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Objective: Blood bicarbonate concentration plays an important role for obstructive sleep apnea (OSA) patients to maintain acid-base balance. We investigated the association between arterial standard bicarbonate ([HCO3-]) and nocturnal hypoxia as well as comorbid hypertension in OSA.Methods: A cross-sectional analysis of 3329 patients in the European Sleep Apnea Database (ESADA) was performed. Arterial blood gas analysis and lung function test were performed in conjunction with polysomnographic sleep studies. The 4% oxygen desaturation index (ODI), mean and minimum oxygen saturation (SpO2), and percentage of time with SpO2 below 90% (T90%) were used to reflect nocturnal hypoxic burden. Arterial hypertension was defined as a physician diagnosis of hypertension with ongoing antihypertensive medication. Hypertensive patients with SBP/DBP below or above 140/90 mmHg were classified as controlled-, uncontrolled hypertension, respectively.Results: The [HCO3-] level was normal in most patients (average 24.0 +/- 2.5 mmol/L). ODI, T90% increased whereas mean and minimum SpO2 decreased across [HCO3-] tertiles (ANOVA, p = 0.030

Resume Les patients sont devenus en 2002 des usagers du systeme de sante en France. Ils sont potentiellement plus actifs et participants en 2021 comme le montre ce point de vue. Ils peuvent apporter leur savoir experientiel de la maladie et de leurs traitements avec la volonte de le partager. Ils peuvent intervenir en 2021 dans le domaine de la representation des usagers, de l’education therapeutique afin d’accroitre l’autonomie de tous, patients et public, de la formation des professionnels, de la recherche clinique ainsi que dans l’evolution du systeme de sante. La justification de l’engagement des patients, leurs roles dans le systeme de sante, la formation, la recherche en sante sont analyses dans une perspective francaise. Enfin, les obstacles a surmonter et les progres a accomplir sont revus pour promouvoir une plus grande democratie sanitaire par l’engagement des patients en France. En 2021, la place des patients reste modeste dans la conception et l’animation de l’ETP et est tres limitee dans le curriculum des etudes medicales sauf exception compte tenu d’un defaut d’information mais aussi de resistances des professionnels de la sante et de l’Universite. Les patients pourraient jouer un role significatif et contribuer a l’evolution du systeme de sante vers plus d’efficacite et de justice.

Resume Introduction Les patients candidats a une chirurgie bariatrique beneficient frequemment d’un depistage de syndrome d’apnees du sommeil (SAS) qui fait partie des recommandations alors que les autres troubles du sommeil, notamment l’insomnie et la privation chronique de sommeil, sont negliges. Methodes Etude transversale evaluant la prevalence et le retentissement de l’insomnie chronique et d’une privation du sommeil, associees ou non a un SAS, sur la qualite de vie et du sommeil de patients adresses en chirurgie bariatrique. Resultats Au total, 88 patients (74 % de femmes, âge median 41 [33,5 ; 50] ans, IMC median a 42 [39,2 ; 45,7] kg/m2) ont ete inclus. La prevalence de l’insomnie chronique etait de 31 % pour une prevalence du SAS de 87 %. 27 % des patients SAS presentaient egalement une insomnie chronique. L’insomnie chronique etait associee a une qualite de vie alteree (EVA EQ5D mediane : 60 [50 ;70] p = 0,04) et a une mauvaise qualite sommeil (Pittsburgh moyen : 8 [6 ; 11] p Conclusion L’insomnie chronique et la privation de sommeil ont des repercussions cliniques pejoratives et meritent d’etre recherchees avant chirurgie bariatrique. L’evolution post-chirurgie de ces sous-groupes de patients necessite d’etre evaluee dans des etudes ulterieures.

National audience

Resume Introduction L’insuffisance cardiaque touche pres de 2 % de la population avec une morbi-mortalite elevee malgre les avancees de la prise en charge therapeutique. Le syndrome d’apnee du sommeil (SAS) constitue un facteur de risque et d’aggravation de la dysfonction myocardique. Etat des connaissances Le SAS est retrouve chez 70 % des patients insuffisants cardiaques, 65 % des patients avec hypertension arterielle refractaire, 60 % des patients avec accident vasculaire cerebral et 50 % des patients avec fibrillation atriale. La morbidite cardiovasculaire associee est multipliee par 2 a 3. Les mecanismes physiopathologiques sont l’hypoxie intermittente nocturne, les variations de capnie, les variations de pressions intrathoraciques et les micro-eveils repetes, le tout concourant en une hyperactivation sympathique, une dysfonction endotheliale et une inflammation systemique. Conclusions La prise en charge du SAS chez les patients presentant une dysfonction myocardique doit etre couplee a la prise en charge cardiologique. Il est necessaire de poursuivre les evaluations scientifiques afin de determiner un parcours de soins precis et la place respective de chacune des prises en charge pneumologique et cardiologique.

