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Objective: Eco-anxiety is a complex construct that has been created to grasp the psychological impact of the consequences of global warming. The concept needs a reliably valid questionnaire to better evaluate its impact on the risk of anxiety and depressive disorders. The Eco-Anxiety Questionnaire (EAQ-22) evaluates two dimensions: 'habitual ecological anxiety' and 'distress related to eco-anxiety'. However, a version in French, one of the world's widely spoken languages, was until now lacking. We aimed to translate and validate the French EAQ-22 and to evaluate the prevalence of the level of the two dimensions of eco-anxiety and the relationship with anxiety and depressive symptoms in a representative adult sample of the French general population., Methods: This study was performed under the auspices of the Institut national du sommeil et de la vigilance (INSV). Participants (18-65 years) were recruited by an institute specialized in conducting online surveys of representative population samples (quota sampling). Two native French speakers and two native English speakers performed a forward-backward translation of the questionnaire. The Hospital Anxiety and Depression scale (HAD) was administered to assess anxiety (HAD-A) and depressive (HAD-D) symptoms and for external validity. Internal structural validity and external validity were analysed., Results: Evaluation was performed on 1004 participants: mean age 43.47 years (SD=13.41, range: [19-66]); 54.1% (n=543) women. Using the HAD, 312 (31.1%) patients had current clinically significant anxiety symptoms (HAD-A>10) and 150 (14.9%) had current clinically significant depressive symptoms (HAD-D>10). Cronbach's alpha coefficient was 0.934, indicating very good internal consistency. Correlation between EAQ-22 and HAD scores was low (r[1004]=0.209, P<0.001), 'habitual ecological anxiety' was correlated less with HAD-A and HAD-D than 'distress related to eco-anxiety', indicating good external validity., Conclusion: This study validates the French EAQ-22 and paves the way for using the EAQ-22 as a global tool for assessing eco-anxiety. Further prospective studies are now required to better evaluate the impact of eco-anxiety on the occurrence of anxiety and depressive disorder., (Copyright © 2023 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Excessive daytime sleepiness (EDS) is multifactorial. It combines, among other things, an excessive propensity to fall asleep ("physiological sleepiness") and a continuous non-imperative sleepiness (or drowsiness/hypo-arousal) leading to difficulties remaining awake and maintaining sustained attention and vigilance over the long term ("manifest sleepiness"). There is no stand-alone biological measure of EDS. EDS measures can either capture the severity of physiological sleepiness, which corresponds to the propensity to fall asleep, or the severity of manifest sleepiness, which corresponds to behavioral consequences of sleepiness and reduced vigilance. Neuropsychological tests (The psychomotor vigilance task (PVT), Oxford Sleep Resistance Test (OSLeR), Sustained Attention to Response Task (SART)) explore manifest sleepiness through several sustained attention tests but the lack of normative values and standardized protocols make the results difficult to interpret and use in clinical practice. Neurophysiological tests explore the two main aspects of EDS, i.e. the propensity to fall asleep (Multiple sleep latency test, MSLT) and the capacity to remain awake (Maintenance of wakefulness test, MWT). The MSLT and the MWT are widely used in clinical practice. The MSLT is recognized as the "gold standard" test for measuring the severity of the propensity to fall asleep and it is a diagnostic criterion for narcolepsy. The MWT measures the ability to stay awake. The MWT is not a diagnostic test as it is recommended only to evaluate the evolution of EDS and efficacy of EDS treatment. Even if some efforts to standardize the protocols for administration of these tests have been ongoing, MSLT and MWT have numerous limitations: age effect, floor or ceiling effects, binding protocol, no normal or cutoff value (or determined in small samples), and no or low test-retest values in some pathologies. Moreover, the recommended electrophysiological set-up and the determination of sleep onset using the 30‑sec epochs scoring rule show some limitations. New, more precise neurophysiological techniques should aim to detect very brief periods of physiological sleepiness and, in the future, the brain local phenomenon of sleepiness likely to underpin drowsiness, which could be called "physiological drowsiness"., Competing Interests: Declaration of Competing Interest No conflicts of interest were reported for this study., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

INSOMNIA AND THE BIOLOGICAL CLOCK. Multiple physiological and biological rhythms known as «circadian» are generated by the biological clock that controls them within the suprachiasmatic nuclei of the hypothalamus. However, the most emblematic circadian rhythm is that of sleep and awakening. It is therefore crucial to check how the clock may be involved in chronic insomnia. What is the influence of the clock on the time and quality of sleep? What are the typical clock disorders that explain insomnia in adolescents, shift and night workers, the elderly and the blind individuals? What are the tools to recommend in general and specialized medicine in the evaluation of the clock in insomnia? What influence finally of the light on the clock and the light therapy to recommend? So many questions and elements of understanding often-poorly known of chronic insomnia., Competing Interests: D. Léger déclare avoir participé à des interventions ponctuelles pour Idorsia, BioSerenity, Vanda Pharmaceuticals, iSommeil, Sanofi et avoir été pris en charge, à l’occasion de déplacements pour congrès, par Linde, SOS Oxygène et VitalAire. A. Rouen déclare avoir été pris en charge, à l’occasion de déplacements pour congrès, par Asten. M.-F. Vecchierini déclare des essais et des conférences pour Bioprojet et Resmed, et avoir été prise en charge, à l’occasion de déplacements pour congrès, par SOS Oxygène, Linde, Bioprojet et ResMed. V. Pitron déclare n’avoir aucun lien d’intérêts.

PHARMACOTHERAPIES FOR INSOMNIA. The first line of treatment in adult chronic insomnia is cognitive behavioral therapy (CBT). However, its difficult accessibility limited its use and medications are still often prescribed. Considering the drugs with marketing authorization, Z-drugs (zolpidem and zopiclone) if taken at the right hour and dosage promote sleep initiation and have less deleterious effects than benzodiazepines, especially the long-acting ones which should be avoided. This class of drugs cannot be prescribed longer than 28 days. Some antihistaminic licensed drugs are authorized as hypnotics, with a low proof of efficacy and a risk of adverse event as sedation and somnolence the next day. Their prescription should be avoided in old subjects. Some clinicians used antidepressant sedative medications, at low dosage, as hypnotic drugs but "off label", outside authorization. Now melatonin, an endogenous synchronizer of biologic rhythms, has obtained the authorization for the treatment of insomniac troubles, in subjects of at least 55 years old, in its slow- release formula, replacing the physiological decline of this hormone with aging. Melatonin is not a hypnotic, but has soporific properties, inducing sleep, improving sleep efficacy, sometimes sleep duration and morning alertness. When discontinued, it induced no withdrawal syndrome. It has shown no risk of abuse potential and no deleterious side-effects, if used at the right dose and in the absence of hepatic interaction with other compounds. Finally, a new class of hypnotics, "the orexin antagonists" has its first representative on the French market: daridorexant. The place of these molecules in the therapeutic strategy for chronic insomnia needs to be clarified.

