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Study Objectives To establish whether the recent EEG and behavioral criteria of arousal disorders apply to sexsomnia. Methods EEG and behavioral markers upon N3 sleep interruptions in videopolysomnography were retrospectively compared in 24 participants with sexsomnia, 41 participants with arousals disorders, and 40 healthy controls. The specificity and sensitivity of previously suggested EEG and behavioral cutoffs for supporting arousal disorders diagnosis were measured in the sexsomnia vs. control groups. Results Participants with sexsomnia and arousals disorders showed a higher N3 fragmentation index, slow/mixed N3 arousal index, and number of eye openings during N3 interruptions than healthy controls. Ten (41.7%) participants with sexsomnia (vs. one sleepwalker and no control) displayed an apparently sexual behavior (masturbation, sexual vocalization, pelvic thrusting, and hand within the pajama) during N3 arousal. An N3 sleep fragmentation index ≥6.8/h of N3 sleep and two or more N3 arousals associated with eye opening was 95% specific but poorly (46% and 42%) sensitive for diagnosing sexsomnia. An index of slow/mixed N3 arousals ≥2.5/h of N3 sleep was 73% specific and 67% sensitive. An N3 arousal with trunk raising, sitting, speaking, showing an expression of fear/surprise, shouting, or exhibiting sexual behavior was 100% specific for a diagnosis of sexsomnia. Conclusions In patients with sexsomnia, videopolysomnography based markers of arousal disorders are intermediate between healthy individuals and patients with other arousal disorders, supporting the concept of sexsomnia as a specialized, but less neurophysiologically severe, NREM parasomnia. Previously validated criteria for arousal disorders partially fit in patients with sexsomnia.

International audience; Background: Excessive daytime sleepiness (EDS) in individuals with OSA syndrome persisting despite good adherence to CPAP is a disabling condition. Pitolisant is a selective histamine H3-receptor antagonist with wake-promoting effects.Research question: Is pitolisant effective and safe for reducing daytime sleepiness in individuals with moderate to severe OSA adhering to CPAP treatment but experiencing residual EDS?Study design and methods: In a multicenter, double-blind, randomized (3:1), placebo-controlled, parallel-design trial, pitolisant was titrated individually at up to 20 mg/day and taken over 12 weeks. The primary end point was change in the Epworth Sleepiness Scale (ESS) score in the intention-to-treat population. Key secondary end points were maintenance of wakefulness assessed by the Oxford Sleep Resistance Test, Clinical Global Impressions scale of severity, the patient's global opinion, EuroQoL quality-of-life questionnaire score, Pichot fatigue questionnaire score, and safety.Results: Two hundred forty-four OSA participants (82.8% men; mean age, 53.1 years; mean Apnea Hypopnea Index with CPAP, 4.2/h; baseline ESS score, 14.7) were randomized to pitolisant (n = 183) or placebo (n = 61). ESS significantly decreased with pitolisant compared with placebo (-2.6; 95% CI, -3.9 to -1.4; P < .001), and the rate of responders to therapy (ESS ≤ 10 or change in ESS ≥ 3) was significantly higher with pitolisant (71.0% vs 54.1%; P = .013). Adverse event occurrence (mainly headache and insomnia) was higher in the pitolisant group compared with the placebo group (47.0% and 32.8%, respectively; P = .03). No cardiovascular or other significant safety concerns were reported.Interpretation: Pitolisant used as adjunct to CPAP therapy for OSA with residual sleepiness despite good CPAP adherence significantly reduced subjective and objective sleepiness and improved participant-reported outcomes and physician-reported disease severity.

International audience; Introduction: This study analyzes anatomical variations of the thoracic cage (TC) according to spinopelvic alignment, age and gender using stereoradiography in erect position.Methods: This retrospective multicentric study analyzed computed parameters collected from free-standing position bi-planar radiographs, among healthy subjects. Collected data were: age, gender, pelvic parameters (Pelvic Incidence, Pelvic Tilt (PT) and Sacral Slope), T1-T12 Kyphosis (TK), L1-S1 Lordosis (LL), curvilinear spinal length, global TC parameters (maximum thickness and width, rib cage volume, mean Spinal Penetration Index (SPI)), 1st–10th rib parameters (absolute and relative (to the corresponding vertebra) sagittal angles).Results: Totally, 256 subjects were included (140 females). Mean age was 34 (range: 8–83). Significant correlations were found between TK and TC thickness (0.3, p

Aims Periodic breathing is frequent in patients with severe heart failure. Apart from being an indicator of severity, periodic breathing has its own deleterious consequences (sleep-related oxygen desaturations, sleep fragmentation), which justifies attempts to correct it irrespective of the underlying disease. Animal models and human data suggest that baclofen can reconfigure respiratory central pattern generators. We hypothesised that baclofen, a GABAB agonist, may thus be able to correct periodic breathing in humans. Methods Healthy volunteers were exposed to hypoxia during sleep. Participants who developed periodic breathing (n = 14 [53 screened]) were randomly assigned to double-blind oral baclofen (progressively increased to 60 mg/d) or placebo. The primary outcome was the coefficient of variation (CoVar) of respiratory cycle total time considered as an indicator of breathing irregularity. Secondary outcomes included the CoVar of tidal volume, apnoea-hypopnoea index, sleep fragmentation index and ventilatory complexity (noise limit). Results The analysis was conducted in 9 subjects after exclusion of incomplete datasets. CoVar of respiratory cycle total time significantly increased with baclofen during non-rapid eye movement sleep (median with placebo 56.00% [37.63-78.95]; baclofen 85.42% [68.37-86.40], P = .020; significant difference during the N1-N2 phases of sleep but not during the N3 phase). CoVar of tidal volume significantly increased during N1-N2 sleep. The apnoea-hypopnoea index, sleep fragmentation index and ventilatory complexity were not significantly different between placebo and baclofen. Conclusion Baclofen did not stabilise breathing in our model. On the contrary, it increased respiratory variability. Baclofen should probably not be used in patients with or at risk of periodic breathing.

