Search

Introduction: Up to 40% of patients present an apnoea-hypopnoea index (AHI)g20/h at a chronic delay post-stroke. The ventilatory phenotype of sleep apnoea (SA) after stroke is not yet precisely described. Aim and objectives: To determine the prevalence and ventilatory phenotypic traits of obstructive (OSA), central (CSA), and coexistent OSA/CSA sleep apnoea at a chronic delay following a first-ever ischemic stroke. Methods: Cross-sectional analysis of a prospective, monocentric cohort conducted in a university hospital. 380 consecutive unselected first-ever stroke or transient ischemic attack (TIA) patients were screened over a 3-year period. Full-night polysomnography (PSG), arterial blood gases (ABG), and hypercapnic ventilatory response (HCVR) using a rebreathing test method were performed at a median [Q1; Q3] delay of 134.5 [97; 227.3] days following stroke onset. Results: PSG, ABG, and HCVR were obtained in 112 patients with a first-ever ischemic stroke. Using an AHI cut-off of 15 events.hour-1 of sleep, 56 (50.0%) patients were classified as having moderate to severe SA. Among them, 31 (55.4%) and 25 (44.6%) presented OSA and Coexistent OSA/CSA or CSA respectively. CO2 chemosensitivity significantly differed according to the presence or the type of SA. Coexistent OSA/CSA and CSA patients exhibited higher CO2 chemosensitivity levels compared to No SA patients (p=0.043). No difference was observed regarding ABG parameters. Conclusions: A higher CO2 chemosensitivity in Coexistent OSA/CSA and CSA patients following stroke may dedicate these patients to specific care and ventilatory support.

International audience; Purpose: In children, the usual indications for continuous positive airway pressure (CPAP) are residual OSA after adenotonsillectomy and/or persistent OSA due to obesity. Data concerning adherence (hours/night) following ambulatory CPAP initiation are scarce.Methods: An observational cohort of 78 children was followed over 2 years. All exhibited sleep-disordered breathing (SDB) symptoms, were assessed by polysomnography, and prescribed CPAP. CPAP was initiated at hospital for 10 children.Results: OSA children, mean age 10.4 ± 3.2 years, were mostly males (75.6%), with a mean body mass index of 21.2 ± 7.3 kg/m2, and mean apnea+hypopnea index of 12.2 ± 10.6 events/hour. Seventy-two children were still on CPAP at 3 months, 63 at 6 months, 55 at 1 year, and 34 at 2 years. CPAP was discontinued thanks to rehabilitation programs, dento-facial orthopedics, and/or weight loss. Mean CPAP adherence at 1, 3, 6, 12, and 24 months was respectively 6.1 ± 2.8, 6.2 ± 2.6, 6.2 ± 2.8, 6.3 ± 2.8, and 7.0 ± 2.7 h/night. There was a trend towards higher CPAP adherence and younger age, primary versus middle/high school attendance, higher baseline apnea+hypopnea index, and neurocognitive disorders.Conclusion: In our population, mean CPAP adherence defined in hours per night was high and did not decrease during the 24-month follow-up. These findings support the feasibility of ambulatory CPAP initiation in non-syndromic OSA. The high CPAP adherence is expected to be associated with improvements in neurocognition, and in metabolic and cardiovascular parameters.

Aims: A particularly high burden of sleep apnea is reported in patients treated with cardiac implants such as pacemakers and defibrillators. Sleep apnea diagnosis remains a complex procedure mainly based on sleep and respiratory indices captured by polysomnography (PSG) or respiratory polygraphy (PG). We aimed to evaluate whether implantable cardiac devices are reliable for sleep apnea diagnosis compared to reference methods. Method and results: We performed a systematic literature search (PubMed, Cochrane Library) to identify relevant studies and finally included 13 studies involving 647 patients in the meta-analysis. The majority of patients were men, of mean age of 70.5 ± 4.8 years. Sensitivity of cardiac implants for sleep apnea diagnosis ranged from 60 to 100%, specificity from 50 to 100% with a prevalence of sleep apnea varying from 22 to 91%. The overall performance of cardiac implants for sleep apnea diagnosis was assessed by a randomized bivariate meta-analysis and completed by pre-specified sensitivity analyses for different implant types and brands. For an apnea-hypopnea index threshold ≥30 events/hour during polysomnography (corresponding to severe sleep apnoea), the optimal respiratory event threshold for cardiac implants was 31.5/hour with a sensitivity of 80% (61-91%) and specificity of 70% (53-83%). Subgroup analyses on implant type and brand provided no additional information owing to the small number of studies. Conclusions: The respiratory disturbance index provided by cardiac implants is clinically relevant and might improve access to sleep apnea diagnosis in at risk cardiovascular populations.

