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Obstructive sleep apnea (OSA) remains massively underdiagnosed, due to limited access to polysomnography (PSG), the highly complex gold standard for diagnosis. Performance scores in predicting OSA are evaluated for machine learning (ML) analysis applied to 3D maxillofacial shapes.The 3D maxillofacial shapes were scanned on 280 Caucasian men with suspected OSA. All participants underwent single night in-home or in-laboratory sleep testing with PSG (Nox A1, Resmed, Australia), with concomitant 3D scanning (Sense v2, 3D systems corporation, USA). Anthropometric data, comorbidities, medication, BERLIN, and NoSAS questionnaires were also collected at baseline. The PSG recordings were manually scored at the reference sleep center. The 3D craniofacial scans were processed by geometric morphometrics, and 13 different supervised algorithms, varying from simple to more advanced, were trained and tested. Results for OSAS recognition by ML models were then compared with scores for specificity and sensitivity obtained using BERLIN and NoSAS questionnaires.All valid scans (n = 267) were included in the analysis (patient mean age: 59 ± 9 years; BMI: 27 ± 4 kg/mThe combination of 3D geometric morphometrics with ML is proposed as a rapid, efficient, and inexpensive screening tool for OSA.NCT03632382; Date of registration: 15-08-2018.

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

Background Unintentional leaks (ULs) are frequent adverse effects in CPAP-treated patients. We previously published a novel methodology for analyzing the determinants of UL using polysomnography. We now propose a simplified recording system using a type 3 polygraphic device (Somnolter; Nomics S.A.). Research Question (1) To describe individual UL determinants provided by the Somnolter software in automatic-CPAP-treated OSA patients; (2) To subsequently describe the clinical consensus of four physicians on how to manage each individual UL situation. Study Design and Methods Somnoler recordings performed under nasal automatic-CPAP were automatically analyzed with APIOS software. For each polygraphic recording, APIOS provided the OR and the CIs for potential determinants of UL: mouth opening, CPAP pressure, body position, and mandibular oscillation. Based on these results, each of four physicians was asked to choose one of four strategies: (1) increase or decrease therapeutic pressure; (2) change nasal mask for oro-nasal mask/chinstrap; (3) favor a nonsupine or supine position; (4) no action for individual leak management. Subsequently, a meeting was held to determine a consensus choice for each individual case. Results Seventy-eight consecutive patients underwent home-polygraphy with Somnolter. Fifty recordings were analyzed (16 females; 65 [57-75] years of age; BMI = 31.1 [27.4-35.3]). Individual diagnosis of UL was routinely feasible. The determinants of UL were heterogeneous in the population, and diagnosis of UL was not feasible in 10 patients. Based on the results from this analysis, we established consensus leak management strategies at the individual level. The average Cohen κ coefficient for the four raters was 0.58. Pressure modification was proposed in 36% of patients, no action in 24%, installation of a facial mask/chinstrap in 22%, and positional treatment in 18%. Interpretation The use of type 3 polygraphy for characterizing leak determinants in patients treated with nasal automatic-CPAP is feasible in routine practice. Leak determinants are patient specific. Interrater concordance for determining individual leak management strategies demonstrated a “fair” level of agreement. Trial Registry ClinicalTrials.gov ; No.: NCT03381508; URL: www.clinicaltrials.gov ).

Background Diuretics have been reported as effective for reducing OSA severity by preventing fluid retention and reducing rostral fluid shift. The benefit of diuretics might vary depending on the OSA clinical phenotype and comorbidities. To test this hypothesis, we conducted a propensity score-matched cohort analysis of data from the French national sleep apnea registry "Observatoire Sommeil de la Federation de Pneumologie." Research Question Which phenotypic subtypes of OSA may benefit from diuretics? Study Design and Methods A propensity score analysis was used to determine the impact of diuretics on OSA severity. Matching (ratio 1:4) was performed by using a 0.1 collider for the propensity score. Severe OSA was defined as an apnea-hypopnea index (AHI) > 30 events/h, and the usefulness of diuretics was assessed by using a logistic regression model. Results The 69,564 OSA patients studied in the OSFP prospective observational cohort had a median age of 56.9 years (interquartile range: 47.4; 65.6), 67% were men, and the median AHI was 28 (14; 43) events/h. Among them, 9,783 (14.1%) were treated with diuretics. Diuretics reduced OSA severity in overweight or moderately obese patients (P = .03) and in patients with hypertension (P Interpretation Diuretics appear to have a positive impact on OSA severity in overweight or moderately obese patients with hypertension. A prospective study is needed to confirm that diuretics are of interest in combined therapies for hypertensive patients with OSA.

Background Noninvasive ventilation (NIV) is standard of care for chronic hypercapnic respiratory failure, but indications, devices, and ventilatory modes are in constant evolution. Research Question To describe changes in prevalence and indications for NIV over a 15-year period; to provide a comprehensive report of characteristics of the population treated (age, comorbidities, and anthropometric data), mode of implementation and follow-up, devices, modes and settings used, physiological data, compliance, and data from ventilator software. Study Design and Methods Cross-sectional observational study designed to include all subjects under NIV followed by all structures involved in NIV in the Cantons of Geneva and Vaud (1,288,378 inhabitants). Results A total of 489 patients under NIV were included. Prevalence increased 2.5-fold since 2000 reaching 38 per 100,000 inhabitants. Median age was 71 years, with 31% being > 75 years of age. Patients had been under NIV for a median of 39 months and had an average of 3 ± 1.8 comorbidities; 55% were obese. COPD (including overlap syndrome) was the most important patient group, followed by obesity hypoventilation syndrome (OHS) (26%). Daytime Pa co 2 was most often normalized. Adherence to treatment was satisfactory, with 8% only using their device Interpretation Use of NIV is increasing rapidly in this area, and the population treated is aging, comorbid, and frequently obese. COPD is presently the leading indication followed by OHS. Trial Registry ClinicalTrials.gov; No.: NCT04054570; URL: www.clinicaltrials.gov

International audience; Bruxism is a heterogeneous condition related to various underlying mechanisms, including the presence of OSA. This case report illustrates that sleep mandibular movement monitoring and analysis could provide a useful opportunity for detection of both sleep bruxism and respiratory effort. The current case suggests that tracking of respiratory effort could enable evaluation of bruxism and its potential interactions. Successful treatment of sleep-related respiratory effort may lead to improved or resolution of bruxism in cases where such a causal relationship does exist.