Background and objective Average volume-assured pressure support-automated expiratory positive airway pressure (AVAPS-AE) combines an automated positive expiratory pressure to maintain upper airway patency to an automated pressure support with a targeted tidal volume. The aim of this study was to compare the effects of 2-month AVAPS-AE ventilation versus pressure support (ST) ventilation on objective sleep quality in stable patients with OHS. Secondary outcomes included arterial blood gases, health-related quality of life, daytime sleepiness, subjective sleep quality and compliance to NIV. Methods This is a prospective multicentric randomized controlled trial. Consecutive OHS patients included had daytime Pa CO2 > 6 kPa, BMI ≥ 30 kg/m2 , clinical stability for more than 2 weeks and were naive from home NIV. PSG were analysed centrally by two independent experts. Primary endpoint was sleep quality improvement at 2 months. Results Among 69 trial patients, 60 patients had successful NIV setup. Baseline and follow-up PSG were available for 26 patients randomized in the ST group and 30 in the AVAPS-AE group. At baseline, Pa CO2 was 6.94 ± 0.71 kPa in the ST group and 6.61 ± 0.71 in the AVAPS-AE group (P = 0.032). No significant between-group difference was observed for objective sleep quality indices. Improvement in Pa CO2 was similar between groups with a mean reduction of -0.87 kPa (95% CI: -1.12 to -0.46) in the ST group versus -0.87 kPa (95% CI: -1.14 to -0.50) in the AVAPS-AE group (P = 0.984). Mean NIV use was 6.2 h per night in both groups (P = 0.93). NIV setup duration was shorter in the AVAPS-AE group (P = 0.012). Conclusion AVAPS-AE and ST ventilation for 2 months had similar impact on sleep quality and gas exchange.

Pathologies of the respiratory system can by accompanied by alterations of the biomechanical function of the rib cage, as well as of its morphology and movement. The assessment of such pathologies could benefit from rib cage kinematic analysis during breathing, but this analysis is challenging because of the difficulties in observing and quantifying bone movements in vivo. This work explored the feasibility of using biplanar x-rays to study rib cage modifications at different lung volumes and evaluated the potential of the method to characterize rib cage kinematic patterns in patients. Forty-seven asymptomatic adults and eleven obstructive sleep apnea syndrome (OSAS) patients underwent biplanar x-rays at three lung volumes: normal breathing, maximal and minimal volume. Rib cage and spinopelvic positional parameters were computed from 3D reconstruction of the skeleton. Results showed that inspiration mostly mobilized the ribs and costo-vertebral junction, while expiration was driven by the spine. OSAS patients had a different sagittal profile at rest than asymptomatic subjects, but these differences decreased at maximal and minimal volume. This suggests that patients employed different biomechanical strategies to attain a trunk configuration similar to asymptomatic subjects at minimal and maximal lung volume. This study confirmed that the proposed method could have an impact for the clinical assessment and understanding of pathologies involving breathing function, and which directly affect rib cage morphology.

International audience; Maxillomandibular deformity (MMD) and body posture appear to be correlated. However, no systematic literature review of the available evidence to support this correlation has been performed to date. The aim of this study was to conduct a systematic literature review on posture and MMD. This systematic literature review was registered in the PROSPERO database. Systematic searches of the MEDLINE, Scopus, Cochrane Library, and Web of Science databases were performed. In total, 13 clinical studies were included. Nine found a significant association between MMD and body posture or body balance: two studies showed a correlation between increased cervical lordosis and skeletal class III MMD, two studies showed an interaction between mandibular deviation and scoliosis, four studies demonstrated a significant association between lumbar column and pelvis anatomy and MMD, and one study found a correlation between displacement of the centre of mass and MMD. However, the level of evidence is low; the methods used to evaluate body posture and MMD were inconsistent. Orthognathic surgery could modify body posture. Although there seems to be an interaction between body posture and facial deformity, the number of studies is too small and the level of evidence too low to strongly support this association.

New finding What is the central question of this study? Transition to supine posture induces an inspiratory load associated with cortical activation in awake healthy subjects. Some obstructive sleep apnoea patients exhibit this cortical activity in the sitting position contributing to the arousal-dependent compensation of their upper airway abnormalities. Does a transition to the supine posture in awake obstructive sleep apnoea patients increase this cortical activity? What is the main finding and its importance? The transition to supine posture induces a reduction in the cortical activity despite evidence of an increase in genioglossus activity, suggesting that genioglossus activation is not driven by cortical activity. Abstract The anatomy and mechanical properties of the upper airway (UA) depend on posture. Lying in a supine position causes cephalad fluid shift to the neck, thus narrowing the UA and predisposing the individual to obstructive sleep apnoea (OSA). Increased UA dilator muscle activity during wakefulness prevents the UA collapse but the underlying mechanism has not yet been elucidated. In the sitting position during wakefulness, some OSA patients exhibit preinspiratory cortical activity (preinspiratory potential, PIP) probably related to UA abnormalities. The aim of this study was to investigate changes in the preinspiratory cortical activity and UA dilator muscle in OSA patients during postural challenge. An electroencephalogram was used to detect PIP, and the genioglossus electromyographic activity and ventilation were analysed in 17 awake, male OSA patients while they were sitting, just after lying down, and then in response to leg positive pressure to enhance cephalad fluid shift. The prevalence of PIP decreased from 53% (sitting) to 12% (supine) (P = 0.002) in association with increased genioglossus activity (tonic from median (25th, 75th centiles) 2.3 (1.8, 2.8)% to 3.6 (1.7, 5.0)% of voluntary deglutition, P = 0.019; phasic from 2.3 (1.9, 2.8)% to 3.7 (2.0, 6.1)%, P = 0.024), and with increased transcutaneous carbon dioxide pressure (from 43.0 (42.4, 44.2) to 44.6 (43.5, 45.2) mmHg). No change was observed during leg-positive-pressure application. Moving from the sitting position to the supine position reduces respiratory-related premotor cortical activity in awake OSA patients. The concomitant increase in genioglossus activity, therefore, is not driven by cortical respiratory activity.

(1) Background: osteopathic manipulation of the sphenopalatine ganglia (SPG) blocks the action of postganglionic sensory fibres. This neuromodulation can reduce nasal obstruction and enhance upper airway stability. We investigated the manipulation of the SPG in 31 patients with obstructive sleep apnoea syndrome (OSAS); (2) Methods: Randomised, controlled, double-blind, crossover study. Participants received active (AM), then sham manipulation (SM), or vice versa. The primary endpoint was apnoea-hypopnoea index (AHI). Secondary endpoints were variation of nasal obstruction evaluated by peak nasal inspiratory flow (PNIF) and upper airways stability evaluated by awake critical closing pressure [awake Pcrit]), at 30 min and 24 h. Schirmer’s test and pain were assessed immediately post-manipulation. Tactile/gustatory/olfactory/auditory/nociceptive/visual sensations were recorded. Adverse events were collected throughout. (3) Results: SPG manipulation did not reduce AHI (p = 0.670). PNIF increased post-AM but not post-SM at 30 min (AM-SM: 18 [10; 38] L/min, p = 0.0001) and 24 h (23 [10; 30] L/min, p = 0.001). There was no significant difference on awake Pcrit (AM-SM) at 30 min or 24 h). Sensations were more commonly reported post-AM (100% of patients) than post-SM (37%). Few adverse events and no serious adverse events were reported. (4) Conclusions: SPG manipulation is not supported as a treatment for OSAS but reduced nasal obstruction. This effect remains to be confirmed in a larger sample before using this approach to reduce nasal congestion in CPAP-treated patients or in mild OSAS.

