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Also written with the NUTRIREA-3 Trial Investigators and the Clinical Research in Intensive Care and Sepsis (CRICS-TRIGGERSEP) Group; International audience; BackgroundThe optimal calorie and protein intakes at the acute phase of severe critical illness remain unknown. We hypothesised that early calorie and protein restriction improved outcomes in these patients, compared with standard calorie and protein targets.MethodsThe pragmatic, randomised, controlled, multicentre, open-label, parallel-group NUTRIREA-3 trial was performed in 61 French intensive care units (ICUs). Adults (≥18 years) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned to early nutrition (started within 24 h after intubation) with either low or standard calorie and protein targets (6 kcal/kg per day and 0·2–0·4 g/kg per day protein vs 25 kcal/kg per day and 1·0–1·3 g/kg per day protein) during the first 7 ICU days. The two primary endpoints were time to readiness for ICU discharge and day 90 all-cause mortality. Key secondary outcomes included secondary infections, gastrointestinal events, and liver dysfunction. The trial is registered on ClinicalTrials.gov, NCT03573739, and is completed.FindingsOf 3044 patients randomly assigned between July 5, 2018, and 8 Dec 8, 2020, eight withdrew consent to participation. By day 90, 628 (41·3%) of 1521 patients in the low group and 648 (42·8%) of 1515 patients in the standard group had died (absolute difference –1·5%, 95% CI –5·0 to 2·0; p=0·41). Median time to readiness for ICU discharge was 8·0 days (IQR 5·0–14·0) in the low group and 9·0 days (5·0–17·0) in the standard group (hazard ratio [HR] 1·12, 95% CI 1·02 to 1·22; p=0·015). Proportions of patients with secondary infections did not differ between the groups (HR 0·85, 0·71 to 1·01; p=0·06). The low group had lower proportions of patients with vomiting (HR 0·77, 0·67 to 0·89; p

Tidal expiratory flow limitation (EFL), which may herald airway closure (AC), is a mechanism of loss of aeration in ARDS. In this prospective, short-term, two-center study, we measured static and dynamic chest wall (Est,cw and Edyn,cw) and lung (Est,L and Edyn,L) elastance with esophageal pressure, EFL, and AC at 5 cmH(2)O positive end-expiratory pressure (PEEP) in intubated, sedated, and paralyzed ARDS patients. For EFL determination, we used the atmospheric method and a new device allowing comparison of tidal flow during expiration to PEEP and to atmosphere. AC was validated when airway opening pressure (AOP) assessed from volume-pressure curve was found greater than PEEP by at least 1 cmH(2)O. EFL was defined whenever flow did not increase between exhalation to PEEP and to atmosphere over all or part of expiration. Elastance values were expressed as percentage of normal predicted values (%N). Among the 25 patients included, eight had EFL (32%) and 13 AOP (52%). Between patients with and without EFL Edyn,cw [median (1st to 3rd quartiles)] was 70 (16-127) and 102 (70-142) %N (P = 0.32) and Edyn,L338 (332-763) and 224 (160-275) %N (P \textless 0.001). The corresponding values for Est,cw and Est,L were 70 (56-88) and 85 (64-103) %N (P = 0.35) and 248 (206-348) and 170 (144-195) (P = 0.02), respectively. Dynamic E(L) had an area receiver operating characteristic curve of 0.88 [95% confidence intervals 0.83-0.92] for EFL and 0.74[0.68-0.79] for AOP. Higher Edyn,L was accurate to predict EFL in ARDS patients; AC can occur independently of EFL, and both should be assessed concurrently in ARDS patients.NEW & NOTEWORTHY Expiratory flow limitation (EFL) and airway closure (AC) were observed in 32% and 52%, respectively, of 25 patients with ARDS investigated during mechanical ventilation in supine position with a positive end-expiratory pressure of 5 cmH(2)O. The performance of dynamic lung elastance to detect expiratory flow limitation was good and better than that to detect airway closure. The vast majority of patients with EFL also had AC; however, AC can occur in the absence of EFL.