Summary Background Positive airway pressure (PAP) has become a prominent treatment for children with sleep-disordered breathing. However, there are no large-scale studies to clarify whether PAP is well tolerated in children, and which factors are associated with better adherence to PAP therapy. In this study, we aimed to clarify adherence patterns of PAP therapy in a large paediatric population. Methods We did a cross-sectional big-data analysis in children from Oct 1, 2014, to Aug 1, 2018, using existing data derived from PAP devices uploaded nightly in the AirView cloud database. The AirView database is a usage tracking system available to all patients who are assigned PAP therapy, which requires consent from the patient or parent or guardian. All patients older than 4 years and younger than 18 years who used continuous or automated PAP devices were evaluated. Only patients living in the USA and enrolled with a single insurance company were included. If patients were participating in an engagement programme, programme onset must have been within 7 days of therapy onset. Our primary outcome was the proportion of patients who used PAP continuously over 90 days. The primary outcome was assessed in all patients who met the age inclusion criterion and had reliable age data available. Data on missing PAP use were imputed as zero, but data on other metrics were not imputed and excluded from analysis. Findings We used data recorded from Oct 1, 2014, to Aug 1, 2018. Of 40 140 children screened, 36 058 (89·8%) were US residents and 20 553 (90·1%) of them met the eligibility criteria and had accessible data (mean age 13·0 years [SD 3·7]). On the basis of 90 days of monitoring data, 12 699 (61·8%) patients continuously used PAP. Factors significantly associated with adherence included age group, residual apnoea–hypopnoea index, use and onset of patient engagement programmes, PAP pressure, and nightly median PAP mask leak, all over the 90-day study period. Interpretation To our knowledge, our study represents the largest analysis of children using PAP therapy to date. The findings suggest that adherence to PAP therapy is lower than in previous reports from adults. However, numerous actionable factors were associated with improvements in adherence and should be used strategically in clinical decision making to improve PAP adherence in children. Funding ResMed.

Background/objective For obstructive sleep apnea (OSA) patients on continuous positive airway pressure (CPAP) treatment, the apnea-hypopnea index (AHI) is a key measure of treatment efficacy. However, the residual AHI is CPAP brand specific. Here, we studied changes in residual AHI in patients who used two different brands over their treatment history. Patients/methods Using our CPAP telemonitoring database of 3102 patients, we compared the residual AHI of 69 patients before and after change in their CPAP device. Results A paired Wilcoxon signed-rank test revealed a significant difference between brands in the reported AHI, which might be clinically misleading. Conclusions These findings suggest that physicians should be alerted to the differences between brands and learned societies should push for standardization of AHI reporting.

Objective Obstructive sleep apnea (OSA) syndrome is one of the most frequent chronic diseases in the general population. The nocturnal rostral fluid shift is accepted as a key mechanism in OSA pathogenesis in medical conditions associated with fluid overload. The main objective of this study was to assess the prevalence of OSA in patients with lymphedema. Methods A prospective study was conducted in patients with lymphedema hospitalized for complete decongestive therapy between December 2016 and November 2017. A nocturnal respiratory polygraphy, an Epworth sleepiness scale, and lymphedema volume measurements were performed on the first day of decongestive therapy. OSA was diagnosed in patients with an apnea-hypopnea index of five or more events per hour and patients who had been previously diagnosed with OSA and treated by continuous positive airway pressure were identified. Results Forty-three patients completed the study. The prevalence of OSA was 74% and was higher for patients with lymphedema of the lower limbs (85%) vs upper limbs (56%). OSA severity was correlated with a marker of lower limb lymphedema severity (P = .012). The body mass index was higher than in patients with OSA than patients without OSA (median, 31.0 kg/m2 [25th; 75th percentiles, 25.3; 37.0 kg/m2] vs median, 24.2 kg/m2 [25th; 75th percentiles, 22.7; 26.7 kg/m2]; P Conclusions Patients with lymphedema presenting for complete decongestive therapy present a high prevalence rate of OSA, particularly in those with lower limb lymphedema. OSA severity was correlated with a marker of lower limb lymphedema severity. These results suggest that overweight and obese patients with lymphedema should be screened systematically for OSA.

Purpose The pathophysiology of nonarteritic anterior ischemic optic neuropathy (NAION) is not completely understood. Studies of the retinal vasculature phenotype in patients with NAION could help us to understand vascular abnormalities associated with the disease. Design Retrospective case series with matched control subjects. Methods Study population: 57 patients with NAION and 57 control subjects matched to NAION patients for sex, age, systemic hypertension, diabetes, and obstructive sleep apnea syndrome between September 2007 and July 2017. Main Outcome Measures All patients and control subjects underwent a complete ocular examination and 45° funduscopic color photographs. The widths of the 6 largest arteries in zone B (between 0.5 and 1 optic disc diameter from the optic disc), summarized by the central retinal artery equivalent (CRAE), the widths of the 6 largest veins in zone B, summarized by the central retinal vein equivalent (CRVE), the arteriole to venule ratio, tortuosity, and fractal dimension were measured on the 2 groups using Vessel Assessment and Measurement Platform for Images of the Retina, a software tool for efficient semiautomatic quantification of the retinal vasculature morphology in fundus camera images. The Wilcoxon signed-rank test and MacNemar χ2 test for paired sample and generalized estimating equations for modeling the Vessel Assessment and Measurement Platform for Images of the Retina parameters as dependent variables were used. Results CRVE and fractal dimension (D0a) were significantly higher in the NAION group when compared with the control group, whereas the arteriole to venule ratio and vascular tortuosity were significantly lower. Compared with control subjects, acute NAION yielded an increased CRAE value (174 ± 33 vs 160 ± 13 μm) while resolution NAION yielded a decreased CRAE value (152 ± 12 vs 156 ± 33 μm). Acute NAION yielded an increased CRVE value (244 ± 35 vs 210 ± 21 μm) while resolution NAION yielded an unchanged CRVE value. We found no difference between groups for age, refraction, optic disc diameter, CRAE, or fractal dimension. Conclusions Retinal vascular parameters were different in our sample between NAION and control patients, especially at the acute stage of the disease. Our results suggest a normalization of the same parameters at the resolution stage.

