Sleep breathing disorders, isolated and combined, included obstructive sleep apnea (n = 14, already treated in seven), sleep hypoxemia (n = 1) and previously undiagnosed hypoventilation (n = 5). Modafinil was taken by 16 patients (well tolerated in 10), resulting in improved sleepiness over a mean 5-year follow-up period. Conclusion Sleepiness affects more than half of adult patients with PWS, with a variety of hypersomnia disorder (narcolepsy, hypersomnia, and borderline phenotypes) and breathing sleep disorders. Earlier diagnosis and management of sleep disorders may improve sleepiness, cognition, and behavior in these patients.
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Affiliation(s)
- Adelina Ghergan
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pathologies du Sommeil (Département R3S) et Centre de Référence National pour Narcolepsie, Hypersomnie et Syndrome de Kleine-Levin, Paris, France
| | - Muriel Coupaye
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Nutrition, Centre de Référence National pour Syndrome de Prader-Willi et Institut Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Smaranda Leu-Semenescu
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pathologies du Sommeil (Département R3S) et Centre de Référence National pour Narcolepsie, Hypersomnie et Syndrome de Kleine-Levin, Paris, France
| | - Valérie Attali
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pathologies du Sommeil (Département R3S) et Centre de Référence National pour Narcolepsie, Hypersomnie et Syndrome de Kleine-Levin, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Jean-Michel Oppert
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Nutrition, Centre de Référence National pour Syndrome de Prader-Willi et Institut Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Isabelle Arnulf
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pathologies du Sommeil (Département R3S) et Centre de Référence National pour Narcolepsie, Hypersomnie et Syndrome de Kleine-Levin, Paris, France
| | - Christine Poitou
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Nutrition, Centre de Référence National pour Syndrome de Prader-Willi et Institut Cardiométabolisme et Nutrition (ICAN), Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1166 Nutriomique team 6, Paris, France
| | - Stefania Redolfi
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pathologies du Sommeil (Département R3S) et Centre de Référence National pour Narcolepsie, Hypersomnie et Syndrome de Kleine-Levin, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
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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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Jacq O, Arnulf I, Similowski T, Attali V. Upper airway stabilization by osteopathic manipulation of the sphenopalatine ganglion versus sham manipulation in OSAS patients: a proof-of-concept, randomized, crossover, double-blind, controlled study. Altern Ther Health Med 2017; 17:546. [PMID: 29262824 PMCID: PMC5738827 DOI: 10.1186/s12906-017-2053-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 12/07/2017] [Indexed: 11/10/2022]
Abstract
Background Osteopathic manipulative treatment (OMT) of the sphenopalatine ganglion (SPG) is used empirically for the treatment of rhinitis and snoring and is thought to increase pharyngeal stability. This trial was designed to study the effects of this treatment on pharyngeal stability evaluated by critical closing pressure in obstructive sleep apnoea syndrome. Methods This single-centre, randomized, crossover, double-blind study compared active manipulation and sham manipulation of the SPG. Randomization was computer-generated. Patients each received one active manipulation and one sham manipulation at an interval of 21 days and were evaluated 30 min and 48 h after each session administered by a qualified osteopath. Neither the patients, nor the investigator performing the evaluations were informed about the order of the two techniques (double-blind). The primary endpoint was the percentage of responding patients presenting increased pharyngeal stability defined by a variation of critical closing pressure (Pcrit) of at least −4 cmH2O at 30 min. Secondary endpoints were the variation of Pcrit in absolute values, sleepiness and snoring. Others endpoints were lacrimation (Schirmer’s test), induced pain, sensations experienced during OMT. Results Ten patients were included and nine (57 [50; 58] years, comprising 7 men, with an apnoea-hypopnoea index of 31.0 [25.5; 33.2]/h; (values are median [quartiles])) were analysed. Seven patients were analysed for the primary endpoint and nine patients were analysed for secondary endpoints. Five patients responded after active manipulation versus no patients after sham manipulation (p = 0.0209). Active manipulation induced more intense pain (p = 0.0089), increased lacrimation (ns) and more tactile, nociceptive and gustatory sensations (13 versus 1) compared to sham manipulation. No significant difference was observed for the other endpoints. Conclusions Osteopathic manipulative treatment of the SPG may improve pharyngeal stability in obstructive sleep apnoea syndrome. This trial validates the feasibility of the randomized, controlled, double-blind methodology for evaluation of this osteopathic treatment. Studies on a larger sample size must specify the efficacy on the apnoea-hypopnoea index. Trial registration The study was retrospectively registered in the clinicaltrial.gov registry under reference NCT01193738 on 1st September 2010 (first inclusion May 19, 2010). Electronic supplementary material The online version of this article (doi: 10.1186/s12906-017-2053-0) contains supplementary material, which is available to authorized users.