Background: The impact of removing the upper airway lymphoid tissue and in particular, tonsillectomy, in adults with OSA has not been demonstrated in large populations. Aims: To compare the severity of OSA and the prevalence of cardiovascular, metabolic and respiratory co-morbidities between patients with OSA who had undergone previous tonsillectomy and those who had not. Methods: The 19,711 participants in this study came from the European sleep apnea database (ESADA) which comprises data from unselected adult patients aged 18–80 years with a history of symptoms suggestive of OSA referred to sleep centers throughout Europe. Results: There were no differences between the two groups in terms of sex ratio and age (146 patients with previous tonsillectomy vs. 19565 patients without). Patients who had undergone tonsillectomy had a lower body mass index (29.3 ± 5.2 kg/m2 vs 32.2 ± 6.6 kg/m2, p < 0.001), lower subjective sleep latency (17.1 ± 17.8 min vs 25.5 ± 30.4 min, p = 0.001), lower ODI (15.7 ± 18.3 events/hour vs 30.7 ± 26.1 events/hour, p < 0.001), and SpO2, European Respiratory Society, ERS, The ESADA network has previously received support from the European Union COST action B26 and the European Respiratory Society. We gratefully acknowledge unrestricted seeding grants from ResMed Inc and Philips Respironics Inc. for establishment of the organisation and the database. Excellent technical assistance in terms of centre monitoring and database maintenance was provided by Ann-Christin Lundquist, RN and Jeanette Norum, RN.

Introduction Adaptive servo-ventilation (ASV) is a non-invasive ventilation mode for suppressing CSA-CSR. FACE is an observational prospective multicentre cohort study designed to assess the effects of adding ASV (PaceWave™, AutosetCS™; ResMed) to standard care on morbidity and mortality in symptomatic chronic HF patients who have CSA or co-existing central and obstructive sleep-disordered breathing (SDB). Objective To collect real life clinical data and long-term follow-up of all CHF patients grade of severity (reduced (HFrEF), mid-range (HFmrEF) or preserved ejection fraction (HFpEF)) with SDB requesting ASV. Methods Medical history, medications, clinical presentation, sleep study, cardiac function and quality of life were assessed at inclusion. Patients are followed up to 2 years. Inclusion data are presented in median with interquartile range or in % of the sample. Results 509 CHF pts were included, 72 [64; 79] year old, men (88%) and with a BMI of 28 [25; 32] kg/m2. Patients were HFrEF, HFmrEF and HFpEF, in 31, 20, and 50% respectively and 27% had a cardiac implant. Current or former tobacco and alcohol users were 46 and 14% respectively. Main comorbidities were hypertension (72%), diabetes (37%), COPD (12%), atrial fibrillation (40%). ASV indications were predominant CSA (69%), emergent CSA (6.4%) and coexistent OSA-CSA not controlled on CPAP (25%). Although, SDB was severe with a mean AHI per hour of 41 [31; 55] and a sleep time with SpO2 Conclusion SDB were widespread distributed in a heterogeneous population of CHF patients with different etiologies, comorbidities and HF severity classes. A cluster analysis has been conducted to identify different phenogroups.