Background The management of patients with high cardiovascular risk and OSA must target not only improving adherence to CPAP, but should also include strategies aimed at reducing BP and increasing physical activity. The study aims to evaluate the effectiveness of an integrated intervention using remote patient telemonitoring in reducing BP in high cardiovascular risk patients with OSA. Methods In a multicenter, open, randomized trial, patients with OSA were randomly assigned at CPAP initiation to usual care or multimodal telemonitoring for 6 months. Telemonitoring used electronic equipment collecting information about BP, symptoms, CPAP side effects, and physical activity with home care providers prespecified protocoled actions. The primary effectiveness outcome was assessed using home self-measured BP on 3 consecutive days. Secondary outcomes included CPAP compliance, symptoms, and physical activity. Results Of 306 patients with a median age of 61.3 years [interquartile range, 54.1; 66.1], who were predominantly men, 226 (74%) with a BMI of 32.0 [28.7; 35.6] kg/m2 and an apnea-hypopnea index of 46 [35; 61] events/h, 149 received usual care and 157 received telemonitoring. After 6 months of CPAP, home self-measured BP did not differ significantly between groups. In secondary analyses, there was no significant difference in steps per day, but a significant increase in CPAP adherence and an improvement in daytime sleepiness and quality of life in favor of the multimodal telemonitoring. Conclusions In OSA patients with high cardiovascular risk, multimodal telemonitoring was not superior to usual CPAP care for improving home BP; however, telemonitoring improved adherence and patient-centered outcomes.

Obstructive sleep apnea is a condition whose evolution is poorly understood and difficult to predict, in spite of its high prevalence and serious complications, due to the complexity of its initial symptoms and systemic consequences. In this contribution we discuss the characterisation of a group of patients suffering from this condition through the use of complex networks. Similarity relationships between different subjects are mapped into a network using the recently proposed convergence/divergence formalism. Topological features are then extracted from this structure, and used to feed a classification model forecasting the future evolution of patients after a standard treatment. Results indicate that the complex network approach is able to extract information over and above standard data mining models, thus yielding a new way for the characterisation, and hence for the understanding, of this complex condition.

Background Excessive sleepiness (ES) is a common symptom of OSA, which often persists despite primary OSA therapy. This phase III randomized withdrawal trial evaluated solriamfetol (JZP-110) for the treatment of ES in adults with OSA. Methods After 2 weeks of clinical titration (n = 174) and 2 weeks of stable dose administration (n = 148), participants who reported improvement on the Patient Global Impression of Change (PGI-C) and had numerical improvements on the Maintenance of Wakefulness Test (MWT) and Epworth Sleepiness Scale (ESS) were randomly assigned to placebo (n = 62) or solriamfetol (n = 62) for 2 additional weeks. Coprimary end points were change from weeks 4 to 6 in MWT and ESS. Results In the modified intention-to-treat population (n = 122), MWT mean sleep latencies and ESS scores improved from baseline to week 4 (from 12.3-13.1 to 29.0-31.7 minutes and from 15.3-16.0 to 5.9-6.4, respectively). From weeks 4 to 6, participants treated with solriamfetol maintained improvements (least squares [LS] mean [SE] changes of −1.0 [1.4] minutes on MWT and −0.1 [0.7] on ESS), whereas participants treated with placebo worsened (LS mean [SE] change of −12.1 [1.3] minutes on MWT and 4.5 [0.7] on ESS); LS mean differences between treatments were 11.2 minutes (95% CI, 7.8-14.6) and −4.6 (95% CI, −6.4 to −2.8) on MWT and ESS, respectively. Fewer participants treated with solriamfetol reported worsening on the PGI-C from weeks 4 to 6 (20% vs 50%; P = .0005). Common adverse events included headache, dry mouth, nausea, dizziness, and insomnia. Conclusions This study demonstrated maintenance of solriamfetol efficacy and safety over 6 weeks. Trial Registry ClinicalTrials.gov; No.: NCT02348619; URL: www.clinicaltrials.gov; EudraCT No.: 2014-005515-16

International audience; Dear editors, we read with a great interest the Brief Communication entitled “Acoustic stimulation time-locked to the beginning of sleep apnea events reduces oxygen desaturations: a pilot-study”, by Waeber et al.

