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Background: Previous studies have yielded inconsistent findings regarding the association between OSA and cancer in humans., Research Question: Is there an association between indexes of sleep-disordered breathing severity and cancer incidence in patients investigated for suspected OSA?, Study Design and Methods: Data from a large multicenter cohort of cancer-free patients investigated for OSA were linked to health administrative data to identify new-onset cancer. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate the association of cancer incidence with OSA severity and nocturnal hypoxemia., Results: After a median follow-up period of 5.8 years (interquartile range, 3.8-7.8), 718 of 8,748 patients (8.2%) had received a diagnosis of cancer. On unadjusted Kaplan-Meier survival analyses, cancer incidence was associated with increasing severity of OSA (log-rank test, P < .0005) and nocturnal hypoxemia (log-rank test, P < .0001 for both oxygen desaturation index and percent night time with oxygen saturation < 90% [T90]). After adjustment for anthropomorphic data, smoking and alcohol consumption, comorbid cardiac, metabolic, and respiratory diseases, marital status, type of sleep study, and study site, only T90 was associated with cancer incidence (adjusted hazard ratio, 1.33; 95% CI, 1.05-1.68 for T90 ≥ 13% vs < 0.01%; P = .02). On stratified analyses, the association between T90 and cancer appeared stronger in older patients with obesity and no adequate OSA therapy. Among the most frequent cancer sites, nocturnal hypoxemia was associated with lung and breast malignancies., Interpretation: Nocturnal hypoxemia was associated with all-cancer incidence in patients investigated for OSA. Whether OSA therapy might reduce the risk of cancer needs further evaluation., (Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Backgound and Objectives: The disadvantages of custom-made mandibular advancement devices (MAD) for obstructive sleep apnoea (OSA) therapy are the cost and delay required to manufacture the device. This study aimed to evaluate the efficacy of a titrable, thermoplastic MAD compared to a custom-made MAD for OSA therapy., Methods: In this prospective nonrandomized study, 158 patients with OSA from two French sleep centers were treated for 6 months with a titrable thermoplastic MAD (n = 86) or a custom-made MAD (n = 72). The primary outcome was the change in sleep-disordered breathing (SDB) severity., Results: After adjustment for baseline values, age, body mass index and study site, no significant intergroup differences were observed between thermoplastic and custom-made MAD for the outcome of apnoea, hypopnoea and oxygen desaturation indices. No between treatment differences were observed for the outcome of subjective sleepiness, symptoms of snoring and fatigue, depressive symptoms, and quality of life. Thermoplastic MAD therapy was associated with higher side effects scores for tooth pain (p < 0.0001) and self-reported occlusal changes (p = 0.0069). Mean (SD) reported compliance was lower in the thermoplastic MAD group than in the custom-made MAD group (6.4 [0.2] vs 7.1 [0.1] h/night; p = 0.035)., Conclusions: This study demonstrates the efficacy of a titrable thermoplastic MAD in reducing SDB and related symptoms in patients with mild to severe OSA. Reported compliance at 6 months was high despite more dental discomfort than with custom-made MAD., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Baclofen, a gamma-aminobutyric acid-B agonist with muscle-relaxant properties, is widely used in patients with severe spasticity. In animals, baclofen has been shown to decrease respiratory drive. In humans, however, use of baclofen at the standard dose did not significantly impair sleep-disordered breathing in a susceptible population of snorers. Recently, there has been increasing interest in the role of baclofen for the treatment of alcohol dependence. We describe severe central sleep apnea (CSA) in four patients with none of the conditions commonly associated with CSA who were receiving chronic baclofen therapy for alcohol withdrawal. In one patient, baclofen withdrawal was associated with a complete resolution of CSA. Three patients were treated by adaptive servo-ventilation while continuing their treatment with baclofen. Given the increasing number of patients receiving baclofen for alcohol withdrawal treatment, physicians should be aware that these patients might be affected by severe CSA. Future studies are