Background Although short- and long-term survival in critically ill patients with cancer has been described, data on their quality of life (QoL) after an intensive care unit (ICU) stay are scarce. This study aimed to determine the impact of an ICU stay on QoL assessed at 3 months in patients with solid malignancies. Methods A prospective case-control study was conducted in three French ICUs between February 2020 and February 2021. Adult patients with lung, colorectal, or head and neck cancer who were admitted in the ICU were matched in a 1:2 ratio with patients who were not admitted in the ICU regarding their type of cancer, curative or palliative anticancer treatment, and treatment line. The primary endpoint was the QoL assessed at 3 months from inclusion using the mental and physical components of the Short Form 36 (SF-36) Health Survey. The use of anticancer therapies at 3 months was also evaluated. Results In total, 23 surviving ICU cancer patients were matched with 46 non-ICU cancer patients. Four patients in the ICU group did not respond to the questionnaire. The mental component score of the SF-36 was higher in ICU patients than in non-ICU patients: median of 54 (interquartile range: 42–57) vs. 47 (37–52), respectively (p = 0.01). The physical component score of the SF-36 did not differ between groups: 35 (31–47) vs. 42 (34–47) (p = 0.24). In multivariate analysis, no association was found between patient QoL and an ICU stay. A good performance status and a non-metastatic cancer at baseline were independently associated with a higher physical component score. The use of anticancer therapies at 3 months was comparable between the two groups. Conclusion In patients with solid malignancies, an ICU stay had no negative impact on QoL at 3 months after discharge when compared with matched non-ICU patients.

Obstructive sleep apnoea syndrome (OSAS) is characterized by recurrent partial or complete pharyngeal collapses during sleep. The pathophysiology of OSAS is complex and multifactorial. Factors influencing upper airway patency include a reduction in upper airway dimensions that can result from both anatomical and functional alterations (obesity, fluid shift or maxillo-facial structural changes), and increased pharyngeal collapsibility owing to reduced neuromuscular compensation and lack of the pharyngeal protective reflex during sleep. Severe OSAS is associated with a high cardiometabolic risk. Obstructive apnoeic events incorporate a range of stressors that activate mechanisms contributing to the initiation and progression of cardiac, vascular and metabolic diseases. Obstructed breathing induces markedly negative intrathoracic pressure and also provokes hypoxia and hypercapnia. The hypoxaemic stress is further amplified by the subsequent reoxygenation (intermittent hypoxia), resulting in the generation of reactive oxygen species (ROS), sympathetic activation and inflammation. OSAS is able to increase the number of fatal and non-fatal cardiovascular events, including arrhythmias, myocardial infarction and stroke. OSAS is associated with dyslipidemia, type 2 diabetes, its poor control and non-alcoholic fatty liver disease. Screening, diagnosis and integrated care of OSAS should be included in an aggressive management of risk reduction in chronic cardiovascular and metabolic diseases.

Among patients with confirmed obstructive sleep apnoea the prevalence of acromegaly was 0.35% http://ow.ly/eyrq302v4AI

BackgroundObstructive sleep apnea (OSA) is associated with cardiovascular co-morbidities and mortality. Arterial stiffness is an independent predictor of cardiovascular risk and mortality, and is influenced by the presence of OSA and related comorbidities. There is a paucity of data regarding long-term evolution of arterial stiffness in CPAP-treated OSA patients. We aimed to prospectively study long term PWV variations and determinants of PWV deterioration.MethodsIn a prospective obese OSA cohort, at time of diagnosis and after several years of follow-up we collected arterial stiffness measured by carotid-femoral pulse wave velocity (PWV), clinical and metabolic parameters, and CPAP adherence. Univariate and multivariate analyses were performed in order to determine contributing factors.ResultsSeventy two OSA patients (men: 52.8%, median age: 55.8 years and median BMI of 38.5 kg/m2) with a prevalence of hypertension: 58.3%, type 2 diabetes: 20.8%, hypercholesterolemia: 33.3%, current or past smoking: 59.7%, were evaluated after a median follow-up of 7.4 [5.8; 8.3] years. Over the period of follow-up, the median increase in PWV was 1.34 [0.10; 2.37] m/s. In multivariate analysis, the increase in PWV was associated with older age (10 extra years was associated with a 5.24 [1.35; 9.12] % increase in PWV) and hypertension (a significant increase in PWV of 8.24 [1.02; 15.57] %). No impact of CPAP adherence on PWV evolution was found.ConclusionPWV progression in CPAP-treated OSA patients is mainly related to pre-existing cardio-metabolic comorbidities and not influenced by CPAP adherence. In this high cardiovascular risk population, it is crucial to associated weight management and exercise with CPAP treatment.