Introduction: Pitolisant a Histamin H3-receptor inverse agonist waking agent for Excessive Daytime Sleepines (EDS) treatment in narcolepsy showed efficacy on EDS in Obstructive Sleep Apnea (OSA) patients with EDS treated respectively with and without Continuous Positive Airway Pressure (CPAP). Objective: Its efficacy and safety at 20mg/day was evaluated through an Individual patient data meta-analysis vs placebo.Methods: Epworth Sleep Scale (ESS) and Oxford Sleep Resistance (Osler) tests were co-primary endpoints tested at 0.025 significance and Fatigue (Pichot Scale) was secondary. Results: A significant mean ESS reduction of -3.06([95%CI -4.1,-2.02], Pl 0.001) was found with Pitolisant versus placebo and 81% more patients decreased final ESS to less than 10 (RR= 1.81 [95%CI 1.36, 2.39], pl 0.001). The Osler Final/Baseline was also 18% better (ratio=1.18[95%CI 1.02,1.35], P=0.022). A clinically meaningful EDS effect of Pitolisant measured by the aggregate Z-score on ESS and Osler was 0.71([0.46, 0.97], Pl 0.001). Finally, a significant mean Pichot Fatigue reduction of -1.23([-2.29,0.18], P=0.022) was found. These effects were shown invariant across various subgroups of the population (age,gender,work conditions). Finally these effects were not impacted as to whether or not CPAP was used. Side effect incidence was similar in both groups. Conclusions: These results confirm pitolisant efficacy on EDS and Fatigue symptoms in sleepy OSA patients versus placebo, evaluated by the ESS, Osler, EDS Z-score and Pichot Fatigue, irrespective of CPAP use. Bioprojet sponsored this analysis. CC is an employee of bioprojet pharma. JLP, YD, VA, were investigators, PL received honoraria from bioprojet.

STUDY OBJECTIVES: Mandibular advancement devices (MADs) are an alternative to continuous positive airway pressure for the management of obstructive sleep apnea (OSA). The ORthèse d’avanCée mAndibulaire dans le traitement en DEuxième intention du SAHOS sévère (ORCADES) study is investigating the long-term effectiveness of MAD therapy in patients with OSA who refused or were intolerant of continuous positive airway pressure. Five-year follow-up data are presented. METHODS: Data were available in 172 of 331 patients treated with a custom-made computer-aided design/computer-aided manufacturing biblock MAD (Narval CC; ResMed, Saint-Priest, France). The primary end point was treatment success (≥50% decrease in apnea-hypopnea index from baseline). RESULTS: Five-year treatment success rates were 52% overall and 25%, 52%, and 63%, respectively, in patients with mild, moderate, or severe OSA. This reflects a decline over time vs 3–6 months (79% overall) and 2 years (68%). Rates declined in all patient subgroups but to the greatest extent in patients with mild OSA. The slight worsening of respiratory parameters over time was not associated with any relevant changes in sleepiness and symptoms. Moderate or severe OSA at baseline, treatment success at 3–6 months, and no previous continuous positive airway pressure use were significant independent predictors of 5-year treatment success on multivariate analysis. No new safety signals emerged during long-term follow-up. The proportion of patients using their MAD for ≥4 h/night on ≥4 days/wk was 93.3%; 91.3% of patients reported device use of ≥6 h/night at 5 years. At 5-year follow-up, 96.5% of patients reported that they wanted to continue MAD therapy. CONCLUSIONS: Long-term MAD therapy remained effective after 5 years in >50% of patients, with good levels of patient satisfaction and adherence. CITATION: Vecchierini MF, Attali V, Collet JM, et al. Mandibular advancement device use in obstructive sleep apnea: ORCADES study 5-year follow-up data. J Clin Sleep Med. 2021;17(8):1695–1705.

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

Introduction: Pitolisant is a histamine H3-receptor antagonist/inverse agonist waking agent reducing sleepiness in narcolepsy. Objectives: HAROSA1 1 year study evaluated Pitolisant 20mg/d (P) efficacy and safety on residual excessive daytime sleepiness (rEDS) in obstructive sleep apnea patients (OSA) treated with CPAP with a good compliance. Methods: 2 periods were defined in HAROSA1: a 12 weeks double blind period (DB) comparing P vs placebo (pl) (n=244) and then was proposed a 40 weeks open label period (OL) with P (n=206). The primary criteria was the Epworth sleep scale (ESS) change and the main secondary criteria were sleep latency OSleR test (OSL), Pichot fatigue score (PF) and safety. Results: After 1 year, in patients with P during DB, we observed an additional ESS reduction -1.21 ± 3.12, an increase of OSL and an improvement of PF -1.6 ± 5.8 during OL. In patients with pl during DB and P during PO, we observed an ESS reduction -4.07 ± 5.29, an increase of sleep latency and improvement of PF-1.2 ± 5.8. Most frequent side effects were headaches, insomnia, nausea, vertigo without cardiovascular impact observed. Conclusion: After 1 year, OSA patients with CPAP and presenting rEDS treated with Pitolisant during DB were improved during OL on ESS, OSL and PF: Pitolisant efficacy was maintained during 1 year. OSA Patients with CPAP presenting rEDS with placebo during DB, then treated with Pitolisant (OL) were improved with a similar ESS reduction. Pitolisant showed a favourable benefit risk balance to manage rEDS in OSA patients with CPAP.