Background and aim: Obstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia. The current study examined the effects of positive airway pressure (PAP) treatment on lipid status in the European Sleep Apnea Database (ESADA). Methods: The prospective cohort study enrolled 1564 OSA subjects (74% male, mean age 54 ± 11y, body mass index (BMI) 32.7 ± 6.6 kg/m2 and apnea-hypopnea index (AHI) 40.3 ± 24.4 n/h) undergoing PAP therapy for at least three months (mean 377.6 ± 419.5 days). Baseline and follow-up total cholesterol (TC) from nine centers were analyzed. Repeated measures and logistic regression tests (adjusted for age, sex, weight changes, lipid lowering medication, PAP compliance, and treatment duration) were used to compare changes in TC concentration. Incident risk for a coronary heart disease event (CHD) was used to compute a Framingham CHD risk score (estimated from age, BMI, blood pressure, and TC). Results: Adjusted means of TC decreased from 194.2 mg/dl to 189.3 mg/dl during follow-up (p = 0.019). A clinically significant (10%) reduction of TC at PAP follow-up was observed in 422 patients (27%). Duration of PAP therapy was identified as independent predictor for TC reduction, which implies an approximately 10% risk reduction for incident CHD events (from 26.7% to 24.1% in men and from 11.2% to 10.1% in women, p < 0.001 respectively). Conclusion: This observational study demonstrates a reduction of TC after long-term PAP treatment. The close association between TC concentration and cardiovascular (CV) mortality suggests that identification and treatment of OSA may have a beneficial effect on overall CV risk due to this mechanism. This possibility needs to be evaluated in prospective randomized studies. © 2020 Elsevier B.V., ResMed Foundation European Respiratory Society, ERS European Respiratory Society, ERS European Respiratory Society, ERS, The ESADA network has received support from the European Union COST action B26 and the European Respiratory Society (ERS) funded Clinical Research Collaboration (CRC). Unrestricted seeding grants from the ResMed Foundation and the Philips Respironics Foundation for establishment of the database in 2007 and 2011 are gratefully acknowledged. The ESADA network has a scientific collaboration with Bayer AG., Nonfinancial support was provided by the European Sleep Research Society (ESRS) and the European Respiratory Society (ERS) in terms of logistics for communication, meetings and data presentations for the ESADA collaborators., Dr. Verbraecken reports grants and personal fees from ResMed, Bioprojet, Jazz Pharmaceutics; personal fees from Philips, Sanofi, Agfa-Gevaert, grants from AirLiquide; personal fees from Springer, Westfalen Medical, SomnoMed, Vivisol, Total Care, Medidis, Fisher & Paykel, Wave Medical, OSG, Mediq Tefa, NightBalance, Heinen & Löwenstein, AstraZen, Accuramed, Bekaert Deslee Academy and UCB Pharma, outside the submitted work. Dr. Hedner reports grants from ResMed, Philips Respironics, and the European Respiratory Society all related to maintenance of database on behalf of the ESADA group during the conduct of the study. Dr. Grote reports grants from Bayer, Resmed, Respironics/Philips, and from the European Respiratory Society during the conduct of the study; non-financial support and other from Itamar Medical, Resmed, Philips, and Astra Zeneca, outside the submitted work. In addition, Dr. Grote has a patent on sleep apnea therapy licensed. The remaining co-authors have no conflict of interest to declare.

Background Chronic intermittent hypoxia (IH), the major feature of obstructive sleep apnea (OSA) increases myocardial infarct size. Recent data demonstrate that IH-induced cardiomyocyte susceptibility to infarction could be explained by mitochondrial function and/or dynamics alterations. Moreover, AMP-activated protein kinase (AMPK), a major protein involved in cardiomyocyte metabolism is activated by IH in striated skeletal muscle. However, we recently found that AMPK failed to be activated in myocardium from mice exposed to IH. Objective We aimed at demonstrating whether AMPK activation can be beneficial for ischemia-reperfusion injury following chronic IH exposure. Methods Mice were exposed to 21 days of IH (21-5% FiO2, 60 s-cycles, 8 h/day), or normoxia (N) and treated or not with metformin (300 mg.kg−1.day−1). Infarct size was measured after in vivo ischemia (45 min) and reperfusion (90 min). Mitochondrial function was assessed using oxygraphy and spectrofluorimetry. Mitochondrial dynamics and AMPK activation were assessed by Western blot. An insulin tolerance test was also performed. Results Metformin abolished the IH-induced increase in infarct size whereas it did not improve systemic insulin sensitivity. Metformin activated AMPK and did not impact the decrease in mitochondrial respiration (O2 maximal consumption in complex I and II and respiratory control ratio). However, AMPK activation by Metformin seems to reestablish the distinctive IH impact on mitochondrial dynamics (fission and mitophagy). Conclusion Metformin treatment is protective against ischemia-reperfusion injury induced by IH only. This suggests that metformin could be an alternative treatment to the currently restrictive one for apneic patients with a high CV risk. Ongoing studies will aim to better characterize the mechanisms by which metformin specifically decreases infarct size under IH.