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.

Introduction Le syndrome obesite-hypoventilation (SOH) est une cause frequente d’insuffisance respiratoire chronique dont la prevalence a augmente au cours des dernieres annees. Le diagnostic de SOH est encore souvent fait a l’occasion d’une hospitalisation pour decompensation respiratoire. Un depistage precoce permettrait de mettre en route des traitements appropries et d’eviter des complications graves. Nous presentons ici les caracteristiques a l’inclusion des patients de l’etude « COHYPOB ». Methodes Il s’agit d’une etude longitudinale, prospective, ouverte, multicentrique francaise (10 centres). Nous avons recrute 187 sujets obeses (IMC ≥ 30 kg/m 2), volontaires, ambulants, sans syndrome obesite hypoventilation connu (= normocapniques le jour). 26 sujets ont ete exclus en raison de la decouverte d’un syndrome d’apnees obstructives du sommeil (SAOS) severe, necessitant un traitement par PPC. Nous avons compare un groupe de patients sans hypoventilation nocturne (HN) avec un groupe de patients presentant des signes d’HN (> 10 episodes de desaturation nocturne ou SpO2 moyenne nocturne Resultats Nous avons inclus 161 sujets, 26 % d’hommes et 74 % de femmes. L’âge moyen etait de 47 ± 13 ans. L’indice de masse corporelle moyen etait de 37 ± 5 kg/m2. 87 (54 %) patients presentaient des signes d’HN isolee. En analyse univariee, les patients obeses avec HN etaient plus âges (53 ± 12 vs 41 ± 11; p = 0.001), plus obeses (IMC: 38,4 ± 5,4 vs 36,0 ± 3,7 kg/m2; p = 0,002), plus dyspneiques a l’effort (p = 0,003), plus somnolents (score d’Epworth: 7,4 ± 4,5 vs 6 ± 3,6; p = 0,034) et plus hypoxemiques le jour (PaO2: 86 ± 13 vs 92 ± 14 mmHg; p = 0,01). Il n’y avait pas de difference significative entre les 2 groupes pour la PaCO2 diurne ni pour les volumes et debits pulmonaires. Conclusion Dans une cohorte de sujets obeses, la moitie presente une hypoventilation nocturne. Le suivi longitudinal de cette cohorte devrait permettre de determiner si cette HN precede la survenue du syndrome obesite hypoventilation.

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 Some COVID-19 patients develop respiratory failure requiring admission to intensive care unit (ICU). We aim to evaluate the effects of pulmonary rehabilitation (PR) post-ICU in COVID-19 patients. Methods Twenty-one COVID-19 patients were evaluated pre- and post-PR and compared retrospectively to a non−COVID-19 group of 21 patients rehabilitated after ICU admission due to respiratory failure. Results PR induced greater 6-min walking distance improvement in COVID-19 patients (+205 ± 121 m) than in other respiratory failure patients post-ICU (+93 ± 66 m). The sooner PR was performed post-ICU, the better patients recovered. Conclusions PR induced large functional improvements in COVID-19 patients post-ICU although significant physical and psychosocial impairments remained post-PR.

Resume Depuis mi-mars 2020, l’epidemie de COVID-19 a conduit a la suspension de la prise en charge des patients presentant des troubles du sommeil et de la vigilance. Bien qu’ayant rarement un caractere urgent, cette prise en charge ne peut etre repoussee indefiniment. Des propositions visant a etablir les modalites de reprise progressive des activites de medecine du sommeil ont ete elaborees grâce a la methodologie CORE qui permet de degager rapidement un consensus d’experts lorsque les donnees probantes sont insuffisantes. La realisation d’explorations diagnostiques du sommeil et de la vigilance doit etre limitee aux patients pour lesquels la balance benefice–risque est favorable de maniere indiscutable et lorsque les resultats sont susceptibles d’avoir un impact decisif sur une strategie therapeutique, en privilegiant la teleconsultation et les enregistrements ambulatoires. Le strict respect de la distanciation physique et des autres mesures barriere, le port d’equipement de protection par le personnel en fonction des tâches, l’utilisation de materiel a usage unique si possible, et des procedures rigoureuses de nettoyage et de desinfection de l’equipement et des locaux doit permettre de limiter les risques de transmission du SARS-CoV-2 entre le patient et les soignants. Les propositions du groupe d’experts sont valables au moment de leur publication mais seront bien entendu reevaluees et completees tres regulierement en fonction de l’evolution des connaissances scientifiques et des recommandations des autorites de sante basees sur l’evolution de l’epidemie.