BackgroundArterial stiffness, measured by pulse wave velocity (PWV), is a strong independent predictor of late cardiovascular events and mortality. It is recognised that obstructive sleep apnoea (OSA) is associated with cardiovascular comorbidities and mortality. Although previous meta-analyses concluded that PWV is elevated in OSA, we feel that an individual patient data analysis from nine relatively homogeneous studies could help answer: to what extent does OSA drive arterial stiffness?MethodsIndividual data from well-characterised patients referred for suspicion of OSA, included in nine studies in which carotid–femoral PWV was measured using a Complior device, were merged for an individual patient data meta-analysis.Results893 subjects were included (age: 56±11 (mean±SD), 72% men, 84% with confirmed OSA). Body Mass Index varied from 15 to 81 kg/m2 (30±7 kg/m2). PWV ranged from 5.3 to 20.5 m/s (10.4±2.3 m/s). In univariate analysis, log(PWV) was strongly related to age, gender, systolic blood pressure, presence of type 2 diabetes (all pConclusionOur individual patient meta-analysis showed that elevated arterial stiffness in patients with OSA is driven by conventional cardiovascular risk factors rather than apnoea parameters.

Introduction: Arterial stiffness measured by carotid-femoral pulse wave velocity (PWV) is elevated in severe OSA. A 1m/s increase in PWV is associated with a 15% increased risk of mortality. There is a paucity of data regarding long term evolution of PWV in CPAP-treated OSA. Aims: To measure PWV evolution in CPAP-treated OSA. Methods: In a prospective obese OSA cohort, we collected PWV, clinical and biological metabolic data, incident cardiovascular events and CPAP adherence at time of diagnosis and after at least 5-year follow-up. Results: 72 OSA (men: 52.8%, median age: 55.8 years and median BMI of 38.5 kg/m2) with a high prevalence of hypertension: 58.3%, Type 2 diabetes: 20.8%, hypercholesterolemia: 33.3%, current and past smoking: 59.7%, were evaluated after a median follow-up of 7.4 [5.8; 8.3] years. The mean increase in PWV was 1.5 (SD: 2.2) m/s. OSA patients with an elevation of PWV ≥2m/s (n=27; 37.5%) exhibited a significantly higher prevalence of diabetes (p = 0.04), and COPD (p = 0.004) and a greater amount of nocturnal hypoxia (time spent with SaO2 Conclusions: The rate of increase in PWV in CPAP-treated OSA is high and mainly related to pre-existing cardio-metabolic comorbidities. Adherence to CPAP does not influence the increase in PWV. In this population at high cardiovascular risk, combining therapeutic modalities by including weight loss and physical activity is crucial beyond CPAP treatment.

Introduction: Insulin-like growth factor-1 (IGF-1) is the main growth factor associated with growth hormone (GH). IGF-1curbs endothelial function and prevents early atherosclerosis by promoting insulin sensitivity and by preventing postprandial dyslipidemia. Low serum IGF-1 levels have been reported to be associated with SAS and might be one of the mechanisms underlying the increased cardiometabolic risk in SAS. We studied IGF-1 levels in a large prospective cohort of patients referred for suspicion of SAS. Methods: In a multicenter study, serum IGF-1 levels were obtained for 817 patients consulting for suspicion of SAS (SAS confirmed for 567 patients). We analyzed the association between serum IGF-1 level below the median value of the general population and variables related to cardiometabolic risk: BMI, apnea hypopnea index (AHI), cholesterol and triglycerides (TG). Results: In our cohort, IGF-1 level below the median (138 ng/ml) was associated with increased BMI and AHI (respectively OR = 2.83; p Conclusion: There is a relationship between low levels of IGF-1 and predictors of cardiovascular risk in SAS. IGF-1 is a potential prognostic biomarker in SAS patients. Our results also provide insights regarding the mechanisms of co-morbidities in these patients.

