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Objective To assess the respiratory function and sleep characteristics of obese adults and children. Methods All patients with non-syndromic, severe obesity (BMI ≥ 3 z-scores for children and ≥ 40.00 kg/m2 for adults), referred for pulmonary function tests at Lille University Hospital, were retrospectively included. Results A total of 69 children (mean ± SD BMI 36.8 ± 6.7 and mean BMI z-score 4.7 ± 1.0) and 70 adults were included (mean BMI 45.7 ± 6.2). Metabolic syndrome was diagnosed in 13 children (26%) and 40 adults (80%). Reduced lung volumes were observed in 34 children (50.0%) and 16 adults (24.0%) and both the mean functional residual capacity (FRC) and the mean residual volume (RV) were lower in children than in adults (FRC: −1.7 ± 2.1 z-score in children vs. −1.0 ± 1.1 in adults, P = 0.026; and RV: −0.8 ± 1.2 z-score in children vs. −0.1 ± 1.1 in adults, P = 0.002). The prevalence of severe obstructive sleep apnea syndrome was greater in adults (40.7% vs. 18.8%, P = 0.007). Children had a higher average oxygen saturation (median of 96.0% [91.0–98.0] vs. 93.0% [76.0–97.0] in adults, P Conclusion Obesity has consequences for lung volumes in children; however, a longitudinal study is needed to determine the impact on pulmonary expansion and growth.

Pompe disease is a progressive myopathy that combines motor, respiratory, and cardiac impairments. The 6-min walk test is the gold standard for assessing disease severity at the motor level. The objective of this study was to better determine the parameters that influence the total distance covered in patients with Pompe disease.We performed a retrospective review of 15 patients with late-onset Pompe disease who were followed regularly at a single referral center. Logistic regression was used to investigate the links between motor, respiratory and cardiac variables and 6-min walk test performance.When considering baseline clinical and demographic variables, a seven-step backward elimination regression analysis yielded a model with two predictors (age and the use of an assistive device) that explained 85.5% of the variance. When considering the cardiorespiratory variables monitored during gait, a three-step backward elimination regression analysis showed that two predictors (heart rate recovery and the baseline partial pressure of carbon dioxide) explained 42.2% of the variance.Our results highlighted the importance of respiratory and cardiac adaptation during exercise (along with motor ability) during the 6-min walk test in patients with Pompe disease. Further studies of larger cohorts are necessary to validate the model, which might enable investigators to determine whether intra-individual fluctuations in 6-min walk test performance are related to physiological parameters and/or to other variables such as the patient's level of motivation during the test.

International audience; Objective/BackgroundMandibular repositioning device (MRD) therapy is an alternative to continuous positive airway pressure (CPAP). The ORCADES study is assessing the long-term efficacy and tolerability of MRD therapy in OSAS; 2-year follow-up data are presented.Patients/MethodsOSAS 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]).ResultsOf 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

Obstructive sleep apnea (OSA) is associated with an increased aortic root size. This association has never been studied in patients with hypertension undergoing continuous positive airway pressure (CPAP) treatment for OSA. The 24-h blood pressure (BP) monitoring of 142 hypertensive patients undergoing CPAP treatment for OSA was prospectively documented. Aortic root diameter was assessed by echocardiography. The population included 33.8% women, with an overall mean age of 60.7 ± 10.5 years. The median body mass index was 32.7 [29. 5–36.3] kg/m2. The median treatment score was 3 [2–4] anti-hypertensive drugs per day. The median 24-h systolic and diastolic BP were 130 [120–144] and 74.5 [69–82] mmHg, respectively. The night-time systolic and diastolic BP were 119.5 [108–136] and 67 [61–74] mmHg, respectively. The mean diameter of the aorta at the level of the Valsalva sinuses was 34.9 ± 4.4 mm and 20.4 ± 2.3 mm/m when adjusted for height. Patients underwent ventilation for a median duration of 3.8 [1. 7–7.5] years, with a median night-time duration of 6.6 [5. 5–7.5] h per night. The median residual apnea-hypopnea index under ventilation was 2 [1–4] events per hour. A multivariate analysis showed that aortic root size was associated with male gender (p