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.

Resume Chez les patients atteints de maladies neuromusculaires traites par ventilation non invasive (VNI), le choix de l’interface est crucial pour l’efficacite du traitement au long cours. Bien que les masques nasaux soient generalement consideres comme la premiere ligne de traitement, pres d’un tiers des patients atteints de maladies neuromusculaires utilisent une interface oro-nasale. Cependant, les facteurs qui determinent le choix du masque restent mal connus. Nous proposons ici une analyse originale a partir des donnees d’une enquete multicentrique prospective franco-belge qui examine les facteurs lies au type de masque utilise la nuit chez 116 patients adultes neuromusculaires traites par VNI. Chez ces patients, un masque oro-nasal semble plus souvent utilise chez les patients non-Duchenne, plus âges, avec indice de masse corporelle plus eleve, une moindre dependance au ventilateur et une meilleure autonomie des membres superieurs permettant le retrait autonome de l’interface. La realisation d’etudes prospectives controlees pour comparer objectivement l’efficacite et la tolerance des differentes interfaces de VNI dans cette population specifique est encore requise.

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.

Le cadre juridique des pratiques en sante va etre adapte aux progres de la science et de la technologie avec notamment l’encadrement des tests genetiques, des diagnostics preconceptionnels, la maitrise de l’impact de la revolution numerique, la tracabilite des donnees collectees en masse, la redefinition du consentement eclaire du patient face a des systemes complexes, le recadrage des recherches sur l’embryon.

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.

Introduction Sleep bruxism (BXM) is the result of rhythmic muscular masticatory activity (RMMA) and can be captured by masseters surface electromyography (sEMG). Despite the multiple adverse negative consequences of BXM, a simple reliable home diagnostic device is currently unavailable, with in laboratory audio-video polysomnography (type I PSG) remaining the gold standard diagnostic tool. Mandibular movements (MM) recordings during sleep can readily identify RMMA, are simple to set up and can be easily repeated from night to night. Here, we aimed to identify stereotypical MM in patients with BXM, and to develop RMMA automatic detection and BXM diagnosis using an artificial intelligence-based approach. Methods MM were recorded by a dedicated sensor (Sunrise, Namur, Belgium) in 12 patients with BXM during type I PSG. The Sunrise system consists of a coin-sized hardware that is comfortably placed on the subject’s chin. Its embedded inertial measurement unit communicates via Bluetooth with a smartphone and automatically transfers MM signals to a cloud-based infrastructure at the end of the night. Data processing and analysis are then performed in Python programming language. A time series cluster analysis was applied to sequences of masseters sEMG and MM signals during BXM episodes (n=300) and during spontaneous micro-arousals (n=300). Then, a convolutional neuronal network (CNN) was developed to identify BXM and distinguish it from spontaneous micro-arousals while exclusively relying on MM signal. Results Based on the cluster analysis, BXM periods were characterized by a specific pattern of MM signals (higher frequency and amplitude), which was closely associated with the sEMG signals but clearly differed from the MM signal patterns during micro-arousals. CNN-based classifier distinguished the BXM events from other RMMAs during micro-arousals and respiratory efforts with an overall accuracy of 91%. Conclusion Sleep bruxism can be automatically identified, quantified, and characterized with mandibular movements analysis supported by artificial intelligence technology. Support This work was supported by the French National Research Agency (ANR-12-TECS-0010), in the framework of the “Investissements d’avenir” program (ANR-15-IDEX-02). https://life.univ-grenoble-alpes.fr.