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Weiss N, Attali V, Bouzbib C, Thabut D. Altered distal-proximal temperature gradient as a possible explanation for sleep-wake disturbances in cirrhotic patients. Liver Int 2017; 37:1776-1779. [PMID: 29149489 DOI: 10.1111/liv.13590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Nicolas Weiss
- Sorbonne Universités, Université Pierre et Marie Curie Paris 6, Paris, France.,Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France.,INSERM UMR_S 938, CDR Saint-Antoine Maladies métaboliques, Biliaires et fibro-inflammatoire du foie & Institut de Cardiométabolisme et Nutrition, ICAN, Paris, France.,Unité de réanimation neurologique, Département de neurologie, pôle des maladies du système nerveux, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris et Institut de neurosciences translationnelles IHU-A-ICM, Paris, France
| | - Valérie Attali
- Sorbonne Universités, Université Pierre et Marie Curie Paris 6, Paris, France.,Service d'Exploration des Pathologies du Sommeil (Département "R3S"), Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris& Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Charlotte Bouzbib
- Sorbonne Universités, Université Pierre et Marie Curie Paris 6, Paris, France.,Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France.,INSERM UMR_S 938, CDR Saint-Antoine Maladies métaboliques, Biliaires et fibro-inflammatoire du foie & Institut de Cardiométabolisme et Nutrition, ICAN, Paris, France.,Unité de Soins Intensifs d'Hépato-gastroentérologie, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Dominique Thabut
- Sorbonne Universités, Université Pierre et Marie Curie Paris 6, Paris, France.,Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France.,INSERM UMR_S 938, CDR Saint-Antoine Maladies métaboliques, Biliaires et fibro-inflammatoire du foie & Institut de Cardiométabolisme et Nutrition, ICAN, Paris, France.,Unité de Soins Intensifs d'Hépato-gastroentérologie, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, 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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Attali V, Straus C, Pottier M, Buzare MA, Morélot-Panzini C, Arnulf I, Similowski T. Normal sleep on mechanical ventilation in adult patients with congenital central alveolar hypoventilation (Ondine's curse syndrome). Orphanet J Rare Dis 2017; 12:18. [PMID: 28115003 PMCID: PMC5256543 DOI: 10.1186/s13023-017-0569-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/11/2017] [Indexed: 01/13/2023] Open
Abstract
Background The purpose of this study was to describe the sleep structure (especially slow wave sleep) in adults with congenital central hypoventilation syndrome (CCHS), a rare genetic disease due to mutations in the PHOX2B gene. Fourteen patients aged 23 (19.0; 24.8) years old (median [1rst-3rd quartiles]) with CCHS underwent a sleep interview and night-time attended polysomnography with their ventilatory support. Their sleep variables were compared to those collected in 15 healthy control subjects matched for age, sex and body mass index. Results The latency to N3 sleep was shorter in patients (26.3 min [24.0; 30.1]) than in controls (49.5 min [34.3; 66.9]; P = 0.005), and sleep onset latency tended to be shorter in patients (14.0 min [7.0; 20.5]) than in controls (33.0 min [18.0; 49.0]; P = 0.052). Total sleep time, sleep stage percentages, sleep fragmentation as well as respiratory and movement index were within normal ranges and not different between groups. Conclusions Normal sleep in adult patients with CCHS and adequate ventilator support indicates that the PHOX2 gene mutations do not affect brain sleep networks. Consequently, any complaint of disrupted sleep should prompt clinicians to look for the usual causes of sleep disorders, primarily inadequate mechanical ventilation. Shorter N3 latency may indicate a higher need for slow wave sleep, to compensate for the abnormal respiratory-related cortical activity during awake quiet breathing observed in patients with CCH.