Background: The Sleep Beliefs Scale (SBS) is a well-known tool to design and monitor personalized sleep health promotion at an individual and population level. The lack of an established French version limits the development of effective interventions targeting these populations. Thus, the aim of this study was to validate the French version of the SBS in a representative sample of the general population., Methods: Quota sampling was used to recruit 1,004 participants (18-65 years, mean age: 43 years, 54% of female) who underwent an online survey to complete the SBS, and to assess sleep schedules, sleep quality and disorders, and mental health. Cronbach's α coefficient, confirmatory factor analysis, item-internal consistency (IIC), and item discriminant validity (IDV) of the SBS were computed to assess internal validity while bivariate associations with sleep schedules, sleep quality and disorders, and mental health were used to assess external convergent and discriminant validity., Results: The mean score on the SBS was 12.3 ± 4.9. Item 19 ("Quiet & Dark") showed the highest rate of correct answers ( n  = 801, 79.8%), while item 20 ("Recovering sleep") showed the lowest rate of correct answers ( n  = 246, 24.5%). Overall, the SBS showed satisfactory internal consistency ( α  = 0.87) and confirmed the three-factor structure proposed by the original study. All items were found consistent (IIC > 0.4) and discriminant (IIC > IDV) except for item 20 ("recovering lost sleep by sleeping for a long time"). Females, older participants, and subjects with short time-in-bed, poor sleep quality, insomnia, and circadian rhythm disorder had higher SBS scores while participants with depressive symptoms had lower SBS scores., Conclusion: We successfully translated and validated the French version of the SBS in a representative sample, making it a reliable instrument for researchers and clinicians to assess and target sleep beliefs. Correct answers vary from 25 to 80% which underlines the importance of continuing sleep health promotion campaigns by targeting poorly understood behaviors. Our findings also shed light on the fickleness of beliefs that are prone to vary within individuals across time, in step with societal changes. Several associated factors were identified, thus contributing to our understanding of sleep beliefs and offering insights for personalized approaches to enhance sleep health and overall well-being., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Coelho, Rey, Labonne, Adan, Taillard, Geoffroy, Cugy, Dakar, Philip, Poirot, Royant-Parola, Hartley, Vecchierini and Micoulaud-Franchi.)

Background and Objective: Continuous positive airway pressure (CPAP) in the treatment of severe obstructive sleep apnoea (OSA) can be used in fixed CPAP or auto-adjusted (APAP) mode. The aim of this prospective randomized controlled clinical study was to evaluate the 3 month-efficacy of CPAP used either in fixed CPAP or APAP mode., Methods: Eight hundred one patients with severe OSA were included in twenty-two French centres. After 7 days during which all patients were treated with APAP to determine the effective pressure level and its variability, 353 and 351 patients were respectively randomized in the fixed CPAP group and APAP group. After 3 months of treatment, 308 patients in each group were analysed., Results: There was no difference between the two groups in terms of efficacy whatever the level of efficient pressure and pressure variability (p = 0.41). Exactly, 219 of 308 patients (71.1%) in the fixed CPAP group and 212 of 308 (68.8%) in the APAP group (p = 0.49) demonstrated residual apnoea hypopnoea index (AHI) <10/h and Epworth Score <11. Tolerance and adherence were also identical with a similar effect on quality of life and blood pressure evaluation., Conclusion: The two CPAP modes, fixed CPAP and APAP, were equally effective and tolerated in severe OSA patients., (© 2023 Asian Pacific Society of Respirology.)

The obstructive sleep apnoea syndrome (OSAS) affects 1-4% of adolescents. It represents a transitional stage between paediatric and adult OSA and is characterized by specific symptoms. BACKGROUND: The persistence of childhood OSAS during adolescence is not frequent. Risk factors are male sex, obesity and a history of tonsillectomy or adenoidectomy. Symptoms may be misleading such as tiredness and depressive disorders. In adolescence, untreated OSAS may result in neuro-behavioural and cognitive deficits, systemic inflammation, cardiovascular and metabolic disorders. The French Society of Research and Sleep Medicine organized a meeting on OSAS in adolescents. A multidisciplinary group of specialists (pulmonologists, pediatricians, ENT and maxillo-facial surgeons, dentofacial orthopedists/orthodontists, myofunctional therapists and sleep specialists) exchanged their experience, discussed publications and drew up a consensus document on the diagnosis and polysomnographic criteria for OSAS in adolescents. They proposed a practical diagnostic guideline and follow-up for these adolescents. OUTLOOK AND CONCLUSION: A good knowledge of the particularities of this pathology by the physician will lead to an early diagnosis, propose adapted multifactorial treatments and avoid the deleterious consequences of this pathology at adult age., (Copyright © 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

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., (© 2021 American Academy of Sleep Medicine.)

The French Medicine and Research Sleep Society had organized a consensus conference about sleep/wake circadian rhythms and their disorders. During this conference a subgroup of 11 sleep doctors/researchers looked specifically at the use of MEL in different pathologies. This article gives a summary of the main results of MEL therapy in some neurological diseases and insomnia approved by this consensus group. Exogenous MEL, which crosses the blood-brain barrier, has been used as a treatment in its two available forms: an immediate release form that principally shows a chronobiotic action and a long release form that mimics the physiological MEL secretion rhythm and is used to replace reduced physiological secretion. MEL secretion decreases frequently with age, mostly in elderly insomniacs and dementia patients. Results of level A studies show that MEL therapy, used as an add-on treatment, has beneficial effects in mild cognitive impairment (MCI) and Alzheimer patients with sleep disorders in improving sleep quality and in regulating the sleep/wake rhythm. MEL has to be prescribed as early as possible and for a long period, at a dose of 2 to 5 or 10 mg. It may have a beneficial effect on cognitive function in MCI but shows no effect in moderate to severe Alzheimer's disease. It should be emphasized that there are no serious side effects with MEL treatment. In these diseases, light therapy used 12 hours before melatonin treatment has a positive synergic effect. In REM sleep behavior disorder, immediate release MEL should be prescribed first as its side effect profile is much better than clonazepam shortly before bedtime. MEL has a good efficacy on clinical symptoms and PSG REM sleep without atonia episodes and is well tolerated. In Parkinson disease with sleep disorders and without REM sleep behavior disorder, MEL seems to improve subjective sleep quality but no conclusions can be drawn. There is insufficient scientific proof for using MEL as a prophylactic treatment in primary headache, migraine and cluster headache. In epileptic patients, MEL can be safely used to regulate the sleep/wake rhythm and to improve insomnia but more randomized controlled studies are necessary. In primary or no-comorbid insomnia, only a 2 mg dose of slow release MEL, 1 to 2 hours before bedtime, over a period of 3 to 12 weeks, is recommended. It decreases sleep onset latency, improves quality of sleep, morning alertness and quality of life without serious side effects and without withdrawal symptoms., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