Introduction La cohorte prospective multicentrique FACE a pour objectif de fournir des donnees a long terme « en vie reelle » sur une population d’insuffisants cardiaques (a fraction d’ejection ventriculaire gauche alteree ou preservee) presentant des apnees centrales predominantes ou combinees a des apnees obstructives, eligibles a l’ASV. Les caracteristiques initiales des patients inclus dans la cohorte sont presentees ici. Methodes Les antecedents medicaux, la presentation clinique, les traitements medicamenteux, les resultats du diagnostic initial des troubles respiratoires du sommeil, la fonction cardiaque et la qualite de vie ont ete evalues a la visite d’inclusion. Les patients ont ete suivis jusqu’a 2 ans. Les donnees de la visite d’inclusion sont presentees en mediane et interquartiles ou en pourcentage de l’echantillon. Resultats Cinq cent neuf CHF patients ont ete inclus, âge median 72 [64 ; 79] ans, majorite d’hommes (88 %) avec un IMC median de 28 [25 ; 32] kg/m2. Les patients inclus etaient pour partie des patients avec une insuffisance cardiaque a fonction systolique alteree (FEVG 50 %) dans 31, 20, et 50 % des cas respectivement. Vingt-sept pour cent d’entre eux avaient un implant cardiaque. Les consommateurs actuels ou anciens de tabac et d’alcool etaient respectivement de 46 % et 14 %. Les principales comorbidites etaient l’hypertension (72 %), le diabete (37 %), la BPCO (12 %), la fibrillation auriculaire (40 %). Les patients presentaient un syndrome d’apnees centrales du sommeil predominant (69 % des patients), emergent (6,4 % patients) et coexistant OSA-CSA non controlees par PPC (25 %). Bien que les TRS aient ete severes avec un IAH median de 41[31 ; 55] evt/h et un temps de sommeil passe avec une SpO2 Conclusion Les troubles respiratoires du sommeil sont largement representes dans une population variee de patients insuffisants cardiaques chroniques. Les patients ICC presentaient des etiologies, des comorbidites et des types d’ICC differents. Une analyse en cluster de cette population a ete effectuee afin d’identifier differents phenogroupes.

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

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Resume Les patients atteints d’un syndrome d’apnees obstructives du sommeil (SAOS) presentent des modifications des taux urinaires et sanguins de certains biomarqueurs cardio-metaboliques. Des augmentations des taux de catecholamines, de marqueurs inflammatoires et lipidiques ou encore des modifications des marqueurs du metabolisme glucidique sont frequemment observees au moment du diagnostic du SAOS et peuvent etre attribuees au SAOS ou a ses comorbidites. Chez ces patients SAOS, de nombreuses etudes en ouvert montrent un effet benefique du traitement par pression positive continue (PPC) sur ces biomarqueurs cardio-metaboliques. Cependant, cet effet ne semble pas etre aussi clairement etabli a partir des donnees des essais randomises et controles (PPC versus sham PPC). Une synthese de ces donnees est donc necessaire, afin d’isoler les biomarqueurs a priori sensibles a la PPC pour lesquels un suivi regulier serait informatif pour documenter l’effet de PPC.

Resume Les resultats preliminaires de l’etude SERVE-HF ont donne lieu a la diffusion d’une information de securite conduisant a la contre-indication de l’utilisation d’une ventilation auto-asservie (VAA) pour le traitement des apnees centrales chez les patients avec insuffisance cardiaque systolique symptomatique chronique avec fraction d’ejection du ventricule gauche (FEVG) ≤ 45 %. L’objectif de cet article est de faire le point sur ces resultats et d’apporter une argumentation reposant sur les donnees de la litterature en faveur de la poursuite de l’utilisation de cette ventilation dans des indications differentes telles que : insuffisance cardiaque a FEVG conservee, syndrome des apnees du sommeil (SAS) complexe, SAS central induit par les opiaces, SAS central idiopathique, SAS central consequence d’un accident vasculaire cerebral. Ces differents elements nous conduisent a proposer la mise en place de registres dedies aux patients desappareilles de leur VAA d’une part, et d’autre part dans le cadre des prochaines mises en place de ce type de ventilation dans ces indications specifiques afin d’assurer la securite des patients et permettre des decisions argumentees concernant l’utilisation de la VAA.

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

Introduction La cohorte prospective multicentrique FACE a pour objectif de fournir des donnees a long terme « en vie reelle » sur une population d’insuffisants cardiaques (a fraction d’ejection ventriculaire gauche alteree ou preservee) presentant des apnees centrales predominantes ou combinees a des apnees obstructives, eligibles a l’ASV. L’analyse en classe latente (LCA) a ete proposee pour definir des phenogroupes homogenes de patients pouvant evoluer differemment. Methodes Presentation clinique, donnees du sommeil, fonction cardiaque et qualite de vie ont ete evaluees a la visite d’inclusion. Les patients etaient traites pour leur insuffisance cardiaque chronique et etaient eligibles a une prise en charge de leurs troubles respiratoires du sommeil (TRS) par ASV. La morbidite et la mortalite ont ete recueillies apres trois mois de suivi. Le critere principal etait le delai de survenu du premier evenement : deces, hospitalisation imprevue pour aggravation de l’insuffisance cardiaque, greffe cardiaque ou dispositif d’assistance circulatoire mecanique. Resultats Cinq cent neuf patients insuffisants cardiaques chroniques ont ete inclus dans l’analyse ITT, l’analyse en classe latente a identifie 6 phenogroupes bien definis. Au suivi a 3 mois, on observait une difference significative de l’incidence du critere principal entre les groupes (p Fig. 1 ). Conclusion Une analyse en cluster permettant de definir des phenogroupes homogenes bases sur la fonction cardiaque, le type de SAS, l’acceptation du traitement par ventilation auto-asservie est une methodologie prometteuse pour predire le devenir des patients insuffisants cardiaques chroniques.