Obstructive sleep apnea (OSA) is associated with cardiovascular (CV) co-morbidities and mortality. Arterial stiffness, assessed with pulse wave velocity (PWV) is an independent predictor of CV events and mortality. Studies have shown that PWV is elevated in OSA patients and might improve after continuous positive airway pressure treatment. However the impact of traditional risk factors on the OSA-PWV relationship has not been evaluated. We pooled 10 of our studies where PWV was measured with the same technic (Complior SP, Alam Medical, France). The final cohort included 901 subjects (age: 56±12 (mean±SD) -73% male -84% with confirmed OSA): 22%, 39% 18%, 12 and 9% with normal, overweight, obese, severe obesity and morbid obesity respectively. PWV ranged from 5.3 to 20.5 m/s (10.4±2.3). In univariate analysis, PWV was strongly related to age (p Our individual meta-analysis shows that PWV in OSA patients is mainly driven by standard risk factors: age, SBP and BMI. Apnea parameters have little independent influence. While treating OSA symptoms is important for patient quality of life, managing the whole CV risk implies combined therapies addressing the overall CV risk.

Introduction: Acromegaly has a prevalence about 0.01% in general population. SAS is experienced by up to 80% of those with acromegaly. The high frequency of acromegaly-related co-morbidities and late diagnosis make screening for acromegaly advisable in at risk populations such as SAS. Aims: To determine the prevalence of undiagnosed acromegaly in patients referred for SAS, using a standardized questionnaire and systematic measurement of serum insulin-like growth factor-1 (IGF-1). Methods: Patients referred for SAS to one University Hospital or to 10 participating private practices. Clinical data, co-morbidities and medications were recorded via the French Sleep Observatory. Included patients underwent polysomnography or respiratory polygraphy. When IGF-1 levels were elevated for age, a second measurement was made and combined with GH levels obtained during an Oral Glucose Tolerance Test. If necessary the patient underwent pituitary MRI and was examined by an endocrinologist for definite diagnosis of acromegaly. Results: Of 873 patients prospectively included, 817 had a measurement of serum IGF-I. 2 patients with acromegaly caused by pituitary adenoma were diagnosed and treated; both had severe SAS. The prevalence of acromegaly in our cohort was 0.25%. 567 patients had moderate to severe SAS with an apnea-hypopnea index>15; in this group the prevalence of acromegaly was 0.35% (27 fold the prevalence in the general population). Conclusion: The prevalence of acromegaly in patients with SAS is very high. Further studies are needed to evaluate the cost-effectiveness of systematic screening in patients presenting with SAS to diagnose acromegaly earlier and prevent complications and comorbidities.

Background: In moderately to severely obese patients with obstructive sleep apnea (OSA), the effects of long-term positive airway pressure (PAP) treatment on cardiovascular risk are poorly defined. Purpose: To assess the effect of continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) on the occurrence of cardiovascular events in obese OSA patients. Methods: We performed a noninterventional observational study in obese OSA patients recruited between 2007 and 2010 at the Sleep Center, University of Grenoble, treated with CPAP or NIV, and followed for 5.6 years by a single home care provider. Baseline clinical characteristics, blood chemistry, and respiratory and vascular function were assessed. Incident cardiovascular events were investigated by phone interviews. Results: A total of 103 patients (55 men, 48 women; age and body mass index [BMI] at diagnosis 54.1 ± 10.5 years and 40.3 ± 5.5, respectively [mean ± standard deviation]; CPAP: n = 75; NIV: n = 28) agreed to participate in the study. Grade I, II, and III obesity occurred in 17.5, 33.0, and 49.5% of the sample, respectively. In patients using PAP treatment (n = 69), the mean nightly use was 6.3 ± 2.4 h. Thirty-one patients stopped PAP treatment during follow-up. Three patients on NIV died. Nonfatal cardiovascular events (n = 27) occurred in 19 patients, who were older and showed higher number of comorbidities and triglyceride levels than patients without events. In the patients who interrupted treatment, the event rate was high and increased with the number of comorbidities, while BMI at baseline did not predict events. Conclusions: The study suggests that regular PAP treatment may be associated with protection against cardiovascular risk in obese OSA patients, especially in the presence of multiple comorbidities.