The French society of medical research on sleep (SFRMS) appointed a group of experts to conduct a consensus conference in order to study the indications and prescription status of exogenous melatonin (MEL). Eleven sleep physicians/researchers investigated in subgroups the use of MEL in different domains of healthcare in line with their subspecialties (circadian sleep/wake rhythm disorders, psychiatric disorders, neurological disorders, pediatric and neurodevelopmental disorders). In this article we present a summary of the main conclusions of the expert group on MEL therapy in circadian sleep/wake rhythm disorders such us delayed sleep-wake disorder, non-24-hour sleep wake rhythm disorder and jet lag., (Copyright © 2020. Published by Elsevier Masson SAS.)

Obstructive sleep disordered breathing (OSDB), in children and adolescents, need to be treated quite soon to avoid complications. A paediatrician, a sleep specialist, an orthodontist, an ENT and a myofunctional therapist will examine together the children with OSDB and determine the best personalised surgical and medical treatments for each of them. Only medical treatments are reviewed in this article. An international consensus recommended adenotonsillectomy as the first line therapy in young with OSDB. Usually adenotonsillectomy is combined with several important adjunctive medical treatments. Overweight and obesity frequent in adolescents, worsen OSDB and increase persistent OSDB after adenotonsillectomy. Weight loss is obtained by dietary restriction, physical activity, psychological support and sleep hygiene rules. Anti-inflammatory drugs (corticosteroids and leukotriene receptor antagonists) have shown their efficacy in children with moderate OSDB. Orthodontic treatments, rapid maxillary expansion or oral appliance, are used in selected patients according to their maxillo-facial disturbances in adjunction to adenotonsillectomy. Nasal CPAP is rarely useful except in severe OSDB specially in persistent OSDB after adenotonsillectomy. Finally, active or passive, myofunctional therapy is, according to some authors, an indispensable adjunct treatment to avoid persistent OSDB after adenotonsillectomy. These personalized medical treatments of OSDB are either administered jointly with adenotonsillectomy or in a hierarchal order.

Objective/background: Mandibular repositioning device (MRD) therapy is an alternative to continuous positive airway pressure (CPAP). The Orkney Complex Disease Study-ORCADES study is assessing the long-term efficacy and tolerability of MRD therapy in obstructive sleep apnoea syndrome (OSAS); two-year follow-up data are presented., Patients/methods: OSAS 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])., Results: Of 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 <5/h, <10/h and <15/h was achieved in 30%, 56% and 72% of patients, respectively. On multivariate analysis, ≥50% decrease in AHI at 3-6 months and absence of nocturia at 3-6 months were significant predictors of MRD treatment continuation. Adverse events were generally mild, and the majority occurred in the first year of treatment., Conclusions: Two years' treatment with an MRD was effective and well tolerated in patients with mild to severe OSAS who refused or were intolerant of CPAP., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: Mandibular repositioning devices (MRDs) are an effective treatment option for obstructive sleep apnea syndrome (OSAS), particularly in patients who refuse or cannot tolerate continuous positive airway pressure (CPAP). However, sex differences in the response to therapy and predictors of response are not clearly defined. This analysis of data from the long-term prospective ORCADES trial compared MRD efficacy in men and women with OSAS., Methods: The ORCADES study included patients with newly diagnosed mild-to-moderate or severe OSAS who refused or were non-compliant with CPAP. MRD therapy was titrated over 3-6 months. The primary endpoint was treatment success (≥ 50% decrease in apnea-hypopnea index (AHI)). Complete response was defined using a range of AHI cut-off values (< 5/h, < 10/h, < 15/h)., Results: Overall treatment success rates were 89% in women and 76% in men (p = 0.019); corresponding rates in those with severe OSAS (AHI > 30/h) were 100% and 68% (p = 0.0015). In women vs. men, overall complete response rates at AHI cut-off values of < 5/h, <10/h, and < 15/h were 49 vs. 34% (p = 0.0052), 78 vs. 62% (p = 0.016), and 92 vs. 76% (p = 0.0032). On multivariate analysis, significant predictors of MRD treatment success were overbite and baseline apnea index in men, and neck circumference and no previous CPAP therapy in women. There were sex differences in the occurrence of side effects. Temporomandibular joint pain was the most common reason for stopping MRD therapy., Conclusions: MRD therapy was effective in women with OSA of any severity, with significantly higher response rates compared with men especially in severe OSAS., Trial Registration: www.clinicaltrials.gov (NCT01326143).

Although the prevalence of the obstructive sleep apnoea syndrome (OSAS) is high in adolescents, studies pertaining to adolescent OSAS are less numerous than childhood studies. Cases of adolescent OSAS may consist of residual OSAS after adenotonsillectomy, but most often are de novo cases. Major pathophysiological factors are weight excess or even high-grade obesity, and the association of upper airway narrowing and tonsillar hypertrophy (pharyngeal, palatal or even lingual). ENT and systematic orthodontic assessments are the main points. In case of predisposing factors such as dental, occlusal or dento-facial abnormalities, a specific orthodontic treatment can be discussed. First line treatment is surgical adenotonsillectomy; surgical reduction of the lingual tonsils is seldom required. CPAP treatment may be indicated in the case of severe comorbidities (craniofacial malformations, neuromuscular diseases…) or in obese adolescents with severe residual OSAS. Treatment of adolescent OSAS has to be comprehensive and multidisciplinary, taking into account the specific treatments of obesity and abnormal sleep/wake rhythms., (Copyright © 2019. Published by Elsevier Masson SAS.)