Cardiovascular diseases are the first cause of death in women. Their frequency is underestimated because of their atypical feminine clinical presentation. The pathway "heart, arteries and women", initiated at Lille's hospital center in 2013, was designed to improve pluridisciplinar approaches for women. Thus, obstructive sleep apnea (OSA), known as a metabolic risk factor, was studied in several works. In post-menopausal women with cardiovascular risk, frequency of OSA seems underestimated. Clinical presentation of OSA in feminine patients can be misleading, and its screening seems essential, in light of its major cardiovascular impact.

Introduction : There are currently only little data available on the factors predicting the respective efficacy of fixed CPAP (FP-CPAP) or automated CPAP (APAP) for OSAS treatment. Aims and objectives : We evaluated the efficacy of a 3month-period treatment with FP-CPAP versus APAP on a composit criteria involving apnoea/ hyponoea index (AHI) and the Epworth score (ESS), according to the level of effective pressure (Peff) as well as pressure variability (Pvar). Methods : A multicenter prospective controlled study was conducted in 22 academic and non academic french centers. Initial clinical and polygraphic data were obtained before initiating a 7-day period using APAP delivering a variable pressure between 4 and 20 cm Hg. Then, patients were randomised to either FP-CPAP or APAP used during 3 months, and the data obtained at the end of the study period were analysed according to the inital level of Peff and Pvar. Results : 616 patients (mean age : 56.8 yrs ± 11.2, mean AHI : 51.7/h ± 20.8) were included. CPAP compliance was the same in both groups (FP-CPAP : 5.78h ± 1.9 vs APAP : 5.85h± 1.9) with an identical efficacy on AHI and the ESS (FP-CPAP : 6.11/h ± 7.94 and 6.02 ± 4.37, and APAP 5.71/h ± 6.75 and 6.05 ± 4.5). Despite the lack of influence of Pvar on FP-CPAP vs APAP efficiency, a greater initial pressure variability was associated with a significant higher residual AHI whatever the mode of CPAP applied. Conclusion : The efficiency of FP-CPAP and APAP was identical on OSAS improvement after 3 months of treatment, independently of initial level of effective pressure and variability.

The effectiveness of home NIV for chronic respiratory failure (CRF) is well established. However, little data is available about its epidemiology. The ANTADIR-GAV cohort is aimed to prospectively analyze data from patients initiated to home NIV in France. Methods: Multicentric prospective observational study. Etiology of CRF, demographic data, comorbidities, NIV setting, arterial blood gases, type/parameters of ventilator and interface were collected. Results: From 5/2015 to 12/2016, 964 patients (54% male, age 64±14 y, BMI 28±10 kg/m²) were included in 19 centers. CRF resulted from neuromuscular (51%), thoracic cage (24%) or parenchyma (25%) impairment. The most frequent etiologies were amyotrophic lateral sclerosis (36%), COPD (22%) and obesity hypoventilation (19%). Main comorbidities were hypertension (40%), diabetes (18%), arrhythmia (13%) and coronary heart disease (8%). Before NIV initiation PaO2 was 73±14 and PaCO2 49 ±8 mmHg. Most patients used single circuit pressure ventilators with calibrated leak (99%) and most used modes ST (83%), S (10%) and hybrid (4%). NIV was introduced in 892 patients using a bilevel ventilator without battery (47%) or with battery (45%). A life support ventilator was needed in 8% patients. IPAP, EPAP and backup respiratory rate were respectively 16±4 cmH2O, 7±3 cmH20 and 15±3 c/min. Preferred interface was an orofacial mask (80%). Additional oxygen was needed in 32% patients. NIV was introduced after acute respiratory failure in 43% patients and electively in 57% Conclusion: This cohort gives new insights about recent trends in home NIV practice in France. Recruiting is being pursued and adherence /survival data will be secondarily assessed.