it is still debated whether CPAP or non-invasive ventilation (NIV) reduces cardiovascular (CV) risk in morbidly obese patients. Obese subjects affected by obstructive sleep apnea (OSA) or obesity hypoventilation syndrome (OHS) (n=210) were recruited between 2007-2010 in the Sleep Center, Univ. of Grenoble; 152 of them were treated with CPAP or NIV, and regularly followed by a home-care provider (Agir a dom). Patients underwent phone interviews to assess incident CV events during 5.6 years (range 4.0-6.5 yrs) of follow-up. One hundred seventeen patients (63 men) responded to questionnaire, 3 OSA patients died, and 32 declined/were lost to follow-up (response rate 77%). All patients at baseline underwent: clinical examination, respiratory function assessment, full PSG, vascular function (PWV, PAT). Mean (±SD) age and BMI at diagnosis were 53.6±10.7 yr and 40.6±5.7 kg/m 2 . Patients were affected by OSA (n=100) or OHS (n=17); CPAP (n=89) or NIV (n=28) were prescribed. At follow-up, 32 OSA patients had stopped treatment, 57 were on CPAP, and 28 on NIV. Objective compliance to treatment was similar in patients with/without events in both CPAP and NIV groups (mean adherence 6.3 ± 2.4 h/night). Number of events (0-2) was entered as dependent variable in a Poisson regression model in which independent variables were treatment (CPAP or NIV vs interrupted), follow-up duration, and BMI. CPAP showed a protective effect (coefficient: -4.75, p=0.02). Vascular function measurements did not predict events. Thus, CPAP treatment reduced the risk of CV events in severely obese OSA patients. Funded by ERS STRTF 4008-2013.

Objectif L’acromegalie est une maladie rare (prevalence de 0,008 a 0,013 %) due a l’hypersecretion d’hormone de croissance. Le syndrome d’apnees du sommeil (SAS) a une prevalence de 45 a 80 % chez les patients acromegales. Le but de cette etude multicentrique nationale etait de determiner la prevalence de l’acromegalie non diagnostiquee chez les patients consultants pour une suspicion de SAS. Methodes Les patients consultants pour une suspicion de SAS, au CHU de Grenoble ou chez l’un des 10 pneumologues liberaux participants, ont ete recrutes consecutivement de novembre 2013 a octobre 2014. Les donnees cliniques etaient renseignees sur le CFR electronique de l’OSFP, une polysomnographie/polygraphie (PSG) etait realisee ainsi qu’un dosage sanguin d’IGF-1. En cas de taux d’IGF-1 eleve, le patient etait oriente vers un endocrinologue pour confirmer une eventuelle acromegalie. Resultats Au total, 873 patients ont ete inclus. Deux cas ont ete diagnostiques, chez des patients ayant un SAS severe. De plus, 817 patients ont realise le dosage d’IGF-1, la prevalence de l’acromegalie est de 0,245 % pour l’ensemble des patients ayant consultes. Parmi eux, 567 patients ont un Index Apnee-Hypopnee > 15 parmi les 755 patients ayant des resultats de PSG et un dosage d’IGF-1 : la prevalence chez les patients apneiques est donc de 0,353 % (27 fois la population generale). Conclusion Les patients apneiques representent un groupe particulierement a risque pour le diagnostic d’acromegalie, qui necessite de valider des strategies specifiques de depistage, afin de prevenir les complications et comorbidites de l’acromegalie.

Objectif L’acromegalie est une affection endocrinienne rare (prevalence 45–125 cas/million) due a l’hypersecretion de GH par un adenome hypophysaire. Parmi les acromegales, 65 a 80 % ont un SAS au diagnostic. Un depistage de l’hypersecretion somatotrope semble necessaire parmi les patients consultant pour un SAS. Patients et methodes Patients vus pour une suspicion de SAS au CHU de Grenoble et chez 10 pneumologues liberaux de novembre 2013 a octobre 2014. Les donnees cliniques et co-morbidites etaient renseignees, une polysomnographie/polygraphie et un dosage de l’IGF-1 etaient realises. Lorsque l’IGF-1 etait eleve (fonction de l’âge et du sexe), un dosage de GH au cours de l’HGPO etait realise. Une hypersecretion somatotrope imposait une IRM hypophysaire et une consultation endocrinologique afin d’affirmer une acromegalie. Resultats Parmi 873 patients vus pour suspicion de SAS, 817 ont eu un dosage d’IGF-1 et 755 une polysomnographie/polygraphie. Cinq cent soixante-sept avaient un SAS+ (index apnee/hypopnee > 15) : il s’agissait d’hommes (68 %), plus âges (54 ± 12 vs 48 ± 13 ans, p 2 , p Conclusion Parmi les patients SAS+, la prevalence de l’acromegalie est superieure a 35/10 000, et est plus importante que dans la population generale. Des etudes ulterieures doivent evaluer le cout/efficacite du depistage de l’acromegalie par le dosage de l’IGF-1 chez les patients presentant un SAS.