Certain inappropriate routines can have a negative impact on sleep, leading to sleep disorders or even aggravating pre-existing sleep pathologies. An observational study of 176 patients aged 60 or over, suffering from chronic insomnia, has been carried out in order to find out more about these patients' sleep habits and lifestyles and to identify those that can be corrected to improve insomnia in this population., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Correct diagnosis of restless legs syndrome (RLS) is essential to patient care and treatment. Diagnosis is most often clinical and based on diagnostic criteria: the need to move the legs accompanied to varying degrees by unpleasant sensations, predominantly during the evening and improved by movement. In rare cases, clinical examination is insufficient and a polysomnography is necessary. Once a positive diagnosis has been made, a neurological examination and an assessment of iron status are required. The severity of the RLS must be evaluated to determine whether a specific treatment is necessary. Before treatment, it is essential to ensure that a definite diagnosis of RLS has been made and the phenotype characterised. This enables a personal treatment plan and limits the risk of augmentation syndrome., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

This is the first systematic review of the literature on sleep and its relation to cognition and behaviour in preschool-aged children. In comparison with the literature focused on school-aged children, knowledge involving preschoolers is rather sparse. A total of 26 studies was included in this review, which revealed a high degree of heterogeneity regarding the type and means of measuring sleep variables and behavioural and cognitive variables, as well as the statistical methods employed. Amongst the 13 articles with the largest sample sizes (top 50% of the included studies, 12 different populations), 12 found that a higher quantity or quality of sleep was associated with better behavioural and/or cognitive outcomes. Results point to an association between sleep, behaviour and cognition as early as preschool years, but the strengths of associations reported in the articles were relatively small. Studies with a smaller sample size were less concordant. It is consistent with our findings that the strengths of association are small, and thus require large sample sizes to ensure statistical detection power. Different aspects of sleep were not associated with all cognitive or behavioural features in the same way, which underscores the need for specific measures rather than general ones such as 'sleep problems' or 'behaviour problems' to be able to decipher the relationships. There is also a need for large longitudinal studies using objective measures and accounting for confounding factors. The child's genotype has recently been shown to have a moderating role in the association between sleep and behaviour, and should be further explored., (© 2017 European Sleep Research Society.)

Sleep specialists have proposed measures to counteract the negative short- and long-term consequences of sleep debt, and some have suggested the nap as a potential and powerful "public health tool". Here, we address this countermeasure aspect of napping viewed as an action against sleep deprivation rather than an action associated with poor health. We review the physiological functions that have been associated positively with napping in both public health and clinical settings (sleep-related accidents, work and school, and cardiovascular risk) and in laboratory-based studies with potential public health issues (cognitive performance, stress, immune function and pain sensitivity). We also discuss the circumstances in which napping-depending on several factors, including nap duration, frequency, and age-could be a potential public health tool and a countermeasure for sleep loss in terms of reducing accidents and cardiovascular events and improving sleep-restriction-sensitive working performance. However, the impact of napping and the nature of the sleep stage(s) involved still need to be evaluated, especially from the perspective of coping strategies in populations with chronic sleep debt, such as night and shift workers., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Competing Interests: M.-F. Vecchierini déclare participer à des essais cliniques pour Vanda et Bioproject, faire des travaux scientifiques et des conférences pour Resmed et avoir été prise en charge lors de congrès par UCB Pharma, Elia Médical et Isis Médical.

The French Society of Research and Sleep Medicine (SFRMS) organized a meeting on obstructive sleep apnea syndrome (OSAS) in children. A multidisciplinary group of specialists (pulmonologist, ENT surgeons, pediatricians, orofacial myofunctional therapists, neurophysiologists, and sleep specialists) reached a consensus on the value of isolated or clustered clinical symptoms and of questionnaires completed by parents in the clinical diagnosis and in assessing the severity of OSAS. Are clinical history with validated questionnaires and a rigorous physical examination sufficient to suspect OSAS, to appreciate its severity, and finally to confirm the diagnosis? Usually, a sleep recording of respiratory parameters remains mandatory for the diagnosis of OSAS to be made. However, clinical symptoms are very useful for estimating the probability of the diagnosis and the severity of the disease, and therefore for classifying which children will benefit form polysomnography and for proposing an adapted follow-up after OSAS therapy. Even if they are not able to ascertain the diagnosis of OSAS in children, clinical history, questionnaires, and physical examination are very important. Finally, we propose a classification of the indications for polysomnography in children suspected of having OSAS., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

There are many reasons to take into consideration the sleep disorders in the elderly. The sleep quality degrades with age and is strongly affected by medical conditions, intrinsic sleep disorders, or by a combination of these factors. Other age-related conditions such as severe dementia, dependence or living in institution worsen sleep disturbances in older people. When living alone elderly people, being cognitively impaired and medically disabled, may not be able to complain about sleep problems. Sleep disorders are thus underdiagnosed, unmarked, and insufficiently investigated in the elderly. In this heterogeneous population, sleep assessment should include a global geriatric approach and be individually adapted for each subject. The sleep interview must specially include medical comorbidities, medication uses, and aged-related changes of lifestyle such as retirement, loss of spouse, hospitalization or institutionalization. In the elderly with loss of autonomy, standard sleep assessment is not always adequate and must be replaced by shorter, simpler or observation-based tests such as the Sleep disorders inventory, Observation-based nocturnal sleep inventory, Observation and interview based diurnal sleepiness inventory. When sleep log is impossible, actimetry is an excellent alternative for studying sleep-wake rhythm. Ventilatory polygraphy is a simpler test for detecting sleep apnea than polysomnography. Utilization of sophisticated investigations should be discussed when the feasibility and usefulness is limited.