Introduction Des donnees issues de la recherche fondamentale et clinique suggerent que le syndrome d’apnees hypopnees du sommeil (SAHOS) et la bronchopneumopathie chronique obstructive (BCPO) seraient associes au developpement de la maladie steatosique hepatique non alcoolique (non-alcoolic fatty liver disease [NAFLD]). Nous avons voulu etudier les liens entre ces deux maladies respiratoires et les marqueurs non-invasifs de la NAFLD en realisant une meta-analyse a partir de donnees individuelles issues de plusieurs cohortes cliniques. Methodes Les patients suivis pour une BPCO, d’une part, et les patients enregistres par polygraphie ventilatoire ou polysomnographie pour une suspicion clinique de SAHOS, d’autre part, ont ete inclus dans l’etude. Une ponction veineuse permettait d’effectuer le bilan metabolique et hepatique necessaire pour le calcul des tests non-invasifs de steatose hepatique (Hepatic Steatosis Index) et de fibrose (Fibrotest ou FibroMetre). Une meta-analyse a partir des donnees individuelles a ete realisee pour etudier si la presence et/ou la severite du SAHOS et/ou de la BPCO etaient associees a la presence et la severite de la NAFLD dans ces differentes composantes (steatose et fibrose). Resultats Parmi les 2120 patients analyses, 1584 presentaient une steatose (75 %). En analyse multivariee, les facteurs de risque de steatose etaient un index d’apnee-hypopnee (IAH) > 5/h, un indice de masse corporelle (IMC)> 26 kg/m2, l’âge, le diabete de type 2 (p 26 kg/m2, l’âge, le sexe masculin et le diabete de type 2 (p Conclusion Cette meta-analyse retrouve une association independante entre la steatose hepatique et la presence d’un SAHOS. Il existe une association entre le SAHOS et la fibrose hepatique mais celle-ci est principalement en rapport avec l’obesite des patients. Il n’existe pas de liens independants entre la NAFLD et la BPCO.

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.

Resume L’oxymetrie nocturne est un outil simple et peu couteux, tres utilise en pratique courante dans la prise en charge des troubles respiratoires nocturnes (TRN). Cependant, cette methode a des indications et des limites qu’il faut connaitre et que cette fiche technique a pour objectif de preciser. L’oxymetrie nocturne a un interet indiscutable pour le depistage d’un TRN, la surveillance simplifiee et rapide du traitement d’un TRN par pression positive continue ou ventilation non invasive, pour aider a la titration de l’avancee mandibulaire en cas de traitement par orthese et enfin pour evaluer le degre d’urgence des examens diagnostiques lors d’une suspicion clinique de TRN. En revanche, l’oxymetrie nocturne ne permet pas de confirmer un diagnostic de trouble respiratoire nocturne, de predire la nature obstructive ou centrale d’un SAS ni de depister les TRN sans desaturation.

Une hypoventilation alveolaire peut donc survenir dans deux grandes situations :• une reduction de la ventilation externe due a une dimi-nution de l’activite des centres respiratoires congenitale ou acquise ; ou a une dysfonction neuromusculaire glo-bale comme dans les maladies neuromusculaires ou des muscles respiratoires qui sont incompetents pour faire face a une charge mecanique augmentee comme dans le syndrome obesite- hypoventilation ou les deformations thoraciques ;• une ventilation externe preservee mais une augmentation de l’espace mort physiologique (augmentation du VD/VT).Si, pour certaines pathologies, comme les maladies neuromusculaires rapidement progressives (exemple : la sclerose laterale amyotrophique), la physiopathologie de l’hypoventilation alveolaire est aisement identiA able, pour d’autres pathologies, l’origine de l’hypoventilation est multifactorielle (ex : le syndrome obesite- hypoventilation). Par ailleurs, l’atteinte musculaire peripherique est un des elements essentiels expliquant la dyspnee des patients en insufA sance respiratoire chronique.Au cours de cet article de synthese, nous envisagerons :• l’importance respective de l’atteinte des muscles respira-toires par rapport aux autres mecanismes dans les grandes etiologies d’insufA sance respiratoire chronique ;• les methodes d’exploration des muscles respiratoires ;• les implications pour la mise en œuvre de la ventilation non invasive et la prescription d’un programme de reha-bilitation respiratoire.

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.