Background: Continuous positive airway pressure (CPAP), the reference treatment for obstructive sleep apnoea (OSA), is used by millions of individuals worldwide with remote telemonitoring providing daily information on CPAP usage and efficacy, a currently underused resource. Here, we aimed to implement state-of-the-art data science methods to describe heterogeneity and diversity of time-series of residual apnoea-hypopnoea indexes (rAHI) from CPAP telemonitoring. Methods: We analysed a CPAP telemonitoring database to model and cluster rAHI trajectories. Our primary objective was to use Hidden Markov models (HMMs) as a probabilistic model-based approach to extract features from rAHI time-series. Secondary goals were to identify clusters of rAHI trajectories and their relation to CPAP treatment outcomes, adherence and leaks. Findings: From telemonitoring records of 2,860 CPAP-treated patients (age: 66·31 ± 12·92 years, 69·9% male), HMM modelling revealed three states differing in variability within a given state and probability of shifting from one state to another. Six clusters of rAHI trajectories were identified ranging from well controlled CPAP-treated patients (Cluster 0: 669 (23%); mean rAHI 0·58 ± 0·59 events/hour) to the most unstable (Cluster 5: 470 (16%); mean rAHI 9·62 ± 5·62 events/hour). CPAP adherence was 30 minutes higher in cluster 0 compared to clusters 4 and 5 (p-value

This report is a summary of a workshop focusing on using telemedicine to facilitate the integrated care of chronic obstructive pulmonary disease (COPD). Twenty-five invited participants from 8 countries met for one and one-half days in Stresa, Italy on 7-8 September 2017, to discuss this topic. Participants included physiotherapists, nurses, a nurse practitioner, and physicians. While evidence-based data are always at the center of sound inference and recommendations, at this point in time the science behind telemedicine in COPD remains under-developed; therefore, this document reflects expert opinion and consensus. While telemedicine has great potential to expand and improve the care of our COPD patients, its application is still in its infancy. While studies have demonstrated its effectiveness in some patient-centered outcomes, the results are by no means consistently positive. Whereas this tool may potentially reduce health care costs by moving some medical interventions from centralized locations in to patient's home, its cost-effectiveness has had mixed results and telemonitoring has yet to prove its worth in the COPD population. These discordant results should not be unexpected in view of patient complexity and the heterogeneity of telemedicine. This is reflected in the very limited support offered by the National Health Services to a wider application of telemedicine in the integrated care of COPD patients. However, this situation should challenge us to develop the necessary science to clarify the role of telemedicine in the medical management of our patients, providing a better and definitive scientific basis to this approach.

Aims Obstructive sleep apnea (OSA) characterized by nocturnal intermittent hypoxia (IH) is associated with atherosclerosis and cysteinyl-leukotrienes (CysLT) pathway activation. We aimed to identify the determinants of CysLT pathway activation and the role of CysLT in OSA-related atherosclerosis. Methods and results Determinants of the urinary excretion of LTE4 (U-LTE4) including history of cardiovascular events, polysomnographic and biological parameters were studied in a cohort of 170 OSA patients and 29 controls, and in a subgroup of OSA patients free of cardiovascular event (n = 136). Mechanisms linking IH, the CysLT pathway and atherogenesis were investigated in Apolipoprotein E deficient (ApoE−/−) mice exposed to 8-week IH. In the whole cohort, U-LTE4 was independently influenced by age, minimal oxygen saturation, and a history of cardiovascular events, and correlated significantly with intima-media thickness. In the subgroup of OSA patients free of cardiovascular event, increased U-LTE4 was increased compared to controls and independently related to hypoxia severity and traditional risk factors aggregated in the 10-year cardiovascular risk score of European Society of Cardiology. In IH mice, atherosclerosis lesion size and mRNA levels of 5-lipoxygenase, 5-lipoxygenase activating protein (FLAP) and CysLT1 receptor were significantly increased. This transcriptional activation was associated with the binding of HIF-1 to the FLAP promoter and was strongly associated with atherosclerosis lesion size. CysLT1 receptor antagonism (montelukast) significantly reduced atherosclerosis progression in IH mice. Conclusions IH-related CysLT pathway activation contributes to OSA-induced atherogenesis. In the era of personalized medicine, U-LTE4 may be a useful biomarker to identify OSA patients for whom CysLT1 blockade could represent a new therapeutic avenue for reducing cardiovascular risk.

Many associations between ocular disorders and obstructive sleep apnea (OSA) have been studied, such as nonarteritic anterior ischemic optic neuropathy, glaucoma, papilledema, retinal vein occlusion, eyelid hyperlaxity, lower-eyelid ectropion and recurrent corneal erosions. The objective of this review is to synthetize the possible vascular disorders of the retina and the optic nerve associated with sleep apnea patients and to discuss the underlying pathophysiological hypotheses. Main mechanisms involved in the ocular complications of OSA are related to intermittent hypoxia, sympathetic system activation, oxidant stress, and deleterious effects of endothelin 1. The main evidence-based medicine data suggest that OSA should be screened in patients with ischemic optic neuropathy and diabetic retinopathy. The effect of OSA treatment and emerging therapies are discussed.

Objectif Le syndrome des apnees du sommeil (SAS) en pediatrie est frequent et co_morbide ; un diagnostic simplifie est necessaire en pratique clinique. Nous evaluons ici la performance d’une machine learning basee sur l’analyse de l’effort respiratoire a travers le signal du seul mouvement mandibulaire (MM) pour le diagnostic du SAS pediatrique (Sunrise, Namur, Belgium). Methodes L’etude prospective a ete realisee chez 140 enfants adresses pour une polysommographie au laboratoire de sommeil (PSG) avec enregistrement simultane des MMs. Le diagnostic et la severite sont definis en PSG par un index d’apnee/hypopnee (OAHI) ≥ 1/h (leger), ≥ 5/h (modere) et ≥ 10/h (severe). Resultats La concordance entre la PSG et Sunrise (Sr) est appreciee par un graphe de Bland-Altman comparant l’indice horaire des evenements obstructifs a type d’apnees/hypopnees et de micro-eveils lies a un effort respiratoire (ORDI). La performance de Sr-ORDI est determinee par une courbe ROC evaluant la sensibilite et la specificite aux 3 niveaux de severite de la PSG. Une difference mediane de 1,57 evenements/h (95 %CI : -2,49 ; 8,11) est mesuree entre Sr_ORDI et PSG_ORDI. Les aires (et leurs ecarts interquartiles) sous les courbes de ROC sont respectivement de 0,75 (0,72 ; 0,78), 0,90 (0,86 ; 0,92) et 0,95 (0,90 ; 0,99) aux seuils de severite en PSG de ≥ 1/h, ≥ 5/h et ≥ 10/h. Conclusion L’analyse automatisee de MM procure un diagnostic robuste du SAS pediatrique modere a severe.

