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Background: Sleep had never been assessed immediately after extubation in patients still in the ICU. However, sleep deprivation may alter respiratory function and may promote respiratory failure. We hypothesized that sleep alterations after extubation could be associated with an increased risk of post-extubation respiratory failure and reintubation. We conducted a prospective observational cohort study performed at the medical ICU of the university hospital of Poitiers in France. Patients at high-risk of extubation failure (> 65 years, with any underlying cardiac or lung disease, or intubated > 7 days) were included. Patients intubated less than 24 h, with central nervous or psychiatric disorders, continuous sedation, neuroleptic medication, or uncooperative were excluded. Sleep was assessed by complete polysomnography just following extubation including the night. The main objective was to compare sleep between patients who developed post-extubation respiratory failure or required reintubation and the others. Results: Over a 3-year period, 52 patients had complete polysomnography among whom 12 (23%) developed post-extubation respiratory failure and 8 (15%) required reintubation. Among them, 10 (19%) had atypical sleep, 15 (29%) had no deep sleep, and 33 (63%) had no rapid eye movement (REM) sleep. Total sleep time was 3.2 h in median [interquartile range, 2.0–4.4] in patients who developed post-extubation respiratory failure vs. 2.0 [1.1–3.8] in those who were successfully extubated (p = 0.34). Total sleep time, and durations of deep and REM sleep stages did not differ between patients who required reintubation and the others. Reintubation rates were 21% (7/33) in patients with no REM sleep and 5% (1/19) in patients with REM sleep (difference, − 16% [95% CI − 33% to 6%]; p = 0.23). Conclusions: Sleep assessment by polysomnography after extubation showed a dramatically low total, deep and REM sleep time. Sleep did not differ between patients who were successfully extubated and those who developed post-extubation respiratory failure or required reintubation. [ABSTRACT FROM AUTHOR]

Background: The outcome of depressive symptoms under CPAP therapy for OSA-hypopnea syndrome (OSAHS) has been poorly evaluated. In this multicenter, prospective cohort study, we evaluated the prevalence and correlates of persistent depressive symptoms after long-term CPAP therapy for OSAHS.Methods: This study included 300 patients with OSAHS and depressive symptoms (13-item, self-rated Pichot depression scale [QD2A] ≥ 7) at diagnosis. The primary dependent variable was persistent depressive symptoms after ≥ 1 year of CPAP therapy. Multivariate regression analyses were performed to determine variables independently associated with the persistence of depressive symptoms.Results: After an average of 529 days (range, 365-1,569 days) of CPAP therapy, the mean (SD) QD2A score decreased from 9.2 (2.0) to 5.4 (4.0) (P < .0001), but 125 patients (41.7%) presented persistent depressive symptoms. The persistence of depressive symptoms was independently associated with persistent excessive daytime sleepiness (EDS) (OR, 2.72; 95% CI, 1.33-5.61), comorbid cardiovascular disease (OR, 1.76; 95% CI, 1.02-3.00), and female sex (OR, 1.53; 95% CI, 1.09-2.13). A positive linear trend was observed for the adjusted OR of persistent depressive symptoms with decreasing CPAP effect on the Epworth sleepiness scale (P < .0001).Conclusions: CPAP therapy does not resolve depressive symptoms in many patients with OSAHS. Persistent depressive symptoms are strongly associated with EDS. Active monitoring of depressive symptoms is needed in patients with OSAHS who are treated with CPAP. Interventional trials are required to evaluate the impact of antidepressants, cognitive behavioral therapy, or both on comorbid depression in patients with OSAHS. [ABSTRACT FROM AUTHOR]