Introduction Obstructive sleep apnea is a growing worldwide health problem. The landmark feature of OSA is a chronic intermittent hypoxia (CIH) responsible for multiple organ damages including heart diseases. CIH profoundly alters both visceral adipose tissue (VAT) and heart structures and functions, but little is known regarding their interactions in the context of CIH. We recently showed that VAT senescence drives myocardial alterations through the release of profibrotic factors in aged mice. Thus, we aim at demonstrating that CIH induces a premature vWAT senescent phenotype, responsible for subsequent heart dysfunction. Methods In a first series of animals, ten-week old C57BL6 male mice (n = 10/group) were exposed to 14 days CIH protocol (8 hours daily, 5–21% cyclic inspired oxygen fraction, 60 seconds per cycle). In another series, mice were submitted to VAT surgical lipectomy or sham-surgery (n = 10/group) and then exposed to the same CIH protocol. VAT and heart were assessed by histology for fibrosis (Sirius red), cell hypertrophy (wheat-germ agglutinin) and reactive oxygen species (ROS) (4-HNE), and markers of senescence (p16, p21, p53), inflammation (CD68, Tnfa, Serpine1), fibrosis (Col1a1) and hypertrophy were also evaluated by RT-qPCR and western blot. Results CIH induced an increased macrophage infiltration in VAT, along with an increased expression of senescence markers, ROS production and gene expression of inflammatory and fibrogenic markers. This was associated with CIH-induced myocardial interstitial fibrosis and upregulation of profibrotic gene expression in myocardium. Interestingly, VAT lipectomy prevented CIH-induced myocardial fibrosis. Conclusion Short-term exposure to CIH is sufficient to induce both VAT remodelling, characterized by oxidative stress, inflammation and fibrosis, and cardiac interstitial fibrosis that was prevented by VAT lipectomy. This strongly suggest a causal crosstalk between CIH-induced VAT senescence and cardiac remodeling.

Objective/Background: The Clinical Global Impression scale (CGI) reflects the clinician's assessment of the disease impact on patient's global functioning. We assessed predictors of CGI scale rating in patients with obstructive sleep apnea (OSA). Patients/Methods: Consecutive patients with suspected OSA (n = 7581) were identified in the European Sleep Apnea Database (ESADA). Anthropometrics, comorbidities, apnea severity obtained by polygraphy or polysomnography, and daytime sleepiness [Epworth Sleepiness Scale (ESS)] were assessed. The CGI 7-point scale was completed at the end of the diagnostic process (CGI-severity, ie, CGI-S) and, in a sub-population, at treatment follow-up (CGI-Improvement). Results: CGI-S was rated mild to moderate in 44% of patients. CGI rating at any given apnea intensity was worse in women than in men (p < 0.01). Patients undergoing polygraphy (n = 5075) were more frequently rated as severely ill compared to those studied with polysomnography (19.0% vs 13.0%, p < 0.001). In patients aged

International audience

Introduction Diuretics have been reported as effective for reducing obstructive sleep apnea (OSA) severity by preventing fluid retention and reducing rostral fluid shift. The benefit of diuretics might vary depending upon the OSA clinical phenotype and comorbidities. Objective To test this hypothesis, we conducted a propensity score-matched cohort analysis of data from the French national sleep apnea registry “Observatoire Sommeil de la Federation de Pneumologie” (OSFP). Method A propensity score analysis was used to determine the impact of diuretics on OSA severity. Matching (ratio 1:4) was performed by using a 0.1 collider for propensity score. Severe OSA was defined as an apnea-hypopnea index (AHI) > 30 events/h and the usefulness of diuretics was assessed using a logistic regression model. Results The 69,564 OSA patients studied in the OSFP prospective observational cohort had a median age of 56.9 years [Interquartile range (IQR): 47.4; 65.6], 67% were men, and the median AHI was 28 [14; 43] events/h. Among them, 9783 (14.1%) were treated with diuretics. Diuretics reduced OSA severity in overweight or moderately obese patients (P = 0.03) and in patients with hypertension (P Conclusion Diuretics appear to have a positive impact on OSA severity in overweight or moderately obese patients with hypertension. Diuretics might be prioritized in combined therapies for hypertensive patients with OSA.