Background and objective Sleep Apnea Syndrome (SAS) is a multimorbid chronic disease with individual and societal deleterious consequences. Polysomnography (PSG) is the multi-parametric reference diagnostic tool that allows a manual quantification of the apnea-hypopnea index (AHI) to assess SAS severity. The burden of SAS is affecting nearly one billion people worldwide explaining that SAS remains largely under-diagnosed and undertreated. The development of an easy to use and automatic solution for early detection and screening of SAS is highly desirable. Methods We proposed an Accelerometry-Derived Respiratory index (ADR) solution based on a dual accelerometry system for airflow estimation included in a machine learning process. It calculated the AHI thanks to a RUSBoosted Tree model and used physiological and explanatory specifically developed features. The performances of this method were evaluated against a configuration using gold-standard PSG signals on a database of 28 subjects. Results The AHI estimation accuracy, specificity and sensitivity of the ADR index were 89%, 100% and 80% respectively. The added value of the specifically developed features was also demonstrated. Conclusion Overnight physiological monitoring with the proposed ADR solution using a machine learning approach provided a clinically relevant estimate of AHI for SAS screening. The physiological component of the solution has a real interest for improving performance and facilitating physician's adhesion to an automatic AHI estimation.

Introduction La somnolence diurne excessive (SDE) est un symptome frequent du syndrome d’apnees obstructives du sommeil (SAOS) invalidant chez les patients refusant ou non observant a la pression positive continue (PPC). Pour ces patients, le pitolisant (P) un agent eveillant agoniste inverse selectif des recepteurs H3 (histamine), pourrait etre indique dans le traitement de la SDE. L’etude presentee mesure le maintien de l’efficacite et la tolerance du P a 1 an chez des patients SAOS modere a severe ayant refuse la PPC. Methodes L’etude comportait 2 parties : une partie en double aveugle (DA) de 12 semaines comparant P (titration jusqu’a 20 mg/j) versus placebo (pl) realisee chez des patients SAOS m-s presentant une SDE et ayant refuse la PPC, suivie d’une partie en ouvert (PO) ou ces patients acceptaient de rester dans l’etude durant 40 semaines en beneficiant du P apres une titration (jusqu’a 20 mg/j). L’efficacite etait mesuree par la variation du score de l’echelle d’Epworth (ESS) : critere principal ; le test d’Osler (OSL), le score de Pichot (SP) et la tolerance etant les principaux criteres secondaires. Resultats Parmi les 268 patients SAOS randomises pour la partie DA (200 P ; 68 pl), 236 ont participe a la PO (181 P ; 55 pl). Les patients initialement traites par le P durant la DA ont presente une reduction supplementaire d’ESS (−1,6 ± 3,4) pendant la PO ainsi qu’une augmentation de la latence d’endormissement au test OSL et une amelioration du SP (variation moyenne −1,4 ± 5,9). Les patients sous placebo pendant la DA puis sous P durant la PO ont presente une reduction d’ESS (−5,2 ± 5,4) ; une augmentation de la latence d’endormissement au test OSL et une amelioration du SP (variation moyenne −2,9 ± 6,2). Les effets indesirables les plus frequents etaient les cephalees, insomnie, nausee et vertiges sans impact cardiovasculaire signale. Aucun nouveau signal de pharmacovigilance n’a ete identifie. Conclusion Durant la PO, les patients ayant deja recu le pitolisant durant la phase DA ont continue a s’ameliorer sur plusieurs criteres d’evaluation : ESS, OSL, Pichot. Ceux du bras placebo dans la DA et beneficiant de pitolisant en PO ont montre une amelioration de la somnolence comparable aux patients sous pitolisant durant toute l’etude. Ainsi, le pitolisant demontre un rapport benefice–risque favorable pour la prise en charge de la somnolence chez les patients SAOS refusant ou ne tolerant pas la PPC.

Points essentiels Le syndrome d’apnee-hypopnee obstructive du sommeil (SAHOS) est une pathologie frequente, dont la prevalence et l’expression peuvent varier selon le type de pathologie associee, l’âge ou encore le genre. Ainsi, la prevalence du SAHOS peut aller jusqu’a 80 % en cas d’HTA refractaire. Ceci a permis d’individualiser des clusters de presentation clinique, meme si actuellement, l’individualisation de ces differents phenotypes n’a pas permis de predire une prise en charge ou une evolution differente. Proposer la meilleure strategie au bon patient reste donc un objectif important. Cependant, l’association frequente du SAHOS et de differentes pathologies metaboliques et le haut risque cardiovasculaire ainsi induit est a prendre en compte dans la prise en charge therapeutique et le jugement de la reponse aux traitements instaures. Par une action sur l’ensemble des composantes pathologiques en cause chez ces patients presentant un SAHOS, une prise en charge combinee pourra ainsi permettre un effet benefique optimal.

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.

CPAP is the first-line treatment for moderate to severe OSA syndrome. Up to 25% of patients with OSA syndrome discontinue CPAP treatment due to side effects. Unintentional leakage and its associated annoying consequences are the most frequently reported adverse effects of CPAP. Successive technological improvements have not succeeded in addressing this issue. A systematic review was conducted (1) to assess the impact of different technological advances on unintentional leaks and (2) to determine if any patient characteristics have already been identified as determinants of unintentional leakage. No CPAP modality was superior to another in reducing unintentional leaks and, surprisingly, oronasal masks were associated with higher unintentional leaks. Nasal obstruction, older age, higher BMI, central fat distribution, and male sex might be associated with an increased risk of unintentional leakage. Such leaks remain an important problem. Further studies are needed to improve the understanding of underlying clinical factors so that patients at risk of unintentional leaks may be identified and individualized solutions applied.