The purpose of this article is the assessment of occupational exposure to perchloroethylene (PCE) and its clinical repercussions for dry-cleaning employees. The authors measured atmospheric levels of PCE and blood levels in a population of 50 exposed employees then conducted a study of clinical symptomatology in exposed and non-exposed subjects linked with this solvent. Fifty employees and 95 controls were studied. The median value of atmospheric PCE was 7 ppm (0.22-33), and the median blood level of PCE was 73.6 μg/l (11.8-144). These levels were correlated statistically to the action of sludge scraping and to the existence of automatic scrapers (p < 0.01). Eight percent of PCE blood levels were higher than the biological levels recently set in France. The exposed population did not show excessive signs of drowsiness nor of pre-narcotic syndrome or other symptoms studied. Dry-cleaning employees were exposed to PCE at atmospheric levels lower than the French and American chronic recommended exposure levels but some results were higher than recommended values. For PCE blood levels for the general working population, results were respectively lower than French and American national recommended levels in 92% and 94% cases. Risk should be considered, however, carefully in women of childbearing age, as 64% exceeded the recommended blood levels for pregnant women. This exposure did not generate any studied neurobehavioral symptomatology.

Background: Increasing evidence suggests an association between short sleep with adverse health outcomes: obesity, type 2 diabetes and hypertension. But there are few or no data on "who these short sleepers are" in the general population., Objectives: To describe short sleepers and the associated sleep disorders in young adults., Methods: Cross-sectional telephone survey in a representative sample of 1004 French young adults (25-45 years old). Total sleep time (TST), insomnia, snoring, sleepiness and daytime consequences were assessed using subjective validated tools. Short sleepers were defined as sleeping <6h a weekday (sleep+nap+pauses). Sleep debt was defined as those who "sleep 90 min less than the sleep they need to be in good shape.", Results: Prevalence of short sleep was 18%, insomnia 12%, and sleep debt 20% in the total group. Among short sleepers, 16% had insomnia, 45% sleep debt, and 39% neither. Short sleepers were significantly mostly males, blue collar workers and more overweight and obese compared to nonshort sleepers. Working >10h per day, smoking and drinking coffee after 5p.m. were also significantly associated with short sleep. Short sleepers had higher Epworth sleepiness scale ESS scores (7.8 vs 6.7; p = 0.0058) and more sleepiness while driving (11.5% vs 2.9%; p < 0.0001)., Conclusion: Short sleep is highly prevalent in young adults but is not an homogeneous group, including both insomniacs and subjects with or without sleep debt. Short sleep has to be defined more precisely in order to better understand its impact on public health., (Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.)

Objective: Despite convincing evidence regarding the risk of highway accidents due to sleepiness at the wheel, highway drivers still drive while sleepy. Sleep disorders can affect driving skills, but the relative impact of sleep complaints among a large population of highway drivers is still unknown., Methods: Out of 37,648 questionnaires completed by frequent highway users (registered in an electronic payment system), we ran our analyses on 35,004 drivers who responded to all items. The questionnaire previously used in a telephone survey included socio-demographics, driving and sleep disorders items (Basic Nordic Sleep Questionnaire) and the Epworth Sleepiness Scale., Results: Of all drivers, 16.9% complained of at least one sleep disorder, 5.2% reported obstructive sleep apnea syndrome, 9.3% insomnia, and 0.1% narcolepsy and hypersomnia; 8.9% of drivers reported experiencing at least once each month an episode of sleepiness at the wheel so severe they had to stop driving. One-third of the drivers (31.1%) reported near-miss accidents (50% being sleep-related), 2520 drivers (7.2%) reported a driving accident in the past year, and 146 (5.8%) of these driving accidents were sleep-related. The highest risk of accidents concerned patients suffering from narcolepsy and hypersomnia (odds ratio 3.16, p<.01) or multiple sleep disorders (odds ratio 1.46, p<.001). Other major risk factors were age [18-30 years (OR 1.42, p<.001)] and being unmarried (OR 1.21-fold, p<.01)., Conclusions: In regular highway drivers, sleepiness at the wheel or sleep disorders such as hypersomnia and narcolepsy are responsible for traffic accidents independent of age, sex, marital status or socio-professional categories., (Copyright © 2010 Elsevier B.V. All rights reserved.)