Cardiovascular diseases are the first cause of death in women. Their frequency is underestimated because of their atypical feminine clinical presentation. The pathway "heart, arteries and women", initiated at Lille's hospital center in 2013, was designed to improve pluridisciplinar approaches for women. Thus, obstructive sleep apnea (OSA), known as a metabolic risk factor, was studied in several works. In post-menopausal women with cardiovascular risk, frequency of OSA seems underestimated. Clinical presentation of OSA in feminine patients can be misleading, and its screening seems essential, in light of its major cardiovascular impact.

Introduction The prevalence of morbid obesity has substantially increased and is a major public-health problem. Aims and Objectives The study aim was to compare PFT and SDB in morbidly obese children and adults. Methods We retrospectively included all patients with non-syndromic severe obesityreferred to our hospital for PFT and polysomnography (PSG), from 2010 to 2014. Severe obesity was defined as having a BMI ≥ 120% of the 95th percentile in children (AHA Scientific Statement) and a BMI ≥ 40.00 in adults (WHO Classification). Collected data were demographic, PFT and PSG data. Results 74 children and 70 adults were included. All results are reported in table 1. Conclusions Morbidly obesity consequences differed in children and adults: reduction in lung volumes (TLC, FRC) occurred more often in children while SDB occurred more frequently in adults.

Background Obstructive sleep apnea syndrome (OSAS) is a risk factor for resistant arterial hypertension and aortic dilatation. We assessed the value of systematic screening for OSAS in patients soon after the onset of acute aortic syndrome (AAS). Methods Between January 2010 and June 2014, patients were prospectively screened for post AAS OSAS. The severity of OSAS was defined by the Apnea-Hypopnea Index (AHI) and the Oxygen Desaturation Index (ODI). Blood pressure control was assessed with 24-h ambulatory monitoring. Results The study population comprised 71 patients (males: 64.7%; median age [interquartile range]: 57 [49 to 64] years; type A AAS: 49.3%; type B AAS: 50.7%). According to the AHI, 58 patients (81.7%) had OSAS and 31 (43.6%) had severe OSAS. A prognostic analysis revealed that the descending thoracic false lumen dilatation rate rose significantly with the severity of OSAS ( p = 0.0008 for the AHI and p = 0.0284 for the ODI). The median rate of increase was 7.5 (5 to 10) mm/year in the AHI greater than 30 events/h group and 5.0 (0 to 8) mm/year in the ODI greater than 30 events/h group. With regard to blood pressure control, the diastolic blood pressure varied as function of the ODI category ( p = 0.0074). Conclusions Our results suggest that systematic screening for post-ASS OSAS is of value. The false lumen dilatation rate appears to be related to the severity of OSAS. It remains to be seen whether treatment of OSAS would modify the false lumen dilatation rate.

Objectifs Etudier le devenir a long terme du syndrome d’apnees obstructives du sommeil (SAOS) au cours de la prise en charge de l’acromegalie. Determiner la cinetique d’evolution de l’index d’apnees-hypopnees (IAH). Methode Notre etude porte sur 14 patients acromegales, porteurs d’un SAOS decouvert prealablement ou concomitamment a l’acromegalie. Tous ont beneficie d’un a 4 reevaluations polysomnographiques au cours d’un suivi median de 5 ans et 3 mois. Resultats Dans notre cohorte, 13 patients presentaient une acromegalie controlee, 1 restait dissocie. Au terme du suivi, apres une duree mediane de controle de l’acromegalie de 3 ans et 9 mois, l’IAH de chaque patient s’ameliorait. La severite du SAOS etait diminuee pour 43 % des patients. Deux (14,2 %) etaient gueris. Seul 1 patient parmi les 6 SAOS severe a vu la severite de son SAOS s’ameliorer, suggerant que lorsque le SAOS est initialement severe, il tend a le rester. La cinetique d’evolution du SAOS a ete etudiee chez 7 patients. L’amelioration de l’IAH etait concomitante de l’amelioration des parametres hormonaux et survenait dans les 2 premieres annees de prise en charge. Une fois l’acromegalie controlee, l’evolution de l’IAH etait moindre, meme en cas de controle prolonge. Conclusion Le traitement de l’acromegalie a permis, a long terme une amelioration de la severite du SAOS chez 43 % des patients. L’amelioration de l’IAH etait precoce, justifiant une reevaluation polysomnographique concomitante du controle de l’hypersomatotropisme. Plus a distance du controle de l’acromegalie, la severite du SAOS semble moins se modifier ou de maniere variable.