Background: Mandibular 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., Methods: Eligible 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., Results: A total of 369 patients were included. Overall, MRD treatment was successful (≥50% decrease in AHI) in 76.2% of the participants; complete response (AHI <10/h) was achieved in 63.5%. Severe OSAHS was effectively treated (AHI <15/h) in about 60% of the participants; 38% had complete symptom resolution. Mandibular repositioning devices significantly decreased subjective sleepiness, eliminated symptoms and improved quality of life. They were well tolerated and compliance was excellent. Only 8% of the participants stopped MRD treatment due to side effects., Conclusion: Custom-made Narval(™) MRDs are effective for mild to severe OSA in patients who refuse or are noncompliant with CPAP. They are well tolerated and have excellent compliance., (Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Tasimelteon, a novel circadian regulator, is the first product for the treatment of Non-24-hour Sleep-Wake Disorder (Non-24) approved by either the FDA or the European Medicines Agency (EMA). Tasimelteon is a potent and specific melatonin (MT1 and MT2) receptor agonist with 2 - 4 times greater affinity for the MT2 receptor., Methods: Safety was assessed in two controlled and two open-label studies in blind individuals with Non-24 and in two controlled studies of primary insomnia. Periodic assessments included collection of adverse events (AEs), laboratory testing, electrocardiograms (ECGs), vital sign monitoring, physical examinations and assessment for the potential for suicide. One study included additional assessments for endocrine function., Results: A total of 184 blind individuals with Non-24 received tasimelteon nightly with a median exposure > 1 year. In placebo-controlled studies, 387 patients with insomnia and 42 patients with Non-24 received tasimelteon nightly for 4 - 26 weeks. The total patient years exposure for the six studies assessed here is 258.64 patient years. Discontinuations due to AEs were similar across treatment groups. Overall in the clinical studies described here, AEs attributable to tasimelteon treatment were headache, diarrhea, dry mouth, alanine aminotransferase increased, somnolence, dizziness and nightmare/abnormal dreams. There were no clinically significant differences in treatment group with ECGs, vital signs, withdrawal, endocrine function and suicidality assessments., Conclusion: Long-term tasimelteon administration was safe and well-tolerated. This is supported by placebo-controlled data in both Non-24 and insomnia patients.

Short sleep duration has been shown to be associated with elevated body mass index (BMI) in many epidemiological studies. Several pathways could link sleep deprivation to weight gain and obesity, including increased food intake, decreased energy expenditure, and changes in levels of appetite-regulating hormones, such as leptin and ghrelin. A relatively new factor that is contributing to sleep deprivation is the use of multimedia (e.g. television viewing, computer, and internet), which may aggravate sedentary behavior and increase caloric intake. In addition, shift-work, long working hours, and increased time commuting to and from work have also been hypothesized to favor weight gain and obesity-related metabolic disorders, because of their strong link to shorter sleep times. This article reviews the epidemiological, biological, and behavioral evidence linking sleep debt and obesity.

This article describes the two-process model of sleep regulation. The 24-hour sleep-wake cycle is regulated by a homeostatic process and an endogenous, 2 oscillators, circadian process, under the influence of external synchronisers. These two processes are partially independent but influence each other, as shown in the two-sleep-process auto-regulation model. A reciprocal inhibition model of two interconnected neuronal groups, "SP on" and "SP off", explains the regular recurrence of paradoxical sleep. Sleep studies have primarily depended on observation of the subject and have determined the optimal conditions for sleep (position, external conditions, sleep duration and need) and have studied the consequences of sleep deprivation or modifications of sleep schedules. Then, electrophysiological recordings permitted the classification of sleep stages according to the observed EEG patterns. The course of a night's sleep is reported on a "hypnogram". The adult subject falls asleep in non-REM sleep (N1), then sleep deepens progressively to stages N2 and N3 with the appearance of spindles and slow waves (N2). Slow waves become more numerous in stage N3. Every 90minutes REM sleep recurs, with muscle atonia and rapid eye movements. These adult sleep patterns develop progressively during the 2 first years of life as total sleep duration decreases, with the reduction of diurnal sleep and of REM sleep. Around 2 to 4 months, spindles and K complexes appear on the EEG, with the differentiation of light and deep sleep with, however, a predominance of slow wave sleep., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Narcolepsy (with or without cataplexy), idiopathic hypersomnia (with or without long sleep duration) and Kleine - Levin syndrome are the main central rare hypersomnias. They may be considered models to help us to better understand the mechanisms controlling sleep and waking regulation in humans. When creating the national centers for rare hypersomnias, the aims were: 1) screening and earlier treatment of patients with hypersomnia; 2) improving patient care with guidelines, a specific patient's card, coordination of treatments between centers and professionals, and the development of new treatments; 3) encouraging research studies into the epidemiology, pathophysiology and genotype/phenotype through the creation of clinical, DNA, sera and cerebrospinal fluid banks; 4) increasing public awareness among patients and their relatives, the general public and in the mass media of rare hypersomnias; and 5) regular evaluation of our activities. These goals appear to have been achieved over the past 5 years. However, there are now financial difficulties to be faced, given the increasing demands of patients and professionals while having to stay within the same limited budgets., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Restless legs syndrome (RLS) diagnosis is clinically ascertained on four associated essential criteria according to the recommendations of the workshop at the National Institute of Health published in 2003. Supportive clinical features can help to resolve any diagnosis uncertainty. RLS severity is assessed by a validated rating scale also useful for therapeutic decision and evaluation. Idiopathic forms (familial or sporadic) are the most frequent. Nevertheless secondary forms must be recognized, and etiology, associated pathologies and risk factors investigated. Periodic leg movements (PLM) during wakefulness and more frequently during sleep are present in almost 80 % of patients with RLS. These PLM can be recorded during a suggested immobilization test or during a polysomnography. Deleterious consequences of RLS are important: attention-deficit hyperactivity or tiredness and asthenia, cognitive deficit, psychiatric illness and detrimental impact on quality of life. This high prevalent syndrome is actually better defined but still under-diagnosed probably due to the patients' difficulties to describe their feelings. Practitioners would benefit to interview more systematically their patients complaining of poor sleep about legs discomfort and movements in the evening and at night., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

Sleep in dementias has been mainly studied in Alzheimer disease (AD). Sleep disturbances are found in 25 to 35% of subjects with AD. Subjective and objective disturbances are described. Long nocturnal awakenings disrupt sleep; total sleep time and sleep efficiency are reduced. Slow wave sleep is decreased and sometimes disappears. REM sleep percentage is also reduced and at a later stage of the disease, REM latency is increased. Sleep fragmentation can be associated with excessive daytime napping and sleepiness, and with other behavioral symptoms such as the sundowning syndrome and nocturnal agitation. Sleep abnormalities closely parallel the level of severity of dementia. The rest/activity ratio and the sleep-wake rhythms are more and more disturbed; the phase delay of the temperature rhythm is associated with the severity of the sundowning syndrome. Sleep disturbances and behavioral symptoms are the main reasons to institutionalize the patient. Sleep disturbances are related to multiple factors. Pathophysiological changes resulting of the disease itself, such as damage to the cholinergic pathways and to the circadian pacemaker in the suprachiasmatic nucleus, contribute to sleep changes in AD. Associated medical and psychiatric illness and their different treatments as well as environmental factors also induced sleep disturbances. Sleep-disordered breathing is a highly prevalent condition in AD patients and restless leg syndrome may account for nocturnal agitation. In Parkinson and in Lewy body dementias, sleep disturbances are more severe than in DA and REM sleep behavior disorder can precede by several years these diseases. Sleep attacks and sleepiness are very frequent in Parkinson disease. Specific etiologies should drive specific treatment. Several non pharmacologic treatments are usually associated to treat sleep disturbances in AD: information, increased daytime physical, social activities to minimize daytime naps and exposure to bright light. Some studies found advantages to associate melatonin in the evening.