In healthy subjects, spinal alignment varies with the variations of lung volume and the natural breathing perturbs physiologically the balance. The reciprocal action between respiratory postural perturbation and partial counteraction of cyclic movements of the spine, pelvis and lower limbs represents the posturo-respiratory interaction (PRI). The PRI is centrally controlled. In the Obstructive Sleep Apnoea Syndrome (OSAS) specifics postural dysfunctions related to an abnormal PRI is observed. Numerous tools exist to measure the PRI. We propose an alternative approach which is contactless and non-invasive using airborne ultrasound devices. This approach offers the advantages to simultaneously assess breathing and postural variations and to be easily implemented in clinical settings. We first evaluate the performance of our device to assess the breathing pattern compared to that of a spirometer. We secondly use our approach to qualify the PRI by measuring the postural variation at the level of the T7 vertebra. We introduce a new parameter named pseudo-emergence similar to the classical emergence parameter. This parameter gives a value of 8.33%. This value is close to the median emergence that was compute from predecessor. We have demonstrated that the proposed method allows a reliable measurement of breathing. We also offer a contactless approach of a respiratory pseudo-emergence parameter to evaluate the PRI. The obtained parameters seem promising and consistent with the literature, but need to be confirm. Programme SOUFFLE de l'Institut Universitaire d'Ingénierie en Santé (IUIS)

Excessive daytime sleepiness (EDS) in individuals with OSA syndrome persisting despite good adherence to CPAP is a disabling condition. Pitolisant is a selective histamine H3-receptor antagonist with wake-promoting effects.Is pitolisant effective and safe for reducing daytime sleepiness in individuals with moderate to severe OSA adhering to CPAP treatment but experiencing residual EDS?In a multicenter, double-blind, randomized (3:1), placebo-controlled, parallel-design trial, pitolisant was titrated individually at up to 20 mg/day and taken over 12 weeks. The primary end point was change in the Epworth Sleepiness Scale (ESS) score in the intention-to-treat population. Key secondary end points were maintenance of wakefulness assessed by the Oxford Sleep Resistance Test, Clinical Global Impressions scale of severity, the patient's global opinion, EuroQoL quality-of-life questionnaire score, Pichot fatigue questionnaire score, and safety.Two hundred forty-four OSA participants (82.8% men; mean age, 53.1 years; mean Apnea Hypopnea Index with CPAP, 4.2/h; baseline ESS score, 14.7) were randomized to pitolisant (n = 183) or placebo (n = 61). ESS significantly decreased with pitolisant compared with placebo (-2.6; 95% CI, -3.9 to -1.4; P .001), and the rate of responders to therapy (ESS ≤ 10 or change in ESS ≥ 3) was significantly higher with pitolisant (71.0% vs 54.1%; P = .013). Adverse event occurrence (mainly headache and insomnia) was higher in the pitolisant group compared with the placebo group (47.0% and 32.8%, respectively; P = .03). No cardiovascular or other significant safety concerns were reported.Pitolisant used as adjunct to CPAP therapy for OSA with residual sleepiness despite good CPAP adherence significantly reduced subjective and objective sleepiness and improved participant-reported outcomes and physician-reported disease severity.ClinicalTrials.gov; No.: NCT01071876; URL: www.clinicaltrials.gov; EudraCT N°: 2009-017248-14; URL: eudract.ema.europa.eu.

PURPOSE: In healthy humans, postural and respiratory dynamics are intimately linked and a breathing-related postural perturbation is evident in joint kinematics. A cognitive dual-task paradigm that is known to induce both postural and ventilatory disturbances can be used to modulate this multijoint posturo-ventilatory (PV) interaction, particularly in the cervical spine, which supports the head. The objective of this study was to assess this modulation. METHODS: With the use of optoelectronic sensors, the breathing profile, articular joint motions of the cervical spine, hip, knees and ankles, and centre of pressure (CoP) displacement were measured in 20 healthy subjects (37 years old [29; 49], 10 females) during natural breathing (NB), a cognitive dual task (COG), and eyes-closed and increased-tidal-volume conditions. The PV interaction in the CoP and joint motions were evaluated by calculating the respiratory emergence (REm). RESULTS: Only the COG condition induced a decrease in the cervical REm (NB: 17.2% [7.8; 37.2]; COG: 4.2% [1.8; 10.0] p = 0.0020) concurrent with no changes in the cervical motion. The CoP REm (NB: 6.2% [3.8; 10.3]; COG: 12.9% [5.8; 20.7] p = 0.0696) and breathing frequency (NB: 16.6 min-1 [13.3; 18.7]; COG: 18.6 min-1 [16.3; 19.4] p = 0.0731) tended to increase, while the CoP (p = 0.0072) and lower joint motion displacements (p

Background and aim Hypoglossal nerve stimulation (HNS) decreases obstructive sleep apnoea (OSA) severity via genioglossus muscle activation and decreased upper airway collapsibility. This study assessed the safety and effectiveness at 6 months post-implantation of a novel device delivering bilateral HNS via a small implanted electrode activated by a unit worn externally, to treat OSA: the Genio™ system. Methods This prospective, open-label, non-randomised, single-arm treatment study was conducted at eight centres in three countries (Australia, France and the UK). Primary outcomes were incidence of device-related serious adverse events and change in the apnoea–hypopnoea index (AHI). The secondary outcome was the change in the 4% oxygen desaturation index (ODI). Additional outcomes included measures of sleepiness, quality of life, snoring and device use. This trial was registered with ClinicalTrials.gov, number NCT03048604. Results 22 out of 27 implanted participants (63% male, aged 55.9±12.0 years, body mass index (BMI) 27.4±3.0 kg·m−2) completed the protocol. At 6 months BMI was unchanged (p=0.85); AHI decreased from 23.7±12.2 to 12.9±10.1 events·h−1, a mean change of 10.8 events·h−1 (p5 days per week, and 77% reported use for >5 h per night. No device-related serious adverse events occurred during the 6-month post-implantation period. Conclusions Bilateral HNS using the Genio™ system reduces OSA severity and improves quality of life without device-related complications. The results are comparable with previously published HNS systems despite minimal implanted components and a simple stimulation algorithm., A new method of hypoglossal nerve stimulation to treat sleep apnoea does so bilaterally via an implanted neurostimulator activated externally. Its simplicity and relative non-invasiveness have not compromised its effectiveness relative to older methods. http://bit.ly/2lDCeif

International audience; Background: The biplanar 2D/3D X-ray technology (BPXR) is a 2D/3D imaging system allowing simultaneous stereo-corresponding posteroanterior (PA) and lateral 2D views of the whole body. The aim of our study was to assess the feasibility of cephalometric analysis based on the BPXR lateral skull view to accurately characterize facial morphology. Method: A total of 17 landmarks and 11 angles were placed and/or calculated on lateral BPXR and lateral cephalograms of 13 patients by three investigators. Five methods of angle identification were performed: the direct construction of straight lines on lateral cephalograms (LC-A) and on BPXR (BPXR-A), as well as the calculation of angles based on landmark identification on lateral cephalograms (LA-L) and on BPXR with the PA image (BPXR-LPA) or without (BPXR-L). Intra- and interoperator reliability of landmark identification and angle measurement of each method were calculated. To determine the most reliable method among the BPXR-based methods, their concordance with the reference method, LC-A, was evaluated. Results: Both imaging techniques had excellent intra- and interoperator reliability for landmark identification. On lateral BPXR, BPXR-A presented the best concordance with the reference method and a good intra- and interoperator reliability. Conclusion: BPXR provides a lateral view of the skull suitable for cephalometric analysis with good reliability.