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Affiliation(s)
- Valérie Attali
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France. .,Service des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris, Cedex 13, France. .,Branche "Adultes" du Centre de Référence du Syndrome d'Ondine, F-75013, Paris, France.
| | - Christian Straus
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,Branche "Adultes" du Centre de Référence du Syndrome d'Ondine, F-75013, Paris, France.,Service d'Explorations Fonctionnelles Respiratoires de l'Exercice et de la Dyspnée EFRED, F-75013, Paris, France
| | - Michel Pottier
- Service des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris, Cedex 13, France
| | - Marie-Annick Buzare
- Service des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris, Cedex 13, France
| | - Capucine Morélot-Panzini
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,Unité ambulatoire d'Assistance Respiratoire à Domicile, F-75013, Paris, France.,Service de Pneumologie et Réanimation Médicale, Département R3S, Hopitaux Universitaires Pitié-Salpêtrière Charles Foix, AP-HP, F-75013, Paris, France
| | - Isabelle Arnulf
- Service des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris, Cedex 13, France.,Branche "Adultes" du Centre de Référence du Syndrome d'Ondine, F-75013, Paris, France.,Brain Research Institute-UPMC Paris 6 Univ Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,Branche "Adultes" du Centre de Référence du Syndrome d'Ondine, F-75013, Paris, France.,Service de Pneumologie et Réanimation Médicale, Département R3S, Hopitaux Universitaires Pitié-Salpêtrière Charles Foix, AP-HP, F-75013, 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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Attali V, Chaumereuil C, Arnulf I, Golmard JL, Tordjman F, Morin L, Goudot P, Similowski T, Collet JM. Predictors of long-term effectiveness to mandibular repositioning device treatment in obstructive sleep apnea patients after 1000 days. Sleep Med 2016; 27-28:107-114. [DOI: 10.1016/j.sleep.2016.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/07/2016] [Accepted: 10/14/2016] [Indexed: 11/25/2022]
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Gonzalez-Bermejo J, Morélot-Panzini C, Tanguy ML, Meininger V, Pradat PF, Lenglet T, Bruneteau G, Forestier NL, Couratier P, Guy N, Desnuelle C, Prigent H, Perrin C, Attali V, Fargeot C, Nierat MC, Royer C, Ménégaux F, Salachas F, Similowski T. Early diaphragm pacing in patients with amyotrophic lateral sclerosis (RespiStimALS): a randomised controlled triple-blind trial. Lancet Neurol 2016; 15:1217-1227. [PMID: 27751553 DOI: 10.1016/s1474-4422(16)30233-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 09/02/2016] [Accepted: 09/02/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder associated with respiratory muscle weakness and respiratory failure. Non-invasive ventilation alleviates respiratory symptoms and prolongs life, but is a palliative intervention. Slowing the deterioration of diaphragm function before respiratory failure would be desirable. We aimed to assess whether early diaphragm pacing could slow down diaphragm deterioration and would therefore delay the need for non-invasive ventilation. METHODS We did a multicentre, randomised, controlled, triple-blind trial in patients with probable or definite ALS in 12 ALS centres in France. The main inclusion criterion was moderate respiratory involvement (forced vital capacity 60-80% predicted). Other key eligibility criteria were age older than 18 years and bilateral responses of the diaphragm to diagnostic phrenic stimulation. All patients were operated laparoscopically and received phrenic stimulators. Clinicians randomly assigned patients (1:1) to receive either active or sham stimulation with a central web-based randomisation system (computer-generated list). Investigators, patients, and an external outcome allocation committee were masked to treatment. The primary outcome was non-invasive ventilation-free survival, analysed in the intention-to-treat population. Safety outcomes were also assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01583088. FINDINGS Between Sept 27, 2012, and July 8, 2015, 74 participants were randomly assigned to receive either active (n=37) or sham (n=37) stimulation. On July 16, 2015, an unplanned masked analysis was done after another trial showed excess mortality with diaphragm pacing in patients with hypoventilation (DiPALS, ISRCTN 53817913). In view of this finding, we analysed mortality in our study and found excess mortality (death from any cause) in our active stimulation group. We therefore terminated the study on July, 16, 2015. Median non-invasive ventilation-free survival was 6·0 months (95% CI 