Introduction: Launois-Bensaude syndrome (LBS) is a rare disease, characterized by the accumulation of fatty tissue predominantly in the neck, shoulders and thorax, whose diagnostic is clinical., Objectives: We describe a new case in a 73 year-old man. As the patient was obese, complained of snoring and was treated for hypertension, we looked for a morbid association with an obstructive sleep apnea syndrome (OSAS)., Methods: A polysomnography (PSG) and a cervical magnetic resonance imaging (MRI) were performed., Results: PSG demonstrated OSAS with an apnea-hypopnea index of 43/h. Cervical MRI showed fatty infiltration resulting in airway narrowing at the pharyngeal but not at the tracheal level. Only, 3 cases of such a morbid association have already been published; in 2 of these patients was a tracheal compression. More over a metabolic syndrome was present., Conclusions: This observation draws attention to the need for seeking OSAS among patients affected by LBS, even in a moderate form, and emphasises the roles of the upper airway narrowing by the fat infiltration as well as the role of the metabolic syndrome in the genesis of OSAS.

Objective: To assess the efficacy and compliance of a traction-based mandibular repositioning device (MRD) for treatment of moderate to severe obstructive sleep apnea syndrome (OSAS) under a patient-driven protocol in a routine outpatient care setting., Methods: Forty patients, 10 severe and 30 moderate OSAS sufferers (apnea-hypopnea index [AHI] >30 and between 15 and 30, respectively), were enrolled by four sleep centers. Nocturnal polygraphy, quality of life, and quality of sleep questionnaires were used to measure the effect of treatment after 45 days., Results: Thirty-five patients completed the study. Frequency of respiratory events, daytime sleepiness, snoring, patient assessment of sleep quality, specific short-form multipurpose health survey (SF-36) and the Pittsburgh Sleep Quality Index (PSQI) improved significantly with the MRD. Sixty percent of patients were "responders" (>50% decrease in AHI); 46% of patients were "full responders" (>50% decrease and AHI <10). Observance of treatment was high; 80% of patients wore the MRD every night. Side effects and patient complaints were minor and transitory. No serious side effects or cases of pathology aggravation were reported., Conclusion: Efficacy on respiratory and somnolence parameters of this innovative traction-based MRD was validated under a simple protocol of care with response rates similar to those published in the literature. This study shows consistent significant improvement by the MRD in quality of life and quality of sleep parameters across several tests. Treatment with the MRD under a simple, patient-driven protocol of care with control of efficacy by nocturnal polygraphy is appropriate in routine outpatient practice for moderate OSAS patients.

This article presents normal EEG characteristics and their maturational pattern in premature infants of 24-30 weeks gestational age. Although the very premature infants with a normal outcome are not that numerous, their normal EEG pattern should be known, as EEG constitutes a basis for neurological prognosis. Background activity is first discontinuous but the discontinuity gradually decreases and the activity is completely continuous at 30 weeks of age, during active sleep. At the same time, interburst intervals become shorter so that the proportion of time without EEG activity decreases. Based on EEG activity and eyes movements, a rough sleep state differentiation appears as early as 25 weeks of gestational age and is complete at 30 weeks. The main EEG figures are high-voltage delta waves, whose frequency is slower and amplitude higher in younger infants. Temporal delta waves occur in sequences and are characteristic of the very premature infant; they progressively become smaller and less numerous and disappear around 27-28 weeks. In contrast, occipital delta waves remain numerous; they are of high voltage and usually bilaterally superimposed with fast rhythms. Both types of frontal delta waves that are seen in 24-27 weeks premature babies disappear with maturation. Bursts of synchronized delta waves, which are less numerous than localized delta waves, also disappear before 28 weeks of gestational age. Finally, diffuse theta bursts which are mainly recorded at 26-27 weeks, progressively focus on temporal areas with maturation. At 30 weeks, they are observed on temporal areas, mainly during slow-wave sleep.

Electroencephalography (EEG) recording techniques in early premature babies are not very different from those used for full-term neonates. Here, we emphasise the most important points: asepsis precautions, full knowledge of the clinical data and drug therapies, fundamental role of a well-trained technician in supervising the EEG recording and monitoring the baby. We discuss the best electrode positions, the most informative montages, and their standardisation between neurophysiological laboratories. Artefact detection constitutes an important aspect of EEG signal analysis in preterm babies of less than 30 weeks. It is obviously necessary to discriminate between meaningful information and artefacts. The complexity of the signal in neonates makes artefact detection difficult. We present some characteristic features and describe some methods for eliminating them. We underline the positive aspect of some artefacts and their clinical use. We emphasise the crucial role of the technicians.

Obstructive sleep apnea (OSA) is associated with impaired airway reflexes. Cough is the main airway defense mechanism but the effect of OSA on cough is unknown. Thirty-two female obese patients scheduled to undergo bariatric surgery were studied. They were classified as presenting OSA (20 patients) when the apnea-hypopnea index (AHI) was greater than 5h. Cough sensitivity was measured with citric acid. Increasing concentrations of nebulized citric acid were delivered until cough was elicited. The concentrations eliciting one (C1) and two coughs (C2) were recorded and log transformed (log C1 and log C2). log C1 and log C2 (median (interquartile)) were 1.90 mg/mL (0.90) and 2.2mg/mL (0.30) in OSA patients and 1.60 mg/mL (0.45) and 1.60 mg/mL (0.45) in non-OSA patients, respectively (comparison between groups: p=0.0372 for log C1 and p=0.0227 for log C2). A significant relationship was observed between AHI and log C1 and log C2. Cough sensitivity is therefore, decreased in female obese OSA patients and this decreased sensitivity is positively correlated with disease severity.

