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Ibrahim Traore,1 Guillaume Eberst,1– 3 Fréderic Claudé,1 Lucie Laurent,1 Aurelia Meurisse,2,3 Sophie Paget-Bailly,2,3 Pauline Roux-Claudé,1 Pascale Jacoulet,1 Cindy Barnig,1 Rachel Martarello,1 Bastien Poirson,4 Kevin Bouiller,5 Catherine Chirouze,5 Julien Behr,6 Franck Grillet,6 Ophélie Ritter,1 Sébastien Pili-Floury,7 Hadrien Winiszewski,8 Emmanuel Samain,7,9 Gilles Capellier,8– 10 Virginie Westeel1– 3 1Respiratory Medicine Department, University Hospital of Besançon, Besançon, France; 2Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France; 3UMR 1098, University of Franche-Comté, Besançon, France; 4Department of Geriatrics, University Hospital of Besançon, Besançon, France; 5Department of Infectious Disease, University Hospital of Besançon, Besançon, France; 6Department of Radiology, University Hospital of Besançon, Besançon, France; 7Anesthesia and Intensive Care Unit, University Hospital of Besançon, Besançon, France; 8Medical Intensive Care Unit, University Hospital of Besançon, Besançon, France; 9Research Unit EA3920, Université de Franche Comté, Besançon, France; 10Australian and New Zealand Intensive Care Research Center, Department of Epidemiology and Preventive Medicine, Monash University, Monash, AustraliaCorrespondence: Ibrahim Traore, Respiratory Medicine Department, University Hospital of Besançon, Besançon, France, Email traore.ibrahim180@gmail.comBackground: Sleep apnea (SA) was reported as possibly exacerbating symptoms of COVID-19, a disease induced by SARS-CoV-2 virus. The same comorbidities are common with both pathologies. This study aimed to estimate the prevalence, characteristics of SA and variation in AHI three months after severe COVID-19 requiring intensive care unit (ICU) admission.Methods: A prospective cohort of patients admitted to ICU for severe COVID-19 underwent an overnight home polygraphy 3 months after onset of symptoms, as part of a comprehensive follow-up program (pulmonary function tests, 6-minute walk tests and chest CT-scan). Patients with an apnea hypopnea index (AHI) ≥ 5 were considered as having SA. We performed a comparative descriptive analysis of 2 subgroups according to the existence, severity of SA and indication for effective SA treatment: patients with absent or mild SA (AHI < 15) vs patients with moderate to severe SA (AHI ≥ 15).Results: Among 68 patients included, 62 (91%) had known comorbidities (34 hypertension, 21 obesity, 20 dyslipidemia, 16 type 2 diabetes). It has been observed a preexisting SA for 13 patients (19.1%). At 3 months, 62 patients (91%) had SA with 85.5% of obstructive events. Twenty-four patients had no or a mild SA (AHI < 15) and 44 had moderate to severe SA (AHI ≥ 15). Ischemic heart disease exclusively affected the moderate to severe SA group. Except for thoracic CT-scan which revealed less honeycomb lesions, COVID-19 symptoms were more severe in the group with moderate to severe SA, requiring a longer curarization, more prone position sessions and more frequent tracheotomy.Conclusion: SA involved 91% of patients in our population at 3 months of severe COVID-19 and was mainly obstructive type. Although SA might be a risk factor as well as consequences of ICU care in severe COVID-19 infection, our results underline the importance of sleep explorations after an ICU stay for this disease.Keywords: SARS-CoV-2, pneumonia, obstructive sleep apnea syndrome, intensive care unit