Numerous processes are involved in 10 meter air pis-tol performance such as physiological (Tremayne andBarry2001), sensorimotor (Cheng et al.2017), or psy-chological (Baeck et al.2012). From a biomechanicalpoint of view, the posture stability has been investi-gated through the athlete’s center of pressure (CoP)(Ko et al.2017) as well as the upper-limb motion(Kevin et al.2003). A high stability, reflected by a lowCoP excursion and velocity, has been related to ahigh performance (Ko et al.2017). To understandhow to maximize the shooter’s stability, several pos-tural features have been discussed. For instance,(Hawkins and Sefton2011) pointed out that thehigher the stance width, the higher the CoP excursionand velocity, and the poorer the shoot performance.Under this framework, a detailed description of theCoP/Posture relationship may be noteworthy tounderstand shoot performance. For this purpose,although most studies focused on the whole-bodyCoP, we hypothesize that getting more insight intothe CoP evolution under each foot may be valuable toimprove performance. The objective of the presentstudy is therefore to compare the CoP under eachfoot for elite and novice shooters.

Objectif Evaluer l’innocuite et l’efficacite, a 6 mois post implantation, d’un nouveau dispositif implantable (Genio®, NYXOAH S.A.) delivrant une stimulation bilaterale du XII pour le traitement du SAHOS modere a severe. Methodes Etude prospective, ouverte, multicentrique (8 centres, Australie, France et Royaume-Uni) chez des patients avec un IAH entre 20 et 60/h, en echec de traitement par PPC et orthese, avec, comme objectifs principaux, la survenue d’evenements indesirables graves (EIG) lies au dispositif et la variation de l’IAH et comme objectifs secondaires, la variation de l’index de desaturations en O2 (IDO), du score d’Epworth, de la qualite de vie et du ronflement et l’observance. Resultats Sur 27 sujets implantes (63 % d’hommes, âge 55,9 ± 12,0 ans, IMC 27,4 ± 3,0 kg/m2), 22 ont termine le protocole. Aucun EIG lie au dispositif n’est survenu au cours des 6 mois suivant l’implantation. A 6 mois, l’IAH a diminue de 23,7 ± 12,2 a 12,9 ± 10,1/h (p Conclusion La stimulation cyclique et bilaterale du XII par le systeme Genio® ameliore de maniere significative plusieurs parametres du SAHOS modere a severe avec un profil de securite et d’adhesion au traitement satisfaisant.

Obstructive sleep apnea syndrome (OSAS) is associated with postural dysfunction characterized by abnormal spinal curvature and disturbance of balance and walking, whose pathophysiology is poorly understood. We hypothesized that it may be the result of a pathological interaction between postural and ventilatory functions. Twelve patients with OSAS (4 women, age 53 years [51–63] (median [quartiles]), apnea hypopnea index 31/h [24–41]) were compared with 12 healthy matched controls. Low dose biplanar X-rays (EOS® system) were acquired and personalized three-dimensional models of the spine and pelvis were reconstructed. We also estimated posturo-respiratory coupling by measurement of respiratory emergence, obtaining synchronized center of pressure data from a stabilometric platform and ventilation data recorded by an optico-electronic system of movement analysis. Compared with controls, OSAS patients, had cervical hyperextension with anterior projection of the head (angle OD-C7 12° [8; 14] vs. 5° [4; 8]; p = 0.002), and thoracic hyperkyphosis (angle T1–T12 65° [51; 71] vs. 49° [42; 59]; p = 0.039). Along the mediolateral axis: (1) center of pressure displacement was greater in OSAS patients, whose balance was poorer (19.2 mm [14.2; 31.5] vs. 8.5 [1.4; 17.8]; p = 0.008); (2) respiratory emergence was greater in OSAS patients, who showed increased postural disturbance of respiratory origin (19.2% [9.9; 24.0] vs. 8.1% [6.4; 10.4]; p = 0.028). These results are evidence for the centrally-mediated and primarily respiratory origin of the postural dysfunction in OSAS. It is characterized by an hyperextension of the cervical spine with a compensatory hyperkyphosis, and an alteration in posturo-respiratory coupling, apparently secondary to upper airway instability.

Hypoglossal Nerve Stimulation (HGNS) can decrease Obstructive Sleep Apnea (OSA) severity via tongue contraction and decreased upper airway collapsibility and thus be an alternative for patients who do not tolerate Positive Airway Pressure. To assess the safety and effectiveness at 6 months post-implantation of a novel device delivering bilateral HGNS to treat OSA: the Genio™ system, a prospective, open-label, non-randomized, single arm treatment study was conducted at eight centers in three countries (Australia, France, UK). Primary outcomes were the incidence of device-related Serious Adverse Events (SAEs) and change in the Apnea-Hypopnea Index (AHI). The secondary outcome was the change in the 4% Oxygen Desaturation Index (ODI). Additional outcomes included measures of sleepiness, quality of life, snoring, and device use. From 27 implanted participants (63% male, aged 55.9±12.0 years, BMI 27.4±3.0 kg/m²), 22 completed the protocol. At 6 months, AHI decreased from 23.7±12.2 to 12.9±10.1, a mean change of 10.8 events/hr [p 5 days per week, and 77% reported use for >5 hours per night. No device-related SAE occurred during the 6-months post-implantation period. In conclusion, bilateral HGNS using the Genio™ system can reduce OSA severity and improve quality of life with an acceptable safety profile.