The prevalence of sleep-disordered breathing (SDB) was evaluated in a male population sample of Lorraine (university staff), with a protocol including a self-completed standardized questionnaire, anthropometry (including neck, waist and hip circumferences) and non-invasive ear, nose, and throat examination. Among 357 subjects present in the institution at the moment of the survey, 334 (93.6%) accepted to participate, and 300 (84%) returned the questionnaires. The anthropometric results corresponded to the French normative values according to gender and age. We chose a value of 32 as limit of the body mass index (BMI) between weight excess and obesity; this limit was exceeded by 7.2% of the subjects. The mean age of the sample was 44.8 (SD 10.1) years; the waist-to-hip ratio was of 0.907 +/- 0.053. The ENT examination found a high prevalence of nasal septum deviations (52.6%), of soft palate (25.2%), and uvula (42%) abnormalities; 32.1% of the subjects had experienced amygdalectomy. The non-responses to the questionnaire were infrequent (less than 2%), except for the questions regarding a history of hypertension (2.6%), weight fluctuations the last 5 years (7.6%), and the number of years in school (12%). The questionnaire included, for each question, the optional answer "don't know"; this answer was chosen for the questions concerning the duration of snoring (37.1%), stopping breathing during sleep (12.7%) and the parental history of narcolepsy (18.7 and 20.7%) and sleep apnoea (33.7 and 36.4%). 5.7% of the subjects declared sleep apnoeas at least once per week: 16.1% had unrefreshing sleep; 10.6% admitted to excessive daytime sleepiness; 41.9% were habitual snorers. These results indicate a prevalence of SDB in our sample which is comparable to the figures obtained in other European studies. Further analysis of our data will indicate if, besides weight excess and its troncular distribution, cigarette smoking and respiratory symptoms, the "minor" ENT abnormalities play a role in the pathogenesis of SDB.

Vigilance is a critical output of adaptative processes related to sleep/wake continuity and circadian rhythms. Since vigilance is highly stressed in the modern technic society, its sudden failures, expressed as fatigue, drowsiness and/or sleepiness, may be dramatically involved in accident's incidence, as observed in work accidents, manufacturing and transport sectors and private life. There is a detectable human factor involved in 70% of cases. Even if there are multifactorial circumstances, human factor such as fatigue, overwork or errors in decision are generally reported. Two main cases may be described: on one hand sleepiness and fatigue occur as sleep deprivation builds up, with an excessive duration of wakefulness (that suggests that it may be prevented by information and hygienic precautions), on the other hand sleepiness is the expression of a sleep illness or disease (and it must be detected early by a clinical biological survey). Three levels are reviewed and discussed for a comprehensive view of abnormal fatigue and sleepiness: what is the prevalence as evaluated by epidemiologic, biologic and psychologic methods? is there any specificity of cognitive disturbances associated with intrinsic or rhythmic dyssomnic illness and how can one evaluate or measures them? on the basis of some experimental reports in normal subjects by changing wake and sleep schedules it is assumed that the recovery which follows a sleep deprivation may be quite different when there is an early or a late night sleep deprivation. Possibilities for self-sleep training are discussed. The actual great interest in abnormal sleepiness is supported by its human and socio-economic consequences. If new pharmacological or physiological treatments have recently be suggested, information and cooperation are required in healthy subjects and in patients. Self-detection in the course of sleepiness is a critical factor: it may be learned and taught by medical preventive projects.

Side effects were compared in 454 patients under phenobarbital and in 133 patients under other antiepileptic agents. Prevalence of adverse effects was 12% and 4% in these two groups, respectively. The fairly low prevalence of untoward reactions to phenobarbital in this study as compared with previously published reports is due to the methodology used. Despite unquestionable drawbacks, especially in patients above 50 years of age at first use, phenobarbital is a valuable therapeutic alternative in some cases.