Halil Yildiz,1 Diego Castanares-Zapatero,2 Philippe d’Abadie,3 Sarah Bailly,4 Jean Cyr Yombi1 1Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, UClouvain, Bruxelles, Belgium; 2Department of Intensive Care, Cliniques Universitaires Saint-Luc, UClouvain, Bruxelles, Belgium; 3Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, UClouvain, Bruxelles, Belgium; 4Department of Hematology, Cliniques Universitaires Saint-Luc, UClouvain, Bruxelles, BelgiumCorrespondence: Halil Yildiz, Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, UClouvain, 10 Av Hippocrate, Bruxelles, 1200, Belgium, Email halil.yildiz@saintluc.uclouvain.beIntroduction: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease, which can be primary (due to genetic mutation) or secondary to malignancy, infection and rheumatologic diseases. Data concerning Belgian patients with adult HLH are lacking.Methods: This retrospective study was performed in a teaching hospital in Belgium. All cases of adult HLH, from December 2010 to April 2022, were reviewed. Patients with more than five HLH-2004 criteria and/or HScore > 80% were included in the study. The objective of our study was to describe clinical and biological characteristics of patients with HLH and attempt to look for variables associated with mortality.Results: Fifty-two patients were included in the final analysis. Mean age (SD) of patients was 48 (18) years old, and 29 patients were of male gender (56%). The underlying diseases associated with HLH were malignancy (M-HLH) in 22 patients, infection related HLH in 20 patients, rheumatologic disease related HLH in 7 patients, idiopathic in 2 patients and secondary to pregnancy in 1 patient. Overall mortality, mortality at 30 days and 90 days were 24/52 (46%), 13/52 (25%) and 4/52 (10%), respectively. In univariate analysis, malignancy, male sex, age and disseminated intravascular coagulation (DIC) were associated with mortality (p < 0.05). In multivariate analysis, only age was significantly associated with mortality (odds ratio, 1.053; 95% confidence interval, 1.016– 1.092; p 0.005).Conclusion: In our study, the most frequent triggers were malignancy and infectious agent followed by rheumatologic disease. Risk factors for mortality were age, male sex, malignancy and DIC, but only age remained significant in multivariate analysis. Treatment guidelines are mainly based on pediatric patients, and it is important for physician to describe adult patients’ outcome to better understand this disease and adapt treatment.Keywords: hemophagocytic lymphohistiocytosis, macrophage activation syndrome, infection, autoimmune disease, malignancy, corticosteroid, tocilizumab, ruxolitinib, mortality

Halil Yildiz,1 Sarah Bailly,2 Eric Van Den Neste,2 Jean Cyr Yombi1 1Departement of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint Luc, Bruxelles, Belgique; 2Departement of Hematology, Cliniques Universitaires Saint Luc, Bruxelles, BelgiqueCorrespondence: Halil YildizDepartement of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint Luc, 10 Avenue Hippocrate, Bruxelles, 1200, BelgiqueEmail halil.yildiz@uclouvain.beIntroduction: Haemophagocytic lymphohistiocytosis (HLH) is a severe disorder with high mortality. The aim of this review is to update clinical management of relapsed/refractory HLH in adults, with a focus on current and new therapies.Methods: We searched relevant articles in Embase and PUBMED with the MESH term “hemophagocytic lymphohistiocytosis; refractory; relapsing; adult.”Results: One hundred eight papers were found; of these, 22 were retained for this review. The treatment of HLH in adult is based on the HLH-94 regimen. The response rate is lower than in pediatric patients, and 20– 30% are refractory to this therapy. DEP regimen and allogenic hematopoietic stem cell transplantation (HSCT) are associated with complete response and partial response in 27% and 49.2%, respectively. However, many patients fail to achieve a stable condition before HSCT, and mortality is higher in them. New drugs have been developed, such as emapalumab, ruxolitinib, and alemtuzumab, and they may be used as bridges to the curative HSCT. They are relatively well tolerated and have few or mild side effects. With these agents, the rate of partial response ranges from 14.2% to 100%, while the rate of complete response is highly variable according to study and medication used. The number of patients who achieved HSCT ranged from 44.8% to 77%, with a survival rate of 55.9% to 100%. However, the populations in these studies are mainly composed of mixed-age patients (pediatric and adult patients), and studies including only adult patients are scarce.Conclusion: Relapsed or refractory HLH in adult patients is associated with poor outcome, and consolidation with HSCT may be required in some cases. Mortality related to HSCT is mainly due to active HLH disease before HSCT and post HSCT complications. New drugs, such as empalumab, ruxolitinib, and alemtuzumab are interesting since these agents may be used as bridges to HSCT with increases in the numbers of patients proceeding to HSCT and survival rate.Keywords: haemophagocytic lymphohistiocytosis, refractory, doxorubicin, etoposide, methylprednisolone regimen, hematopoietic stem cell transplantation, emapalumab

Summary: We recruited 5,970 hypertensive patients with obstructive sleep apnea (OSA) on current antihypertensive treatment from the European Sleep Apnea Database (ESADA) cohort. The group was subdivided into those receiving monotherapy (n = 3,594) and those receiving dual combined therapy (n = 2,376). We studied how major OSA confounders like age, gender, and body mass index as well as the degree of sleep apnea modified office systolic and diastolic blood pressure. Beta‐blockers alone or in combination with a diuretic were compared with other antihypertensive drug classes. Monotherapy with beta‐blocker was associated with lower systolic blood pressure, particularly in non‐obese middle‐aged males with hypertension. Conversely, the combination of a beta‐blocker and a diuretic was associated with lower systolic and diastolic blood pressure in hypertensive patients with moderate–severe OSA. Systolic blood pressure was better controlled in female patients using this combined treatment. Our cross‐sectional data suggest that specific clinical characteristics and type of antihypertensive medication influence the degree of blood pressure control in hypertensive OSA patients. Controlled trials are warranted. [ABSTRACT FROM AUTHOR]