Le pneumologue est le premier acteur du diagnostic et de la prise en charge du syndrome d’apnees du sommeil (SAOS). En dehors de la polygraphie ventilatoire ou de la polysomnographie, le bilan pneumologique va identifier des groupes a risque du fait d’une pathologie respiratoire associee. Les examens paracliniques comportent une exploration fonctionnelle respiratoire et des gaz du sang a la recherche d’un overlap syndrome (BPCO + SAOS) ou d’un syndrome obesite hypoventilation. Le SAOS est associe a une inflammation systemique et bronchique qui justifie d’une surveillance au long cours. Les anomalies anatomiques ORL ne sont pas suffisamment specifiques pour pouvoir predire l’existence d’un SAOS et sa gravite. L’avis ORL et l’imagerie des voies aeriennes superieures (VAS) ont leur place dans le cadre d’un bilan pre-chirurgical eventuel. Il existe egalement une place pour la consultation ORL en cas d’obstruction nasale ou d’intolerance a la pression positive continue du fait des symptomes rhinopharynges non ameliores par la prise en charge medico-technique adaptee. Le SAOS expose a deux principales complications dans la periode perioperatoire : une intubation difficile et 18 des obstructions postoperatoires des voies aeriennes superieures conduisant a des desaturations postoperatoires et une re-intubation. Il est recommande de disposer au moment du diagnostic de SAOS d’une glycemie et d’un bilan lipidique et de verifier la prise en charge si necessaire. Il est egalement necessaire d’evaluer le risque cardiovasculaire augmente chez les patients porteurs d’un SAOS, avec une survenue plus frequente des evenements cardiovasculaires mortels et non mortels. Il convient donc de depister et de prevenir la survenue d’une HTA, d’une insuffisance cardiaque, d’une arythmie, d’une ischemie cardiaque, ou d’un AVC. Sur le plan metabolique, il faudra prendre en charge une surcharge ponderale ou une obesite, en particulier viscerale, ainsi qu’un syndrome metabolique. La pression positive continue et les ortheses de propulsion mandibulaires sont les principaux traitements pour re-ouvrir et stabiliser les voies aeriennes pendant le sommeil. Une prise en charge du SAOS et ses comorbidites passe par l’adaptation de traitements combines, medicamenteux mais aussi hygieno-dietetiques, comprenant la perte de poids ou la rehabilitation, et une prise en charge transversale et multidisciplinaire (pneumologue, cardiologue, endocrinologue, ORL).

Objectif L’insulin-like growth factor-1 (IGF-I) est le principal facteur de croissance lie a l’hormone de croissance (GH). Des etudes suggerent que l’IGF-I est un facteur protecteur vasculaire, participant au maintien de la fonction endotheliale, augmentant la vasodilatation NO-dependante et associe a la sensibilite a l’insuline. Une baisse des niveaux d’IGF-I a ete retrouvee au cours du SAS. Les variations du taux d’IGF-1 en fonction du risque cardiometabolique sont etudiees dans une large cohorte prospective de patients consultants pour une suspicion de SAS. Methodes Au cours d’une etude nationale multicentrique, 817 patients consultants pour suspicion de SAS (SAS confirme chez 567 patients) ont realise un dosage sanguin d’IGF-1. Nous avons analyse le risque d’avoir un IGF-1 inferieur a la mediane pour differentes variables liees au risque cardio-metabolique : index de masse corporelle (IMC), index apnee + hypopnee (IAH), cholesterolemie, triglyceridemie (codees en quartile, a la mediane ou en continu en fonction de l’information apportee). Resultats La mediane d’IGF-1 est de 138 ng/mL. Le risque d’avoir un IGF-1 inferieur a la mediane est associe, apres ajustement pour l’âge et le sexe, a l’augmentation de l’IMC et de l’IAH (avec respectivement : OR = 2,83 ; p Conclusion L’IGF-1 a un role important comme biomarqueur pronostique des patients porteurs d’un syndrome d’apnees du sommeil.