We evaluated the long term effectiveness of maxillomandibular advancement (MMA) for OSAS treatment patients. This retrospective study reviewed the patients treated by MMA for OSAS between 1995 and 2009. They were evaluated by complete polysomnography, cephalometry and quality of life questionnaire. The minimum follow up was 3 years. Success rate was defined by an IAH10 with at least a 50% reduction.88 patients had MMA during this period. 34 accepted the evaluation (28 men, 6 women). Mean age was 52.4 ± 14. Mean follow-up was 12.5 years.Long term success rate was 28% for the entire group, postoperative IAH was reduced between 50 and 80% for all the patients except one. Success rate was 100% for young patients (age45), with BMI25 and IAH45 and SNB75° and narrow retrobasinlingual space (8 mm) and with preoperative orthodontics. Esthetic and sleep results were better with a moderate maxillary advancement and anterior impaction. There was no skeletal relapse. The major postoperative complication was inferior alveolar nerve hypoesthesia.MMA is an effective and stable treatment of OSAS in selected patients. Preoperative orthodontics is recommended.

Objectif La cohorte prospective multicentrique FACE a pour objectif de fournir des donnees a long-terme « en vie reelle » sur une population d’insuffisants cardiaques (a fraction d’ejection ventriculaire gauche alteree ou preservee) presentant des apnees centrales predominantes ou combinees a des apnees obstructives, eligibles a l’ASV. L’analyse en classe latente (LCA) a ete proposee pour definir des phenogroupes homogenes de patients pouvant evoluer differemment. Methodes Presentation clinique, donnees du sommeil, la fonction cardiaque et la qualite de vie ont ete evaluees au moment de l’inclusion. Les patients etaient pris en charge pour leur insuffisance cardiaque chronique et etaient eligibles a une prise en charge de leurs troubles respiratoires du sommeil (TRS) par ASV. La morbidite et la mortalite ont ete recueillies apres trois mois de suivi. Le critere principal est le delai de survenu du premier evenement : deces, hospitalisation imprevue pour aggravation de l’insuffisance cardiaque, greffe cardiaque ou dispositif d’assistance circulatoire mecanique. Resultats 509 patients ICC ont ete inclus dans l’analyse ITT, l’analyse en classe latente a identifie 6 phenogroupes bien definis. Au suivi a 3 mois, on observait une difference significative de l’incidence du critere principal entre les groupes (p Conclusion Une analyse en cluster permettant de definir des phenogroupes homogenes bases sur la fonction cardiaque, le type de SAS, l’acceptation du traitement par ASV est une methodologie prometteuse pour predire le devenir des patients ICC.

Resume Objectif La dysfonction endotheliale (DE) predit la survenue d’evenements cardiovasculaires (CV) tardifs et pourrait etre le lien entre le syndrome d’apnees obstructives du sommeil (SAOS) et les maladies CV. Toutefois, on observe certaines limites methodologiques des meta-analyses anterieures evaluant l’association entre le SAOS et la DE. Methodes Cette meta-analyse sur donnees individuelles portant sur 730 patients sans maladie CV connue issus de 12 etudes a pour objectif d’evaluer une possible association entre la severite du SAOS et la DE. Chaque patient a beneficie d’un enregistrement poly(somno)graphique pour suspicion clinique de SAOS et une evaluation de la fonction endotheliale par plethysmographie digitale. La DE est definie par un indice d’hyperemie reactive transformee en logarithme (Ln-RHI) Resultats Une DE existe respectivement chez 14,9, 18,1 et 26,9 % des patients sans SAOS (indice d’apnee-hypopnee [IAH] 20 min vs Conclusion L’IAH et l’hypoxemie nocturne sont independamment associees a la DE.

Objectif Pathologies du sommeil et infarctus cerebral (IC) sont etroitement lies et possiblement la topographie de l’IC et la pathologie du sommeil interagissent (vigilance, commande ventilatoire et des voies aeriennes superieures). Objectif correlation entre topographie lesionnelle d’un premier IC et syndrome d’apnees du sommeil (SAS). Methodes Cohorte prospective monocentrique de patients âges de 18-85 ans, hospitalises en neuro-vasculaire pour un premier IC non hemorragique sans antecedent neurovasculaire ou sommeil. La topographie de l’IC etait definie sur l’imagerie au diagnostic (IRM ou TDM). A distance de l’IC, les patients realisaient un examen clinique, des auto-questionnaires et une polysomnographie (PSG) selon les recommandations de l’AASM (delai median de PSG [Q1 ;Q3] = 134 jours [97 ;227]). Resultats Sur 142 patients inclus, 53 % presentaient un SAS (IAH ≥ 15 evenements/heure de sommeil, IAH median a 28/h [21 ;43], 52 % obstructif, 25 % coexistant, 23 % central). Les patients post IC etaient peu symptomatiques et non differents (pour SAS et non SAS respectivement, Epworth a 8 [4 ;12] vs 6 [4 ;10] et Pichot 8 [3 ;18] vs 11 [4 ;20]). Les patients SAS etaient plus âges (65 ans [55 ;71] vs 53 [48 ;63]), et majoritairement masculins. Le SAS impactait la macrostructure du sommeil (en minute, Stade I = 16 [8 ;31] vs 9,6 [5 ;22] p = 0,01 et sommeil lent profond = 4 [0 ;9] vs 12 [5 ;17] p Conclusion Les resultats preliminaires semblent indiquer que la topographie de l’IC soit liee a la presence d’un SAS et possiblement sa typologie.