3·6-8·7) in the active stimulation group versus 8·8 months (4·2-not reached) in the control (sham stimulation) group (hazard ratio 1·96 [95% CI 1·08-3·56], p=0·02). Serious adverse events (mainly capnothorax or pneumothorax, acute respiratory failure, venous thromboembolism, and gastrostomy) were frequent (24 [65%] patients in the active stimulation group vs 22 [59%] patients in the control group). No treatment-related death was reported. INTERPRETATION Early diaphragm pacing in patients with ALS and incipient respiratory involvement did not delay non-invasive ventilation and was associated with decreased survival. Diaphragm pacing is not indicated at the early stage of the ALS-related respiratory involvement. FUNDING Hospital Program for Clinical Research, French Ministry of Health; French Patients' Association for ALS Research (Association pour la Recherche sur la Sclérose Latérale Amyotrophique); and Thierry de Latran Foundation.
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Affiliation(s)
- Jésus Gonzalez-Bermejo
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France.
| | - Capucine Morélot-Panzini
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France
| | - Marie-Laure Tanguy
- AP-HP, Groupe Hospitalier Pitié Salpêtrière Charles Foix, Unité de Recherche Clinique, Paris, France
| | - Vincent Meininger
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Centre de Référence Maladies Rares SLA, Département des Maladies du Système Nerveux, Paris, France
| | - Pierre-François Pradat
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Centre de Référence Maladies Rares SLA, Département des Maladies du Système Nerveux, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France
| | - Timothée Lenglet
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Centre de Référence Maladies Rares SLA, Département des Maladies du Système Nerveux, Paris, France
| | - Gaëlle Bruneteau
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Centre de Référence Maladies Rares SLA, Département des Maladies du Système Nerveux, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Institut du Cerveau et de la Moëlle Epinière, ICM, Paris, France
| | - Nadine Le Forestier
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Centre de Référence Maladies Rares SLA, Département des Maladies du Système Nerveux, Paris, France
| | | | - Nathalie Guy
- CHU Gabriel Montpied, Service de Neurologie, Clermont-Ferrand, France; Faculté de Chirurgie Dentaire, Neuro-Dol, INSERM U1107, Douleur Trigéminale et Migraine, Clermont-Ferrand, France
| | | | - Hélène Prigent
- AP-HP, GHU Paris Ouest-site Raymond Poincaré-Service de Physiologie et d'Explorations Fonctionnelles, Garches, France
| | | | - Valérie Attali
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France
| | - Catherine Fargeot
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service Pharmacie UFDMS, Paris, France
| | - Marie-Cécile Nierat
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Catherine Royer
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d'Anesthésie et Réanimation, Paris, France
| | - Fabrice Ménégaux
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Chirurgie Viscérale, Paris, France
| | - François Salachas
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Centre de Référence Maladies Rares SLA, Département des Maladies du Système Nerveux, Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France
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Georges M, Attali V, Golmard JL, Morélot-Panzini C, Crevier-Buchman L, Collet JM, Tintignac A, Morawiec E, Trosini-Desert V, Salachas F, Similowski T, Gonzalez-Bermejo J. Reduced survival in patients with ALS with upper airway obstructive events on non-invasive ventilation. J Neurol Neurosurg Psychiatry 2016; 87:1045-50. [PMID: 27090433 DOI: 10.1136/jnnp-2015-312606] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/23/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Non-invasive ventilation (NIV) is part of standard care in amyotrophic lateral sclerosis (ALS). Intolerance or unavailability of NIV, as well as the quality of correction of nocturnal hypoventilation, has a direct impact on prognosis. OBJECTIVES We describe the importance of NIV failure due to upper airway obstructive events, the clinical characteristics, as well as their impact on the prognosis of ALS. METHODS Retrospective analysis of the data of 190 patients with ALS and NIV in a single centre for the period 2011-2014. 