In healthy humans, postural and respiratory dynamics are intimately linked and a breathing-related postural perturbation is evident in joint kinematics. A cognitive dual-task paradigm that is known to induce both postural and ventilatory disturbances can be used to modulate this multijoint posturo-ventilatory (PV) interaction, particularly in the cervical spine, which supports the head. The objective of this study was to assess this modulation.With the use of optoelectronic sensors, the breathing profile, articular joint motions of the cervical spine, hip, knees and ankles, and centre of pressure (CoP) displacement were measured in 20 healthy subjects (37 years old [29; 49], 10 females) during natural breathing (NB), a cognitive dual task (COG), and eyes-closed and increased-tidal-volume conditions. The PV interaction in the CoP and joint motions were evaluated by calculating the respiratory emergence (REm).Only the COG condition induced a decrease in the cervical REm (NB: 17.2% [7.8; 37.2]; COG: 4.2% [1.8; 10.0] p = 0.0020) concurrent with no changes in the cervical motion. The CoP REm (NB: 6.2% [3.8; 10.3]; COG: 12.9% [5.8; 20.7] p = 0.0696) and breathing frequency (NB: 16.6 min-1 [13.3; 18.7]; COG: 18.6 min-1 [16.3; 19.4] p = 0.0731) tended to increase, while the CoP (p = 0.0072) and lower joint motion displacements (p 0.05) increased.This study shows stable cervical spine motion during a cognitive dual task, as well as increased postural perturbations globally and in other joints. The concurrent reduction in the PV interaction at the cervical spine suggests that this "stabilization strategy" is centrally controlled and is achieved by a reduction in the breathing-related postural perturbations at this level. Whether this strategy is a goal for maintaining balance remains to be studied.

International audience; INTRODUCTION: Continuous positive airways pressure, generally used to treat obstructive sleep apnea-hypopnea syndrome (OSAHS), is not tolerated well by many patients. An alternative is to treat OSAHS with mandibular advancement devices (MAD). This research assesses the long term (> 2 years) effectiveness and the side effects on dental and skeletal parameters of these devices.MATERIAL AND METHODS: We selected 24 patients with moderate to severe OSAHS. All were treated with MADs for at least 2 years. We gathered cephalometric teleradiographs in centric relation and sleep recordings before and after the patients were treated. We evaluated the patients' apnea-hypopnea indexes (AHI) as well as their Epworth sleepiness scale (ESS) scores. We measured the inclination of the central incisors and the positions of the upper and lower jaws.RESULTS: Mandibular advancement devices were used for more than 2 years (3.9 ± 1.9 years). We observed a statistically significant decrease of the patients' AHI and their ESS scores. We also observed a modification of the inclination of the lower central incisors (+0.521; P = 0.047) and of the position of the maxilla (-0.287; P = 0.039).DISCUSSION: We demonstrated the clinical effectiveness of mandibular advancement devices for treating OSAHS, with a very low rate of side effects on dental and skeletal positions.

International audience; Obstructive sleep apnoea syndrome (OSAS) patients do not report breathing discomfort in spite of abnormal upper airway mechanics. We studied respiratory sensations in OSAS patients without and with mandibular advancement device (MAD).Fifty-seven moderate to severe non obese OSAS patients were asked about breathing discomfort using visual analogue scales (VAS) in the sitting position (VAS-1), after lying down (VAS-2), then with MAD (VAS-3). Awake critical closing pressure (awake Pcrit) was measured in 15 patients without then with MAD.None of the patients reported breathing discomfort when sitting but 19 patients (33%) did when lying (VAS-2: -20% or less). A feeling of "easier breathing" with MAD was observed and was more marked in patients reporting breathing discomfort when supine (VAS-3: +66.0% [49.0; 89.0]) than in those not doing so (VAS-3: +28.5% [1.0; 56.5], p = 0.007). MAD-induced change in awake Pcrit was correlated to VAS-3.In conclusion, MAD revealed “latent dyspnea” related to the severity of upper airways mechanics abnormalities in OSAS patients.

New Findings: What is the central question of this study? Moving to supine induces upper airway modifications and a fluid shift to the neck, which represent inspiratory load that predisposes to upper airway collapse.Is there cortical participation in the response to the load induced by transition to a supine posturein awake healthy subjects? What is the main finding and its importance? Moving to supine induces transient cortical activation in awake healthy subjects, with greater fluid shift, supporting possible cortical participation in the response to upper airway load induced by transition to a supine posture. Our findings open new perspectives in the understanding of the pathogenesis of obstructive sleep apnoea. Abstract: Moving from sitting upright to lying supine causes anatomical modifications and a fluid shift to the neck, which represent inspiratory loads that predispose to upper airway collapse. The pre-inspiratory potential (PIP) corresponds to the cortical activity observed during inspiratory load. In the sitting position during wakefulness, some obstructive sleep apnoea patients exhibit PIP, probably in relationship to upper airway abnormalities. The aim of this study was to investigate whether moving to the supine position induces respiratory-related cortical activation (PIP) in awake healthy subjects. The ECG was analysed to detect PIP, and EMG activity of the genioglossus muscle and ventilation were measured in the sitting position, immediately after moving to the supine position, and during application of leg positive pressure in the supine position to promote fluid shift, which was measured by bioelectrical impedance. Twenty-four subjects were included. From sitting to lying, PIP prevalence increased from 1/24 to 11/24 (P=0.002), and ventilation decreased with no change in genioglossus activity. The fluid shift from sitting to supine was higher in the subjects exhibiting PIP while supine compared with the subjects without PIP [median (25th; 75th centiles) 440(430; 520) versus 320(275; 385)ml, P=0.018], without any other differences. From before to during leg positive pressure, PIP disappeared (P=0.006). These results indicate that moving from sitting to lying induces transient respiratory-related cortical activity in awake healthy subjects with greater fluid shift, supporting possible cortical participation in the response to upper airway loading induced by moving from sitting upright to lying supine. This study offers new perspectives in the understanding of obstructive sleep apnoea pathogenesis.

Objectif Etude sur 1 an, evaluant efficacite sur Somnolence Diurne Excessive residuelle (SDEr) et tolerance de Pitolisant (P), agent eveillant agoniste inverse des recepteurs H3 (histamine) versus placebo (pl) chez des patients avec syndrome d’apnees obstructives du sommeil (SAOS) observant sous PPC. Methodes 2 parties : Double aveugle (DA) 12 semaines comparant P (jusqu’a 20 mg/j) versus pl puis partie en ouvert (PO) 40 semaines sous P Critere principal : efficacite mesuree par la variation du score de l’echelle d’Epworth (ESS) Criteres secondaires principaux : test d’Osler (OSL), score de Pichot (SP) et tolerance. Resultats Chez patients sous P durant DA : reduction supplementaire ESS (−1,21 ± 3,12) ; augmentation de la latence d’endormissement au test OSL et amelioration du SP (−1,6 ± 5,8) pendant PO : Chez patients sous pl durant DA puis P durant PO : reduction ESS (−4,07 ± 5,29) ; augmentation de la latence d’endormissement au OSL et amelioration du SP (−1,2 ± 5,8). Effets indesirables les plus frequents : cephalees, insomnies, nausees et vertiges, pas d’impact cardiovasculaire signale. Conclusion Les patients sous Pitolisant pendant DA ont continue a s’ameliorer sur ESS, OSL et Pichot durant la PO. Ceux sous placebo dans DA puis sous Pitolisant en PO ont montre une amelioration de la somnolence comparable aux patients sous Pitolisant durant toute l’etude. Pitolisant demontre un rapport benefice-risque favorable pour la prise en charge de la somnolence chez les patients avec SDEr sous PPC.