Objectif L’atteinte respiratoire dans la SLA se traduit classiquement par une hypoventilation nocturne puis diurne et/ou par un syndrome d’apnees du sommeil (SAS) dont la prevalence est discutee. L’objectif de l’etude est d’evaluer la pertinence de la PCO2 transcutanee nocturne(TcCO2) avant l’apparition d’une hypoventilation diurne, en complement des EFR et d’une polysomnographie initiale. Methodes Le monitorage par TcCO2 associe a une polysomnographie a ete evalue prospectivement chez 46 patients (59 ± 10 ans) ayant initialement une CV > 70 % theo et une PaCO2 Resultats Douze patients ont ete traites par VNI dans les 6 mois suivant l’inclusion. Un SAS modere a severe (IAH > 15/heure) a ete mis en evidence chez 16 patients (35 %). Les criteres majeurs de VNI etaient : une hypoventilation (n = 3), les desaturations nocturnes (n = 3) ou un SAS (n = 5, avec un index apnees-hypopnees (IAH) de 21 a 36), des signes cliniques ou EFR (n = 3). Les criteres EFR initiaux associes a la mise en œuvre d’une VNI dans les 6 mois etaient une CVF plus basse (82, 4 % theo vs 100,4 % theo ; p = 0,0001) et une elevation des bicarbonates (26,9 ± 3,2 vs 25,1 ± 1,7 mmol/L ; p = 0,02). Paradoxalement la TcCO2 nocturne moyenne, le pic ou le pourcentage de temps a une valeur > 50 mmHg n’etaient pas discriminantes. La TcCO2 au reveil etait surtout mal correlee a la PaCO2 simultanee (r = 0,14). L’IAH etait superieur dans le groupe avec VNI (24,6 ± 20 vs 10,7 ± 7,3 % ; p = 0,001) et les desaturations plus severes (SaO2 Conclusion En conclusion les criteres amenant le clinicien a proposer une VNI sont difficiles a codifier dans la SLA, avec une forte prevalence de SAS. Les donnees de PtcCO2 n’apparaissent pas tres discriminantes, en tout cas chez les patients avec atteinte respiratoire initiale moderee.

The studies presented in this article demonstrate the release of an IgE-dependent chemotactic factor for polymorphonuclear neutrophils (PMN) and eosinophils by alveolar macrophages (AMs) from normal subjects (n = 15) and allergic asthmatic patients (n = 15). A 60-minute incubation of normal AMs previously sensitized by 20% nonheated allergic sera with anti-human IgE antibody or the related allergen induced the release of a chemotactic activity (CA) for PMN and eosinophils in culture supernatants. When AMs were obtained from asthmatic patients, direct incubation with anti-IgE or the related allergen induced the same CA, whereas incubation with an unrelated allergen failed to produce CA (neutrophil CA after addition of anti-IgE, 22.5 +/- 3.5 cells per high power field; with related allergen, 15.8 +/- 3.6; with unrelated allergen, 0.7 +/- 1.8; p less than 0.0001). A partial characterization of the neutrophil chemotactic factor was carried out. Enzymatic treatment by trypsin or carboxypeptidase or by heating (56 degrees C for 3 hr) failed to abolish the neutrophil CA. After gel filtration the greater part of the neutrophil CA (80%) was recovered among low-molecular-weight components (300 to 1300 daltons). A preliminary deactivation of PMN by leukotriene B4 suppressed the CA of AM supernatants. These results indicate that IgE-dependent stimulation of AMs produces a neutrophil and eosinophil CA, present in a low-molecular-weight fraction possibly related to leukotrienes, and emphasizes the role of AMs in inflammatory lung processes during allergic asthma.