This article aims at summarizing normal EEG criteria and their maturational pattern in premature infants of 24 to 30 weeks gestational age. Although very premature infants with a normal outcome are not numerous, their normal EEG patterns must be known, as EEG constitutes a basis for neurological prognosis. Background activity is first discontinuous. Discontinuity decreases thereafter with increasing age, so that some long periods of continuous activity may be observed in active sleep, around 30 weeks of age. Conversely, interburst intervals become shorter and the proportion of time without EEG activity is decreasing. Based on EEG activity and eye movements, a rough sleep-state differentiation was described as soon as 25 weeks of gestational age and is completely achieved at 30 weeks. The main EEG figures are high-voltage delta waves of higher amplitude and slower frequency in younger infants. Temporal delta waves occur in sequences, these are very characteristic of the very premature infant; thereafter, they become smaller, less numerous and eventually disappear around 27-28 weeks. In contrast, occipital delta waves remain numerous and of high voltage, are usually bilateral and superimposed with fast rhythms. The two types of frontal delta waves that are observed in 24-27 weeks prematures disappear with maturation. Bursts of synchronized delta waves are less numerous than localized delta waves and also disappear before 28 weeks of age. Finally, diffuse theta bursts are mainly recorded at 26-27 weeks GA and become more localized in temporal areas with maturation. At 30 weeks, they are observed on temporal areas, mainly during slow-wave sleep.

EEG recording techniques in early premature babies are not very different from those used for full-term neonates. Here, we emphasise the most important points: asepsis precautions, full knowledge of the clinical data and drug therapies, the fundamental role of a well-trained technician in supervising the EEG recording and monitoring the baby. The best electrode positions, the most informative montages and their standardisation between neurophysiological laboratories, are suggested. Artifact detection constitutes an important aspect of EEG signal analysis in preterm babies of less than 30 weeks. It is obviously necessary to discriminate between meaningful information and artefacts. The complexity of the signal in neonates makes artifact detection difficult. We present some characteristic features and describe some methods for eliminating them. We underline the positive aspect of some artifacts and their clinical use. We emphasise the crucial role of the technicians.

This review summarizes the well-known clinical features of the obstructive sleep apnea-hypopnea syndrome (OSAHS) and emphasizes new research on this syndrome. Though described in the seventies, the prevalence OSAHS is known mainly in the US. A dramatic increasing in prevalence has been related to the increase prevalence of obesity, raising a substantial public health problem. Discussion continues on the proper definition of the syndrome and degrees of severity. Multiple factors are involved in the pathogenesis of sleep apnea: anatomic abnormalities, mechanical factors, nervous alterations, muscular imbalance between pharyngeal constrictor and dilator muscles or part of a metabolic syndrome? Indeed, obstructive sleep apnea with and without obesity is increasingly implicated in the initiation and progression of metabolic disorders and of cardiovascular diseases (hypertension, cardiac ischemia and probably congestive heart failure, cardiac arrhythmias and strokes). An extended literature reports the neural, humoral, thrombotic, metabolic and inflammatory mechanisms linking OSAHS to endocrinology and cardiovascular diseases. Daytime sleepiness, cognitive, memory and performance deficits with their risks are also stressed. These consequences require treating this syndrome as soon as possible. Multiple interventions (medical, mechanical-nasal positive airway pressure or oral appliances, and sometimes surgical management) can be used but nasal continuous positive airway pressure is the "gold standard" treatment in severe OSAHS. More often multiple interventions are appropriate in a given patient. Finally, there is growing evidence that genetic factors influence the expression of OSAHS. Numerous genetic studies have investigated the etiology of OSAHS with the goal of improving our understanding of its pathogenesis.

Study Objectives: To present normative data of sleep-wake characteristics and to examine risk factors associated with extreme values (i.e., in the 5 lower and upper percentiles of the distribution) in older adults., Design: Cross-sectional telephone survey, Setting: The metropolitan area of Paris, France., Participants: A total of 7010 randomly selected households were contacted. Among them, 1264 households included at least 1 resident 60 years of age or older; 1026 subjects agreed to participate (participation rate: 80.9%)., Interventions: None., Measurements and Results: Subjects were interviewed with the Sleep-EVAL System about their sleeping habits and sleep and psychiatric disorders. In addition, the system administered to all the participants the Psychological General Well-Being Schedule, the Cognitive Difficulties Scale (Mac Nair-R), and an independent living scale. The median nighttime sleep duration was 7 hours without significant difference between the age groups. Factors positively associated with the 5 percentile (4 hours 30 minutes or less) of nighttime sleep duration were obesity, poor health, insomnia, and insomnia accompanied by daytime sleepiness and cognitive impairment. At the other extremity (95th percentile), long sleep (9 hours 30 minutes or more) was associated with organic disease, lack of physical exercise, and lower education. A daytime sleep duration of 1 hour or more (95th percentile) was associated with being a man, cognitive impairment, high blood pressure, obesity, and insomnia. Long sleep latency (95th percentile at 80 minutes) was associated with anxiety, lower education, poor health, insomnia without excessive daytime sleepiness, and obstructive sleep apnea syndrome. Obesity and loss of autonomy in activities of daily living was associated with both early (9 PM or earlier) and late bedtime (1 AM or later) and early (< or = 5 AM) and late (> or = 9 AM) wake-up time., Conclusions: This study illustrates the usefulness of normal distributions of sleep parameters in the general population to calculate different risk factors associated with extreme values of the normal distribution.

This review deals with F responses, which are late responses obtained by supramaximal stimulation of virtually all the motor and mixed peripheral nerves. They are recorded over a muscle innervated by the stimulated nerve. The first description of F-waves was published in the fifties. Their neurophysiological mechanisms have been abundantly discussed in the literature leading to a current consensus, whereby F-waves are considered as antidromic responses produced by a pool of motoneurons activated by peripheral nerve stimulation. In the first part of this review, the neurophysiological mechanisms of F-waves as well as the distinction between these and H reflexes are described from a historical point of view. Other late responses are intentionally not reported; nevertheless A-waves are discussed since they are frequently ill-described in a number of conditions. Stimulation and recording procedures as well as F-wave parameters analysis are detailed, with emphasis on measures most useful for clinical purposes. A rigorous F-wave recording method is mandatory for reliable and meaningful analyses. Physiological factors, which influence F-waves such as ageing, drugs and sleep, must be known and their effects discussed. Also, as maturation is an important factor in clinical neurophysiology, data on F-wave ontogenesis are reviewed and discussed. Finally, the different F-wave alterations described so far in the literature, in either peripheral or central disorders, are listed and commented. It is emphasised that F-waves are particularly useful for the diagnosis of polyneuropathies at a very early stage and for the diagnosis of proximal nerve lesions. F-wave recording is indeed one of the rare methods in routine examination allowing at the same time the functional assessment of motor fibres on their proximal segment, and contributing to the evaluation of motoneuronal excitability.