179 patients tolerating NIV for more than 4 h per night without leaks were analysed. RESULTS Among the 179 patients, after correction of leaks, 73 remained inadequately ventilated at night (defined as more than 5% of the night spent at <90% of SpO2), as a result of obstructive events in 67% of cases (n=48). Patients who remained inadequately ventilated after optimal adjustment of ventilator settings presented with shorter survival than adequately ventilated patients. Unexpectedly, patients with upper airway obstructive events without nocturnal desaturation and in whom no adjustment of treatment was therefore performed also presented with shorter survival. On initiation of NIV, no difference was demonstrated between patients with and without upper airway obstructive events. In all patients, upper airway obstruction was concomitant with reduction of ventilatory drive. CONCLUSIONS This study shows that upper airway obstruction during NIV occurs in patients with ALS and is associated with poorer prognosis. Such events should be identified as they can be corrected by adjusting ventilator settings.
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Affiliation(s)
- Marjolaine Georges
- Département "R3S", Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Valérie Attali
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France Département "R3S", Service des Pathologies du Sommeil AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Jean Louis Golmard
- Département de biostatistiques, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Capucine Morélot-Panzini
- Département "R3S", Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Lise Crevier-Buchman
- Unité de la Voix, Service ORL et Chirurgie Cervico-Faciale, AP-HP, Hôpital Européen Georges Pompidou, Paris, France Université Paris Descartes, CNRS UMR 7018, Paris, France
| | - Jean-Marc Collet
- Département "R3S", Service des Pathologies du Sommeil AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Anne Tintignac
- Département "R3S", Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Elise Morawiec
- Département "R3S", Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Valery Trosini-Desert
- Département "R3S", Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - François Salachas
- Département de Neurologie et Centre de Référence pour la SLA, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Thomas Similowski
- Département "R3S", Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Jesus Gonzalez-Bermejo
- Département "R3S", Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
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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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Launois C, Attali V, Georges M, Raux M, Morawiec E, Rivals I, Arnulf I, Similowski T. Cortical Drive to Breathe during Wakefulness in Patients with Obstructive Sleep Apnea Syndrome. Sleep 2015; 38:1743-9. [PMID: 26158887 DOI: 10.5665/sleep.5156] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 01/06/2015] [Accepted: 05/22/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES The obstructive sleep apnea syndrome (OSAS) involves recurrent sleep-related upper airways (UA) collapse. UA mechanical properties and neural control are altered, imposing a mechanical load on inspiration. UA collapse does not occur during wakefulness, hence arousal-dependent compensation. Experimental inspiratory loading in normal subjects elicits respiratory-related cortical activity. The objective of this study was to test whether awake OSAS patients would exhibit a similar cortical activity. DESIGN Descriptive physiology study. SETTING Sleep laboratory in a large university affiliated tertiary hospital. PATIENTS 26 patients with moderate OSAS according to polysomnography (5 < apnea-hypopnea index [AHI] ≤ 30, n = 14) or severe OSAS (AHI > 30, n = 12); 13 non-OSAS patients for comparison. INTERVENTIONS None. MEASUREMENTS Respiratory time-locked electroencephalographic segments ensemble averaged and analyzed for slow premotor potentials preceding inspiration ("pre-inspiratory potentials" [PIPs]). RESULTS PIPs were present in 1/13 controls and 11/26 patients (P = 0.0336; 4/14 "moderate" and 7/12 "severe" patients). Awake OSAS patients therefore exhibit respiratory-related cortical activity during quiet breathing significantly more frequently than non-OSAS individuals. The corresponding PIPs resemble those observed during prepared voluntary inspirations and in response to experimental inspiratory loads in normal subjects, which involve a cortical network comprising the supplementary motor area. CONCLUSIONS A respiratory-related cortical activity could contribute to the increased neural drive to upper airway and to inspiratory muscles that has previously been described in obstructive sleep apnea, and could therefore contribute to the arousal-dependent compensation of upper airway abnormalities. Whether or not such cortical compensatory mechanisms have cognitive consequences remains to be determined.