Objectif Pitolisant (P), agent eveillant agoniste inverse des recepteurs H3 (histamine) est un traitement de la somnolence diurne excessive (SDE) de la narcolepsie. La synthese de son efficacite, sa tolerance a 20 mg versus placebo (pl) est demontree via une meta-analyse des donnees individuelles patient a partir de 2 etudes chez des patients souffrant d’Apnee Obstructive du Sommeil (SAOS) presentant une SDE residuelle (SDEr) traites ou non par Pression Positive Continue (PPC). Methodes Les score d’Epworth (ESS) et test d’OSleR (OSL) etaient les criteres d’evaluation principaux, le z-score (ESS + OSL), la fatigue (score de Pichot), la reponse au traitement(RT), les principaux criteres secondaires. Resultats Une reduction significative de l’ESS -3,06([95 %CI -4,1,-2,0], p 0 et amelioration OSL) confirma la superiorite de P : ratio RR P20/PCB = 1,81[95 %CI 1,36, 2,39], p Conclusion Ces resultats prouvent l’efficacite de P sur la somnolence et la fatigue mesures par l’ESS, OSleR, Z-score et score de Pichot chez des patients SAOS somnolents avec ou sans PPC.

BackgroundMandibular repositioning devices (MRDs) are usually recommended as the first therapy option in patients with mild-to-moderate obstructive sleep apnoea (OSA). However, data on the long-term efficacy of MRDs are limited, not only in OSA patients who are noncompliant with continuous positive airway pressure (CPAP) but also in those with more severe OSA. The ORCADES study aimed to prospectively determine the long-term efficacy and tolerability of two custom-made Narval™ MRDs for obstructive sleep apnoea–hypopnoea syndrome (OSAHS) patients. The interim 3- to 6-month data are reported.MethodsEligible patients had OSAHS and had refused or were noncompliant with prescribed CPAP. Outcome measurements after gradual mandibular advancement titration included: apnoea–hypopnoea index (AHI), oxygen saturation, sleepiness, symptoms, quality of life, side effects and compliance.ResultsA total of 369 patients were included. Overall, MRD treatment was successful (≥50% decrease in AHI) in 76.2% of the participants; complete response (AHI

Objectif ORCADES est une cohorte prospective multicentrique qui evalue en vie reelle les benefices a long terme (5 ans) d’une orthese d’avancee mandibulaire (OAM) sur mesure (ResMed, Narval™) chez des patients SAHOS legers a severes, refusant ou etant intolerant a la pression positive continue (PPC). Methodes 331 pts SAHOS traites avec une OAM ont ete evalues a 5 ans de suivi sur l’evolution des donnees de polygraphie, de la qualite de vie et des symptomes, de l’observance et la tolerance au traitement, et des effets indesirables maxillo-faciaux et bucco-dentaires. Les donnees a 5 ans de suivi sont presentees ici. Resultats 52 % des patients traites par OAM etaient toujours dans l’etude apres 5 ans de suivi. 8,7 % ont arrete prematurement l’OAM pour manque d’efficacite, 11,4 % pour effets indesirables, 6,6 % ont repris le traitement par PPC. L’IAH a ete reduit significativement (−11,1 [−19,7 ; −4]/h, p Conclusion L’efficacite et la tolerance du traitement par OAM (Narval™) chez les patients intolerants a la PPC sont maintenues a long terme, notamment chez les patients avec un SAHOS severe.

The objective of this study was to test the capacity of vibrotactile stimulation transmitted to the wrist bones by a vibrating wristband to awaken healthy individuals and patients requiring home mechanical ventilation during sleep. Healthy subjects (n = 20) and patients with central hypoventilation (CH) (Congenital Central Hypoventilation syndrome n = 7; non-genetic form of CH n = 1) or chronic obstructive pulmonary disease (COPD) (n = 9), underwent a full-night polysomnography while wearing the wristband. Vibrotactile alarms were triggered five times during the night at random intervals. Electroencephalographic (EEG), clinical (trunk lift) and cognitive (record the time on a sheet of paper) arousals were recorded. Cognitive arousals were observed for 94% of the alarms in the healthy group and for 66% and 63% of subjects in the CH and COPD groups, respectively (p < 0.01). The percentage of participants experiencing cognitive arousals for all alarms, was 72% for healthy subjects, 37.5% for CH patients and 33% for COPD patients (ns) (94%, 50% and 44% for clinical arousals (p < 0.01) and 100%, 63% and 44% for EEG arousals (p < 0.01)). Device acceptance was good in the majority of cases, with the exception of one CH patient and eight healthy participants. In summary this study shows that a vibrotactile stimulus is effective to induce awakenings in healthy subjects, but is less effective in patients, supporting the notion that a vibrotactile stimulus could be an effective backup to a home mechanical ventilator audio alarm for healthy family caregivers.

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.

Study Objectives Excessive sleepiness is a common symptom in Prader–Willi syndrome (PWS), and it negatively impacts the quality of life. Obstructive sleep apnea and narcolepsy phenotypes have been reported in PWS. We characterized sleep disorders in a large cohort of adults with PWS. Methods All consecutive patients with genetically confirmed PWS unselected for sleep-related symptoms, underwent a clinical interview, polysomnography, and multiple sleep latency tests (MSLT, n = 60), followed by long-term (24 hours) polysomnography (n = 22/60). Results Among 60 adults evaluated (57% female, aged 25 ± 10 years, body mass index: 39 ± 12 kg/m2), 67% reported excessive sleepiness. According to the sleep study results, 43% had a previously unrecognized hypersomnia disorder, 15% had an isolated sleep breathing disorder, 12% had combined hypersomnia disorder and untreated breathing sleep disorder, and only 30% had normal sleep. Isolated hypersomnia disorder included narcolepsy in 35% (type 1, n = 1, and type 2, n = 8), hypersomnia in 12% (total sleep time >11 hours, n = 2, and MSLT 8 minutes, n = 10, and 8 minutes < MSLT < 10 minutes, n = 4). Sleep breathing disorders, isolated and combined, included obstructive sleep apnea (n = 14, already treated in seven), sleep hypoxemia (n = 1) and previously undiagnosed hypoventilation (n = 5). Modafinil was taken by 16 patients (well tolerated in 10), resulting in improved sleepiness over a mean 5-year follow-up period. Conclusion Sleepiness affects more than half of adult patients with PWS, with a variety of hypersomnia disorder (narcolepsy, hypersomnia, and borderline phenotypes) and breathing sleep disorders. Earlier diagnosis and management of sleep disorders may improve sleepiness, cognition, and behavior in these patients.