The electroencephalogram (EEG), an easy-to-use and non invasive cerebral investigation, is a useful tool for diagnosis and early prognosis in newborn babies. In newborn full term babies manifesting abnormal clinical signs, EEG can point focal lesions or specific aetiology. EEG background activity and sleep organization have a high prognostic value. Tracings recorded over long period can detect seizures, with or without clinical manifestations, and differentiate them from paroxysmal non epileptic movements. The EEG should therefore be recorded at the beginning of the first symptoms, and if possible before any seizure treatment. When used as a neonatal prognostic tool, EEG background activity is classified as normal, abnormal (type A and type B discontinuous and hyperactive rapid tracing) or highly abnormal (inactive, paroxysmal, low voltage plus theta tracing). In such cases, the initial recording must be made between 12 and 48 h after birth, and then between 4 and 8 days of life. Severe EEG abnormalities before 12 h of life have no reliable prognostic value but may help in the choice of early neuroprotective treatment of acute cerebral hypoxia-ischemia. During presumed hypoxic-ischemic encephalopathy, unusual EEG patterns may indicate another diagnosis. In premature newborn babies (29-32 w GA) with neurological abnormalities, EEG use is the same as in term newborns. Without any neurological abnormal sign, EEG requirements depend on GA and the mother's or child's risk factors. Before 28 w GA, when looking for positive rolandic sharp waves (PRSW), EEG records are to be acquired systematically at D2-D3, D7-D8, 31-32 and 36 w GA. It is well known that numerous and persistent PRSW are related to periventricular leukomalacia (PVL) and indicate a bad prognosis. In babies born after 32 GA with clinically severe symptoms, an EEG should be performed before D7. Background activity, organization and maturation of the tracing are valuable diagnosis and prognosis indicators. These recommendations are designed (1) to get a maximum of precise informations from a limited number of tracings and (2) to standardize practices and thus facilitate comparisons and multicenter studies.

The aim of this prospective study was to describe and quantify EEG patterns in 10 very premature infants (24 weeks 2 days- 26 weeks 4 days GA) without neonatal neurological pathology and with a normal outcome at 3 years of age for nine of them. EEG and eye movements were recorded in the first 5 days of life. All tracings were discontinuous; EEG inactivity (<15 microV) never exceeded 1 min, representing 45.3% of total recording time. The EEG bursts, mainly synchronous, could last up to 83 s when >50 microV and to 197 s when >15 microV. High voltage delta waves (0.5 Hz; up to 330 microV), either smooth or superimposed with 7-12 Hz rhythms, were the most typical and frequent figures, mainly in temporal (mean number 257.2 +/- 73.3) and occipital (237.7 +/- 65.8 per hour recording) areas. In temporal areas, they appeared mainly in clusters; more often unilateral than bilateral (P < 0.05). Occipital delta waves were as often bilateral and synchronous as unilateral. The two distinct frontal delta waves were significantly less numerous than other delta waves (P < 0.05). Bursts of hypersynchronous high voltage delta waves and of diffuse sharp theta waves were less numerous than other waves (P < 0.01). Considering periods with or without eye movements, the mean percentage and the mean longest period of EEG activity (< or =50 microV) were significantly greater (P < 0.01) when eye movements were present, indicating a rough sleep state differentiation as early as 25 weeks CA. These EEG patterns are qualitatively and quantitatively reproducible. They constitute standards of normality and a basis for the determination of neurological prognosis.

Objective: The electroencephalogram (EEG) is used in neonatal intensive care units to assess brain maturation and neurologic prognosis in preterm newborns. Most of these newborns are sedated by opioids because of long-term assisted ventilation. The aim of this study was to describe the effects of sufentanil on the EEG in preterm newborns and to evaluate the consequences of such a treatment on neurologic assessment., Methods: Fifteen preterm newborns <28 days of extrauterine life were studied. All of them were sedated by sufentanil (initial bolus injection of 0.5 micro g/kg, followed by continuous infusion of 0.2 micro g/kg/h). Three EEGs were performed: the first before and during the bolus injection, the second in the 48 hours after the start of the continuous infusion, and the third at least 24 hours after the treatment was stopped. Qualitative and quantitative methods were used to analyze each EEG., Results: EEG patterns were not affected by sufentanil treatment. Bolus injection and continuous infusion induced a significant increase of EEG discontinuity in preterm newborns affecting mean burst percentage and mean and maximum interburst duration., Conclusions: The present data demonstrate that EEG is affected by bolus injection and continuous infusion of sufentanil. Sedation must therefore be considered to avoid misinterpretation of EEGs.

Background: Recent findings suggest that there may be a relationship between excessive daytime sleepiness (EDS) and cognitive deficits. This study aims to determine to what extent EDS is predictive of cognitive impairment in an elderly population., Methods: A total of 1026 individuals 60 years or older representative of the general population living in the metropolitan area of Paris, France, were interviewed by telephone using the Sleep-EVAL expert system. To find these individuals, 7010 randomly selected households were called: 1269 had at least 1 household member in this age range (participation rate, 80.9%). In addition to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and International Classification of Sleep Disorders diagnoses, the system administered to participants the Psychological General Well-being Schedule, the Cognitive Difficulties Scale (MacNair-R), and an independent living scale., Results: Excessive daytime sleepiness was reported by 13.6% of the sample, with no significant difference among age groups. Compared with nonsleepy participants, those with EDS were at increased risk of cognitive impairment on all the dimensions of the MacNair-R scale after controlling for age, sex, physical activity, occupation, organic diseases, use of sleep or anxiety medication, sleep duration, and psychological well-being. The odd ratios were 2.1 for attention-concentration deficits, 1.7 for praxis, 2.0 for delayed recall, 2.5 for difficulties in orientation for persons, 2.2 for difficulties in temporal orientation, and 1.8 for prospective memory., Conclusions: Among elderly individuals in the general population, EDS is an important risk factor for cognitive impairment. A complaint of EDS by an elderly patient should signal the possibility of an underlying cognitive impairment in need of evaluation.