Introduction Adaptive servo-ventilation (ASV) is a non-invasive ventilation mode for suppressing CSA-CSR. FACE is an observational prospective multicentre cohort study designed to assess the effects of adding ASV (PaceWave™, AutosetCS™; ResMed) to standard care on morbidity and mortality in symptomatic chronic HF patients who have CSA or co-existing central and obstructive sleep-disordered breathing (SDB). Objective FACE cohort study was collecting real life clinical data and long-term follow-up in a heterogeneous CHF population with SDB eligible for ASV. Latent class analysis (LCA) was proposed to cluster homogeneous phenogroups that may behaved differently. Methods Clinical presentation, sleep study, cardiac function and quality of life were assessed at inclusion. Patients were on CHF therapy and were offered to be treated by ASV. Morbidity and mortality were collected at 3-month follow-up. The primary end point in the time-to event analysis was the first event of death from any cause, unplanned hospitalization for worsening heart failure or cardiac transplant. Results 509 CHF pts were included in the ITT analysis, LCA identified 6 well defined phenogroups. At 3-month follow-up, there was significant difference between clusters for primary outcome incidence P Fig. 1 ). Conclusion A phenogroup analysis including cardiac functions, SDB and ASV acceptance is promising in predicting outcomes of CHF patients.

Introduction Solriamfetol is a dopamine and norepinephrine reuptake inhibitor indicated to improve wakefulness in adult patients with excessive daytime sleepiness associated with narcolepsy (75-150 mg/d) or obstructive sleep apnea (37.5-150 mg/d). Previous studies reported small mean increases in blood pressure (BP); however, the time course of these effects has not been evaluated. In addition, effects on BP dipping, which has been shown to be a risk factor for adverse cardiovascular outcomes, have not been evaluated. These analyses evaluated the effects of solriamfetol treatment on BP using 24-hour ambulatory blood pressure monitoring (ABPM) and on the percentage of narcolepsy patients with a non-dipping BP profile. Methods Twenty-four-hour ABPM was conducted at baseline and week 8 in a 12-week randomized controlled trial in participants with narcolepsy (n=236). Results At week 8, increases in BP were apparent in the 150 and 300 mg dose groups from 8 AM until 4 PM and 6 PM, respectively. At baseline, 52% (placebo) and 48% (combined solriamfetol) of participants were non-dippers (defined as Conclusion The effects of solriamfetol on BP at the highest approved dose of 150 mg/d are transient across the day. Solriamfetol was not observed to have an increase in non-dipping classification in participants with narcolepsy at any dose studied. Support Jazz Pharmaceuticals

Introduction Solriamfetol is a dopamine and norepinephrine reuptake inhibitor indicated to improve wakefulness in adult patients with excessive daytime sleepiness associated with obstructive sleep apnea (OSA; 37.5-150 mg/d) or narcolepsy (75-150 mg/d). Previous studies reported small mean increases in blood pressure (BP); however, the time course of these effects has not been evaluated. In addition, effects on BP dipping, which has been shown to be a risk factor for adverse cardiovascular outcomes have not been evaluated. These analyses evaluated the effects of solriamfetol treatment on BP using 24-hour ambulatory blood pressure monitoring (ABPM) and on the percentage of OSA patients with a non-dipping BP profile. Methods Twenty-four-hour ABPM was conducted at baseline and week 8 in a 12-week randomized controlled trial in participants with OSA (n=474). Results At week 8, increases in BP were apparent in the 75 and 300 mg dose groups from ~6 AM until 8 PM. At baseline, 58% (placebo) and 55% (combined solriamfetol) of participants were non-dippers (defined as Conclusion The effects of solriamfetol on BP at the highest approved dose of 150 mg/d are transient across the day. Solriamfetol was not observed to have an increase in non-dipping classification in participants with OSA at any dose studied. Support Jazz Pharmaceuticals