Background Choking during sleep may be caused by various respiratory and non-respiratory problems. Objective We aimed at documenting a new, rare cause of hallucinatory choking. Methods We documented the clinical and video-polysomnographic features of 11 adult patients referred for swallowing and choking during sleep. We conducted a systematic search for similar sensations in 68 consecutive adult patients with sleepwalking/sleep terrors and in 37 patients with obstructive sleep apnea. Results. The 11 patients with sleep-related swallowing and choking were all current or former sleepwalkers. The symptoms occurred during the first third of the night. Patients consistently reported the frequent hallucinatory feeling of swallowing an unusual object (ring, nails, pebble, chewing gum, spoon, fork, electrical cables, lizard tail, needles, brush, computer, gas container) that blocked the upper airways during sleep, followed by attempts to unblock them by spitting or swallowing water. When monitored, the choking sensations were not stereotypic, and occurred exclusively during arousals from N3 sleep, despite normal airway patency and absence of epileptic activity. The patients demonstrated simultaneous intense adrenergic stimulation and emotional distress. Of the 68 sleepwalkers, 13% had occasional choking sensations and 4% once inhaled a fictitious object. In the sleep apnea group, choking was never the motive of referral, but 38% of patients had occasional choking sensations, and 5% once inhaled something fictitious. Conclusion While insular seizure could also be discussed, these results suggest that sleep-related swallowing and choking syndrome may be in some cases a rare, specialized variant of the arousal disorders.

Introduction: In healthy subjects, quiet breathing induces specific centre of pressure (CP) oscillations (Caron, O. et al. j neulet 2004; 366:6-9). The aim of this study was to assess if apnoea-induced improved control of balance, is dependent on lung volume. Methods: 26 healthy subjects (10F; 32.9±13y.o.; BMI: 23,7±2,6 kg.m-2) were studied in seating position, during natural breath (NB) and apnoeas at functional residual capacity (FRC), total lung capacity (TLC) and residual volume (RV). CP displacement was recorded with force plate [AMTI] synchronized to optoelectronic system [Vicon] measuring ventilation (41 markers on the trunk). CP Antero-Posterior (AP) range frequency analysis was computed with Fourier transform sampled at 0.02Hz. The apnoeas were compared to NB with a non-parametrical test (Wilcoxon) at the RF±0.1Hz (11 comparison points). Results: Mean breathing frequency (BF) was 15.2±4.2/min. FRC apnoea significantly reduced CP AP range compared to NB; while FRC and TLC apnoeas increased it (Figure 1). Figure 1: CP AP range frequency spectrum centred on BF (*p Conclusion: Apnoea postural stabilization strategy depends on lung volume. It is optimal at FRC with significant decrease of AP range compared to NB; while perturbations appear at higher or lower volumes. Postural disabilities in some chronic respiratory diseases may be partly related to abnormal lung volume relaxation.

Introduction To describe patients with sexsomnia and to contrast their clinical and sleep measures with those of healthy controls and sleepwalkers. Aims and methods Subjects referred for sexsomnia and for sleepwalking/night terror were interviewed, completed the Paris Arousal Disorder Severity Scale (PADSS), and were monitored 1-2 nights with video-polysomnography. Results Seventeen patients (70.6% male, aged 17-76 years) had sexsomnia, with amnestic fondling of the bed partner (n = 11), complete sexual intercourse (n = 8), masturbation (n = 8), and spontaneous orgasm (n = 1). The sexual behaviors were more direct during sleep than during wakefulness (n = 12), leading to 6 sexual assaults, including intra-conjugal rape (n = 3), assault of a family member (n = 2), rape of a friend (n = 1), and forensic consequences (n = 2). In 47% of sexsomnia patients, there was a history or current occurrences of sleepwalking/night terrors. Patients with sexsomnia had more N3 awakenings than healthy matched controls and the same amount as regular sleepwalkers. Half of them presented evidence of cortico-cortical dissociation, including concomitant slow (mostly frontal) and rapid (mostly temporal and occipital) electroencephalography (EEG) rhythms, with concomitant N3 penile erection in 1 case. Of 89 sleepwalkers, 10% had previous episodes of amnestic sexual behaviors, with a higher PADSS-A score and a trend of a higher total PADSS score than the 80 sleepwalkers without sexsomnia. Conclusion In this single-center series, we confirmed the male predominance of sexsomnias and its potential for severe clinical and forensic consequences. The results suggest a continuum of regular sleepwalking, sleepwalking with occasional sexsomnia, and quasi-exclusive sexsomnia.

Background The purpose of this study was to describe the sleep structure (especially slow wave sleep) in adults with congenital central hypoventilation syndrome (CCHS), a rare genetic disease due to mutations in the PHOX2B gene. Fourteen patients aged 23 (19.0; 24.8) years old (median [1rst-3rd quartiles]) with CCHS underwent a sleep interview and night-time attended polysomnography with their ventilatory support. Their sleep variables were compared to those collected in 15 healthy control subjects matched for age, sex and body mass index. Results The latency to N3 sleep was shorter in patients (26.3 min [24.0; 30.1]) than in controls (49.5 min [34.3; 66.9]; P = 0.005), and sleep onset latency tended to be shorter in patients (14.0 min [7.0; 20.5]) than in controls (33.0 min [18.0; 49.0]; P = 0.052). Total sleep time, sleep stage percentages, sleep fragmentation as well as respiratory and movement index were within normal ranges and not different between groups. Conclusions Normal sleep in adult patients with CCHS and adequate ventilator support indicates that the PHOX2 gene mutations do not affect brain sleep networks. Consequently, any complaint of disrupted sleep should prompt clinicians to look for the usual causes of sleep disorders, primarily inadequate mechanical ventilation. Shorter N3 latency may indicate a higher need for slow wave sleep, to compensate for the abnormal respiratory-related cortical activity during awake quiet breathing observed in patients with CCH.