Objectif Face est une cohorte observationnelle en pratique courante d’une population de patients insuffisants cardiaques chroniques (ICC) eligibles a la ventilation auto-asservie (ASV). 6 phenogroupes de patients ICC ont ete definis par une analyse en classe latente. L’analyse de la morbi-mortalite dans ces 6 classes de patients apres 2 ans de suivi est presentee ici. Methodes Trois types d’insuffisants cardiaques, definis par leur fraction d’ejection ventriculaire gauche (FEVG), alteree, moderement alteree et preservee, ont ete inclus. Les patients presentaient les troubles respiratoires suivant : apnees centrales du sommeil (SASC), apnees centrales et obstructives co-existantes non controlees par PPC et SASC emergent sous PPC. L’ASV etait proposee a tous les patients. Les patients qui refusaient l’ASV a l’inclusion ou non-observants ( Resultats Cinq cent trois patients ont ete inclus dans l’analyse ITT a 2 ans. L’ASV presentait un benefice sur la survie (p = 0, 01) dans la population totale. L’analyse du critere principal dans les 6 phenogroupes montrait que les patients ICC avec une FEVG alteree, traites par ASV presentaient le plus mauvais pronostic. L’ASV ne presentait pas de benefice chez les 2 groupes de patients ICC avec une FEVG alteree et un SASC ou un SAOS, mais presentait un effet protecteur chez les patients ICC a FEVG preservee, obeses avec un SASC et chez les patients ICC a FEVG preservee, hypoxemiques avec SAOS predominant. Conclusion Ces resultats sont en ligne avec les donnees des etudes recentes qui ne montraient pas d’effet benefique de l’ASV sur la morbi-mortalite chez les patients ICC a FEVG alteree. Il semble, en revanche, y avoir un effet protecteur chez certains patients ICC a FEVG preservee.

Objectif Evaluer si une perte de poids cliniquement significative (≥ 5 %) chez des participants souffrant de narcolepsie ou d’apnee obstructive du sommeil (AOS) recevant du solriamfetol 75-300 mg/jour ameliorait les biomarqueurs de risque cardiometabolique. Methodes Evaluation, dans un essai d’extension ouvert, des changements de poids, de pression arterielle (PA) et des valeurs biologiques. Resultats Sur 374 participants (124 narcoleptiques, 250 AOS), 96 (26 %) ont eu une perte de poids ≥ 5 %, et 278 (74 %) n’ont pas perdu de poids, dont 34 (9 %) avec une prise de poids ≥ 5 %. Parmi ceux ayant perdu du poids entre baseline et la semaine 40, le pourcentage dont la glycemie etait elevee (> ULN) a diminue (37 a 28 %), de meme pour les triglycerides (TG ; 27 a 22 %) ; le pourcentage de ceux dont le taux de cholesterol total (CT) etait eleve est reste stable (22 a 23 %). Parmi les personnes sans perte de poids, le pourcentage de personnes avec une glycemie elevee ou un CT eleve a augmente (43 a 50 % et 33 a 37 % respectivement), alors que le pourcentage de ceux ayant un taux eleve de TG est reste stable (37 %). Les participants ayant perdu du poids ont reduit leur PA systolique (-2,6 mmHg en moy) et leur PA diastolique (-1,0 mmHg en moy) ; ceux qui n’ont pas perdu de poids ont augmente de 0,7 et 1,2 mmHg, respectivement. Conclusion Parmi les participants traites par solriamfetol avec ≥ 5 % de perte de poids, la PA et le pourcentage de participants ayant un taux de glucose et de TG eleve ont diminue. Ces resultats devront etre confirmes par des etudes prospectives a long terme.

Objectif L’etude avait pour but d’evaluer si l’apparition d’une respiration de Cheyne Stokes (RCS) par telesuivi de patients traites par pression positive continue (PPC) est associee a la detection d’evenements cardiaques significatifs (defini par l’apparition ou la degradation d’une insuffisance cardiaque ou d’un trouble du rythme necessitant un traitement). Methodes AlertApnee est une etude mono centrique, prospective, d’un an. Les patients etaient telesuivis quotidiennement. En cas de RCS identifiee, les patients etaient convoques pour une consultation pneumologique, cardiologique, biologie, electrocardiogramme et echocardiographie. Resultats Un total de 555 patients (56,9 % avec comorbidites cardiovasculaires) ont ete inclus. 78 evenements de RCS (74 patients) ont ete detectes au cours de l’annee de telesuivi. Les causes associees a une RCS etaient l’insuffisance cardiaque (30,8 %), un IAH residuel eleve sous CPAP (26,9 %), les fuites excessives (16,7 %), medicaments (9,0 %), arythmies (7,7 %), insuffisance renale (2,6 %). Un evenement cardiaque significatif a ete identifie chez 20,3 % des patients CSR + et chez 2 % des patients CSR-. La survenue d’un episode de RCS detecte par la PPC augmente le risque d’un evenement cardiaque significatif de 13,79 (p Conclusion Cette etude demontre que la detection d’une RCS par telemonitoring des patients traites par PPC permet la detection precoce d’evenements cardiaques significatifs. La RCS est sensible, precoce, peu couteuse, transparente pour le patient avec une valeur predictive positive robuste.

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

Objectif Etude sur 1 an, evaluant efficacite sur Somnolence Diurne Excessive (SDE) et tolerance de Pitolisant (P), agent eveillant agoniste inverse des recepteurs H3 (histamine) versus placebo (pl) chez des patients avec syndrome d’apnees obstructives du sommeil (SAOS) modere a severe ayant refuse la PPC. Methodes 2 parties : Double aveugle (DA) 12 semaines comparant P (jusqu’a 20 mg/j) versus pl puis partie en ouvert (PO) 40 semaines sous P Critere principal : efficacite mesuree par la variation du score de l’echelle d’Epworth (ESS) Criteres secondaires principaux : test d’Osler (OSL), score de Pichot (SP) et tolerance. Resultats Chez patients sous P durant DA : reduction supplementaire ESS (−1,6 ± 3,4) ; augmentation de la latence d’endormissement au test OSL et amelioration du SP (−1,4 ± 5,9) durant PO Chez patients sous pl durant DA puis P durant PO : reduction ESS (−5,2 ± 5,4) ; augmentation de la latence d’endormissement au OSL et amelioration du SP (−2,9 ± 6,2) Effets indesirables les + frequents : cephalees, insomnies, nausees et vertiges, pas d’impact cardiovasculaire. Conclusion Les patients sous Pitolisant durant DA ont continue a s’ameliorer sur ESS, OSL et Pichot durant la PO. Ceux sous placebo dans DA puis sous Pitolisant en PO ont montre une amelioration de la somnolence comparable aux patients sous Pitolisant durant toute l’etude. Pitolisant demontre un rapport benefice-risque favorable pour la prise en charge de la somnolence chez les patients SAOS refusant ou ne tolerant pas la PPC.

