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Research in the field of Obstructive Sleep Apnea (OSA) has been organized, and has profoundly transformed the quality of life of apneic patients, while even inviting dentofacial orthopedists to contribute to their symptomatic treatment. However, among the points still to be elucidated, the initial cause of the snoring that destabilizes the pharynx occupies a place apart. The objective of this article was to develop the proposal by Jacques Talmant regarding a mechanism capable of explaining the onset of OSA and for a therapy to treat pharyngeal destabilization during sleep. Based on published data, the etiopathogenesis of snoring and its consequences are described. Structural changes secondary to the vibratory trauma caused by snoring can affect each component of the pharyngeal structures and contribute to the collapsibility of this airway segment. By directly optimizing the development of ventilatory capabilities in their patients, orthodontists contribute, indirectly, to optimizing their cardiovascular and neuropsychological functions.

International audience; OBJECTIVE:In an attempt to understand physicians' expectations of chemotherapy, a group of lung cancer specialists was involved in an online survey investigating their opinions by a self-questionnaire. The questionnaire described five different chemotherapy prescription situations for lung cancer patients (stages IIIB or IV).METHOD:A total of 30 expert specialists were invited; 22 responded (73%). For each of the clinical situations, the expert was asked for his opinion on 3 items: cure, prolongation of survival and alleviation of symptoms. Each item was judged on a Likert scale with categories between -2 "not at all probable" and +2 "quite likely".RESULTS:For "cure", the percentage of -2 responses differed significantly according to the clinical situation (Fisher test: P

In accordance with the principle of personal autonomy, expert consensus statements onamyotrophic lateral sclerosis (ALS) recommend early engagement with terminal-phasepatients on the type of symptomatic treatment to be administered in the event of respiratoryfailure, since decompensation progresses too rapidly to allow time for a discussion. TheFrench Parliamentary Act on Patients’ Rights and End-of-Life Care (dated 22 April 2005)grants individuals the right to refuse unreasonable treatment and obliges physicians to takeaccount of any prior instructions given by a person before he/she became incapable ofcommunicating. The provision of prior instructions is a very reassuring situation for thephysician: the autonomous patient indicates his or her choice of end-of-life care. However,there are two pitfalls which must be avoided: (i) holding a discussion for the sole purpose ofobtaining prior instructions and (ii) not acknowledging the patient’s vulnerability. Thepresent study dealt with 35 ALS patients for whom the question of either intensive careor palliative end-of-life care remained open. Even though the great majority of theseindividuals were keen to know their exact state of health, 48% refused to consider thiscircumstance and only 20% expressed prior instructions. These results prompted us toquestion the ethical dimension of the concept of autonomybeyond its founding formulation:can one envisage an incapacity to confront oneself with the existential question of possibledeath? In 80% of cases, the physician will have to take a care decision in the absence of anyprior instructions from the patient. This amounts to more than respecting a person’sautonomy and involves exercising medical responsibility., Par respect du principe d’autonomie, les experts réunis en conférence de consensusrecommandent de discuter de façon anticipée avec le patient atteint de sclérose latéraleamyotrophique (SLA) du traitement de la défaillance respiratoire terminale (accompagner ledécès par des soins palliatifs ou mettre en place une trachéotomie pour une suppléanceventilatoire de survie). La loi Leonetti inscrit un droit pour le patient de refuser unetrachéotomie s’il la considère déraisonnable et prescrit aux médecins de tenir comptedes directives anticipées sur le traitement de la défaillance respiratoire terminale qu’auradonné la personne avant son incapacité à communiquer. Deux écueils sont à éviter : que lavisée de la relation médecin/patient soit l’obtention de ces directives anticipées et que lavulnérabilité du patient, avec ses ambivalences possibles, ne soit pas reconnue. Notre étudea porté sur 35 patients atteints de SLA pour lesquels la question anticipée d’une réanimationou de soins palliatifs de fin de vie a pu être posée. Si la majorité des patients ont demandé àen être informé, 48 % n’ont jamais pu anticiper. Seulement 20 % ont exprié des directivesanticipées. Ces résultats montrent que la discussion est délicate et conduit à nous interrogersur la dimension éthique du concept d’autonomie, au-delà de sa formulation principliste :ne peut-on envisager l’incapacité de se confronter à la question existentielle de la mortpossible ? Plus qu’un exercice de respect de l’autonomie de la personne, il s’agit ici d’unexercice de responsabilité médicale.#