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Affiliation(s)
- Claire Launois
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France
| | - Valérie Attali
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France
| | - Marjolaine Georges
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France
| | - Mathieu Raux
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Surveillance Post-Interventionnelle et d'Accueil des Polytraumatisés (Département d'Anesthésie Réanimation), Paris, France
| | - Elise Morawiec
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France
| | - Isabelle Rivals
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,Ecole Supérieure de Physique et de Chimie de la Ville de Paris, Paris, France
| | - Isabelle Arnulf
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France
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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. Very early screening for sleep-disordered breathing in acute coronary syndrome in patients without acute heart failure. Sleep Med 2014; 15:1539-46. [PMID: 25308397 DOI: 10.1016/j.sleep.2014.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/16/2014] [Accepted: 06/20/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is frequently associated with acute coronary syndrome (ACS). Screening of sleep-disordered breathing (SDB) has not been previously evaluated in ACS within 72 h in intensive care settings and its management could potentially enhance patients' prognosis. This pilot study assessed the feasibility of SDB screening at the early phase of ACS. METHODS All consecutive patients admitted to the coronary care unit (CCU) for ACS without acute heart failure underwent one overnight-attended polysomnography (PSG) within 72 h after admission. A telemonitoring (TM) system was set up to remotely monitor the signals and repair faulty sensors. The 27 recordings were analyzed as respiratory polygraphy (RP) and as PSG, and the results were compared. RESULTS The TM system allowed successful intervention in 48% of recordings, resulting in excellent quality PSG for 89% of cases. The prevalence of SDB [apnea-hypopnea index (AHI) ≥ 15/h] was 82% and mainly consisted of central SDB and periodic breathing, except three patients with OSA. Compared with PSG, RP underestimated AHI, probably due to the poor sleep efficiency, reduction of slow-wave sleep, and alteration of rapid eye movement sleep. CONCLUSION An early SDB screening by remote-attended PSG is feasible in ACS patients shortly after admission to CCU. The TM enhanced the quality of PSG. A high prevalence of central SDB was noticed, for which the etiology remains unknown. Further large-scale studies are needed to determine whether central SDB is an incidental finding in early ACS and whether the presence and severity of SDB have a prognostic impact.
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Affiliation(s)
- Sandra Van den Broecke
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil, Paris, France; Service de Pneumologie, CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium.
| | - Olivier Jobard
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Institut de Cardiologie, ACTION Group, Université Paris-6, Paris, France
| | - Gilles Montalescot
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Institut de Cardiologie, ACTION Group, Université Paris-6, Paris, France
| | - Marie Bruyneel
- Service de Pneumologie, CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Vincent Ninane
- Service de Pneumologie, CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Arnulf
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil, Paris, France; Sorbonne Universités, UPMC Université Paris 06, I5, CRICM, Paris, France; INSERM, UMR_S 975; CNRS UMR 7225, Paris, France
| | - Thomas Similowski
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Paris, France; Sorbonne Universités, UPMC Université Paris 06, UMR_S 1158, "Neurophysiologie Respiratoire Expérimentale et Clinique", F-75005, Paris, France; INSERM, UMR_S 1158, "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France
| | - Valérie Attali
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil, Paris, France; Sorbonne Universités, UPMC Université Paris 06, UMR_S 1158, "Neurophysiologie Respiratoire Expérimentale et Clinique", F-75005, Paris, France; INSERM, UMR_S 1158, "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France
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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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