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

Aim FACE collected real life clinical data and long-term follow-up (FU) in a CHF population with SDB eligible for ASV. We previously identified 6 clinically meaningful clusters using Latent class analysis. We investigate herein whether these clusters may have different morbi-mortality outcomes. Methods Reduced (HFrEF), middle range (HFmrEF) and preserved (HFpEF) CHF classes were included. Eligible SDB were central sleep apnea (CSA), coexistent obstructive central SA not controlled under CPAP and CPAP emergent CSA. ASV was offered to all. Controls were patients who refused ASV at inclusion. Morbi-mortality events were collected for 2 years. Primary endpoint in the time-to event analysis was the first event of death, unplanned hospitalization for worsening HF or cardiac transplant. Results 503 patients were included in the ITT analysis at 2-year FU. ASV was protective for primary outcome (P = 0.01, Fig. 1 A). Cluster behavior regarding primary outcome was different, the worst prognosis was for HFrEF with CSA ( Fig. 1 B). ASV did not benefit in the HFrEF with CSA or OSA clusters ( Fig. 1 C) but was protective for 2 clusters: obese HFpEF with CSA and severe hypoxemic patients with OSA ( Fig. 1 D). Conclusion These results align with recent studies that showed no impact on morbi-mortality of ASV in HFrEF but a protective effect in two HFpEF clusters.

Introduction La prescription de la ventilation non invasive (VNI) a augmente au cours de ces dernieres annees et elle est de plus en plus utilisee chez les sujets âges. Cependant, nous avons peu de donnees quant a son utilisation au long cours chez les personnes tres âgees. Le but de cette etude etait de decrire les patients de plus de 75 ans traites par VNI et de les comparer a ceux de moins de 75 ans egalement traites par VNI. Methodes Il s’agit d’une etude observationnelle transversale multicentrique incluant tous les patients traites par VNI dans les cantons de Geneve et Vaud (1’288’378 habitants) entre 2016 et 2018. Des comparaisons ont ete effectuees entre les patients de plus de 75 ans et de moins de 75 ans concernant les donnees anthropometriques, les diagnostics, les comorbidites, l’impact sur les gazometries arterielles et les oxymetries de pouls nocturne, les aspects techniques de la VNI et l’observance. Resultats Sur un total de 489 patients traites par VNI, 151 patients (31%) avaient plus de 75 ans. Le sexe masculin et les comorbidites etaient plus frequents chez les sujets plus âges (> 75 ans). Il y avait une proportion plus elevee de BPCO et une proportion plus faible de maladies neuromusculaires dans le groupe plus âge (> 75 ans), mais non significative. La correction des gaz du sang arteriel et des oxymetries de pouls nocturne etait similaire dans les deux groupes. Le choix des interfaces etait similaire dans les deux groupes et l’utilisation d’oxygene etait plus frequente dans le groupe plus âge (> 75 ans). Aucune difference significative n’a ete notee en terme de compliance et dans les reglages des ventilateurs (pressions, frequence respiratoire de securite, evenements respiratoires residuels). Les fuites non intentionnelles etaient plus frequentes chez les sujets plus âges (> 75 ans). Conclusion Dans cette etude, un tiers de la population traite par VNI avait plus de 75 ans. Les diagnostics n’etaient pas significativement differentes, avec une proportion plus elevee de BPCO et une proportion plus faible de maladies neuromusculaires dans le groupe plus âge (> 75 ans). Les fuites non intentionnelles etaient legerement plus frequentes dans la population plus âgee (> 75 ans). Cependant, les indices d’efficacite de la VNI (gazometries arterielles, oxymetries de pouls nocturne, evenements respiratoires residuels) et l’observance du traitement etaient similaires dans les deux groupes.

Objectif Evaluation de la performance des implants cardiaques versus polysomnographie pour le diagnostic du SAS. Methodes Une recherche systematique a ete menee pour identifier les etudes repondant a notre objectif. Les performances des implants cardiaques, avec des analyses de sensibilite par fabriquant et types d’implant, ont ete evaluees par une meta-analyse bivariee a effet aleatoire. Le calcul de la sensibilite et la specificite a ete limite au sous-groupe le plus representatif et pour un index d’apnees-hypopnees (IAH)≥ 30/heure. De plus, nous avons effectue des meta-regressions uni et des analyses multivariees pour explorer l’effet des donnees suivantes (âge, IMC, sexe, les prevalences de la fibrillation auriculaire (FA) et du SAS dans la population generale) sur les performances des implants cardiaques. Resultats Cette meta-analyse a porte sur 13 etudes et 647 patients avec donnees valides, en majorite des hommes (> 50 %), d’âge moyen 70,5 ± 4,8 ans. Selon les etudes, la sensibilite variait de 60 a 100 % et la specificite de 50 a 100 % avec une prevalence du SAS de 22 a 91 %. Pour un IAH≥ 30/heure, 6 etudes ont utilise un dispositif de Boston Scientific et 5 etudes ont ete menees avec un stimulateur cardiaque de type pacemaker (PM). La valeur seuil optimale d’evenements respiratoires pour les PMs etait de 31,5/heure avec une sensibilite de 80 % et une specificite de 70 %. Conclusion Le SAS modere a severe, peut etre diagnostique de facon relativement fiable chez le patient porteur d’un implant cardiaque. Ceci devrait participer a l’amelioration du diagnostic de SAS dans les populations a risque cardiovasculaire.