Background Obstructive Sleep Apnea syndrome (OSAS), characterized by intermittent hypoxia (IH) cycles during sleep, induces endothelial dysfunction and atherogenesis lesions, which could be mediated by an increase in endothelial permeability. VE-Cadherin (VECad) cleavage, detected by the soluble extracellular fragment released (sVE), may be a key step in this regulation of endothelial permeability. Objective Our aim was to search for sVE in sera from healthy volunteers submitted to IH, and from OSAS patients before and after treatment by continuous positive airway pressure (CPAP) and to characterize mechanisms regulating VECad cleavage in endothelial cells submitted to IH. Methods sVE was searched in sera from 7 healthy volunteers exposed to IH, 44 OSAS patients and 31 control subjects. Human Aortic Endothelial Cells (HAEC) were exposed to 6 hours of IH in vitro, then endothelial permeability was assessed by measuring trans-endothelial electrical resistance (TEER) and VECad cleavage was evaluated by detecting sVE in cells supernatants after treatment by IH and tyrosine kinase inhibitor (30 μM Genistein or 10 μM PP2), HIF-1 inhibitor (1 μM 2-Methoxyestradiol), an anti-oxidant (100 μM Tempol) or anti-hVEGF blocking antibody (0.5 μg/mL). Results sVE was significantly elevated in healthy volunteers submitted to IH and in OSAS patient sera before treatment, but decreased in OSAS patients after 6 months of CPAP therapy. We found a significant positive correlation between sVE and OSAS severity and between sVE and serum VEGF. In HAEC supernatants, TEER decreased by 37.5% and sVE increased by 39% after cell exposure to IH. These effects were reversed by all the pharmacological inhibitors tested. Conclusion we suggest that, in OSAS, IH increases endothelial permeability by inducing VECad cleavage via the ROS, HIF1, VEGF and tyrosine kinase pathways. Future studies will determine whether sVE could be a potential biomarker to evaluate early endothelial alterations in OSAS.

Complex respiratory events, which may have a detrimental effect on both quality of sleep and control of nocturnal hypoventilation, occur during sleep in patients treated by non-invasive ventilation (NIV). Among these events are patient-ventilator asynchrony, increases in upper airway resistance with or without increased respiratory drive, and leaks. Detection of these events is important in order to select the most appropriate ventilator settings and interface. Simple tools can provide important information when monitoring NIV. Pulse-oximetry is important to ensure that an adequate SpO2 is provided, and to detect either prolonged or short and recurrent desaturations. However, the specificity of pulse-oximetry tracings under NIV is low. Transcutaneous capnography discriminates between hypoxemia related to V/Q mismatch and hypoventilation, documents correction of nocturnal hypoventilation, and may detect ventilator-induced hyperventilation, a possible cause for central apnea/hypopnea and glottic closure. Data provided by ventilator software helps the clinician by estimating ventilation, tidal volume, leaks, rate of inspiratory or expiratory triggering by the patient, although further validation of these signals by independent studies is indicated. Finally, autonomic markers of sympathetic tone using signals such as pulse wave amplitude of the pulse-oximetry signal can provide reliable information of sleep fragmentation.

Obstructive sleep apnoea (OSA) syndrome in adult is defined as an Apnoea-Hypopnoea Index (AHI) of 5 or more per hour of sleep in a context of excessive daytime sleepiness and snoring. OSA is considered as mild with an AHI of 5-15, moderate with an AHI of 15-30, and severe with an AHI greater than 30. OSA is a highly prevalent disease since it should affect 7-15% of the middle-aged population, but most patients are not yet diagnosed for OSA. Middle age, male gender, obesity and arterial hypertension are main risk factors for OSA in adults. OSA patients are exposed to higher neurological and cardiovascular morbidity, including stroke, depression, hypertension, coronary artery disease, heart failure, arrhythmias. Because OSA may lead to life-threatening problems if undiagnosed, anaesthesiologists should be aware of their screening role in the preoperative period. In that way, the STOP-BANG questionnaire is a well-adapted instrument to screen patients for OSA during the preoperative visit. OSA patients are exposed to higher preoperative morbidity in relation with OSA severity, particularly difficult manual ventilation with mask, difficult tracheal intubation and postoperative upper airway obstruction. The unknown diagnosis of OSA is one major contributor to facilitate the occurrence of those events. In the postoperative period, early resuming continuous positive airway pressure and installing the OSA patient in a nonsupine position could be effective in preventing pharyngeal obstruction. Considering the timing of postoperative complications, a careful monitoring in the post-anesthesia care unit for three hours is an appropriate strategy for a majority of OSA patients. Alternatives to opioids should be promoted for postoperative pain control.