required to determine the mechanisms, prevalence, and treatment modalities of sleep-disordered breathing associated with baclofen usage., (Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Background: Sleep Apnea Syndrome (SAS) prevalence increases with age. In the elderly, symptoms are less specific (falls, cognitive or functional decline, polymedication). Polysomnography, the gold standard technique to diagnose SAS, is challenged by sleep laboratories' waiting lists and high associated costs. Nocturnal oximetry is an easy-to-use tool widely available outside the sleep medicine field identifying intermittent hypoxia, the landmark of SAS. It might be an interesting and easy way to screen for SAS in the functionally and cognitively impaired elderly living in long-term care settings., Objectives: The primary goal of this study was to assess the accuracy of the variability index of nocturnal pulse oximetry to detect moderate to severe SAS in patients older than 75 hospitalized in stable condition. The secondary goals were to assess the accuracy of the other indices of pulse oximetry (oxygen desaturation index [ODI]), and to determine the prevalence of moderate to severe SAS in our population., Methods: In-hospital sleep studies with simultaneous respiratory polygraphy and nocturnal pulse oximetry were performed. Comorbidities were assessed by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) in association with a comprehensive geriatric assessment., Results: Eighty patients (mean age 85.3 ± 5.3 years) were included. Seventy-two percent of the patients exhibited moderate to severe SAS (95% CI 58.9-82.9), including 59.5% of severe SAS (apnea + hypopnea index >30/hour). SaO2 variability index using a threshold of 0.51, the sensitivity and negative predictive value (NPV) were 100%. With a value above 0.88, positive predictive value and specificity were high (respectively 96.6% and 93.8%). ODI of 3% or higher and 4% or higher were highly specific but less sensitive., Conclusion: Prevalence of moderate to severe SAS in multimorbid hospitalized elderly patients is high. Automatic analysis of the variability of nocturnal SaO2 is a reliable tool for geriatricians to screen and rule out moderate to severe SAS. Our study suggests an important role of pulse oximetry as the first step in the diagnostic strategy for moderate to severe SAS in this population., (Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)

Study Objectives: To characterize carotid intima-media thickness (IMT) and plaque occurrence in patients with newly diagnosed obstructive sleep apnea (OSA) without known cardiovascular disease., Design: Prospective study., Setting: Sleep Laboratory and Department of Cardiology of Grenoble University Hospital., Patients and Intervention: OSA syndrome is associated with an increased cardiovascular risk. Carotid IMT is recognized as a marker of preclinic atheroma. A small number of studies have analyzed large-artery wall modifications in OSA syndrome. Eighty-three patients (74 men; mean age +/- SD, 48 +/- 11 years; mean body mass index, 27.4 +/- 4.2 kg/m(2)) were included. Mean respiratory disturbance index was 40.7 +/- 19.2/h, mean nocturnal arterial oxygen saturation (Sao(2)) was 93.1 +/- 2.0%, and mean percentage of recording time spent at Sao(2) < 90% was 8.6 +/- 16.8%. Clinical BP was measured following European Society of Hypertension/European Society of Cardiology recommendations, and 24-h ambulatory BP monitoring was assessed. Ultrasonography was used to determine the carotid IMT and atheromatous plaque occurrence., Measurements and Results: Twenty-five of 83 patients (30%) had carotid wall hypertrophy (IMT > 0.8 mm). In a logistic regression model, mean nocturnal Sao(2) < 92% (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.1 to 12.7) was associated with carotid wall hypertrophy. ORs were even higher after adjustment for BP status (OR, 10.6; 95% CI, 1.6 to 50.9 in normotensive patients) and glucose levels (OR, 4.5; 95% CI, 1.0 to 20.9). Mean nocturnal Sao(2) < 92% and minimal nocturnal Sao(2) < 80% (ORs, 3.1 and 3.1; 95% CIs, 1.0 to 9.4 and 1.0 to 8.5, respectively) were associated with the presence of carotid plaque formation independently of the BP status (hypertensive or normotensive)., Conclusions: The severity of oxygen desaturation appears to be one of the best predictors for carotid IMT and plaque occurrence in OSA patients without known cardiovascular disease. Thus, carotid IMT and plaque formation appeared as early cardiovascular consequences in OSA patients.