Introduction Sleep disorder breathing is associated with a worse prognosis of CHF. The multicentre cohort study FACE is collecting real-world clinical data of CHF patients with reduced (HF-rEF), mid-range (HF-mrEF) and preserved (HFpEF) left ventricular ejection fraction (LVEF) with predominant CSA or coexisting central and obstructive sleep apnea (CSA-OSA), eligible for ASV therapy. Methods Morbidity and mortality, cardiac function, quality of life are assessed over a period of 2 years depending on whether the patient was compliant (≥ 3 h/night) with ASV therapy (ResMed, AutoSet CS) or not (control). Primary endpoint is all-cause death or unplanned hospitalization for worsening HF. Cumulative incidence will be estimated by Kaplan–Meier method and compared using log-rank test between ASV & control group. An update of the interim 2-year follow-up (FU) data is presented here. Results Three hundred and ninety-one CHF patients were included in the mITT analysis. Median FU for analysis was 21.6 months. Baseline characteristics were: age 70.7 ± 11.0 y, 87.5% male, body mass index 28.3 ± 5.2 kg/m2. Patients with HF-rEF, HF-mrEF and HFpEF were 38.7%, 22.1% and 39.2% respectively. Patients with an ischemic etiology were 55.2%. Sixty-nine percent had predominant CSA and 31% had CSA-OSA. Patients with severe sleep apnoea (AHI >30/h) were 76.2%. Sixty-six percent of patients were compliant to ASV therapy. In the global population, ASV therapy seemed to be beneficial in inpatients who had the highest level of nocturnal oxygen desaturation (T90, ODI) at baseline (P = 0.013), in obese (P = 0.009) & non-ischemic patientss (P = 0.014) compared to control group. However, the subgroup analysis identified significant improvement of prognosis with ASV only in HFpEF but not in HF-rEF or HF-mrEF. Conclusion ASV therapy is associated with a better prognosis in CHF patients with high level of oxygen desaturation during sleep, non-ischemic HF aetiology and with preserved LVEF. FACE study is a useful tool to better understand which CHF populations with CSA can benefit of ASV therapy.

Surgical treatment of severe obstructive sleep apnea syndrome (OSAS) is currently generally considered as second line therapy after the reference treatment, nasal continuous positive airway pressure (CPAP). In upper airway (UA) resistance syndrome (UARS) and mild and moderate OSAS subjects, surgery is progressively being replaced by oral appliance therapy. This article discusses the rationale for surgical therapy. The surgical procedures for uvulopalatopharyngoplasty (UPPP), nasal surgery, tongue operations, and maxillofacial surgery are described. Young and lean subjects are probably the best candidates for surgery. The methods that appear at this time to be the most clinically useful to detect UA narrowing or collapse sites are cephalometry and fiberoptic endoscopy. However, satisfactory selection of good surgical candidates remains elusive. UPPP treatment response rate in OSAS varies from 5% to 46% depending on the presence or absence of retrolingual narrowing. Maxillomandibular advancement osteotomy (MMO) is an efficient surgical technique for the treatment of severe sleep apnea, particularly in young motivated and nonobese patients. Acute UA obstructions are the more frequent life-threatening complication occurring in the early postoperative procedure. These complications can be avoided by standardizing anesthetic procedures and perioperative protocols. In children obstructive sleep apnea is an adequate indication for adenotonsillectomy. There is need for regular re-evaluation of surgical results and adjustment of treatment at regular time intervals.

Obstructive sleep apnea syndrome (OSAS) has been individualized as a major public health problem. Both its cardiovascular morbidity and symptoms motivate for an accurate diagnosis and appropriate therapeutics. The upper airway resistance syndrome (UARS) has been described because of the hypothesis that repetitive increases in respiratory efforts that are inducing arousals (RERA) might produce a significant disease with associated cardiovascular and cognitive morbidity. International classifications of sleep disorders in 1999 did not individualize UARS but RERA and in 2005 recommend that it be included as part of OSAS but not as a separate entity. In this article, the authors attempt to describe the specificity of this syndrome that may be relevant for both clinicians and researchers.