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BACKGROUND: Oropharyngeal myofunctional therapy is a multi-component therapy effective to reduce the severity of obstructive sleep apnoea (OSA). However, existing protocols are difficult to replicate in the clinical setting. There is a need to isolate the specific effectiveness of each component of the therapy. OBJECTIVE: To assess the effects of a 6 weeks tongue elevation training programme in patients with OSA. METHODS: We conducted a multicentre randomised controlled trial. Eligible participants were adults diagnosed with moderate OSA who presented low adherence to continuous positive airway pressure therapy (mean use

It was recently described that COVID-19 pneumonia patients had an atypical form of the ARDS syndrome and required gentle ventilation. We report here on benefits of CPAP treatment in a patient with COVID-19 pneumonia. A 63-year-old patient of African origin presented to the emergency room with COVID-19 pneumonia. Fever had started 5 days before her admission. On day 4, rapid clinical deterioration associated to a high respiratory rate and increased oxygen requirements was noted. The patient was working in an intensive care unit and refused to be intubated. Oxygen was administered at a rate of 15 litres per minute via a Boussignac valve, which initially restored normal oxygen saturation, but this treatment was poorly tolerated and the patient withdrew it after 2 h. A CPAP set at a pressure of 8 cm of water (Goodknight®) was then introduced with better tolerance, allowing the patient to wear it almost continuously for more than 38 h. The patient also benefited from the administration of methypredinsolone 40 mg. Concerning tolerance, a substantial advantage was noted for CPAP machine compared to the Boussignac valve with in addition, a clear decrease in respiratory rate. We would like to encourage the use of CPAP, better tolerated for extended hours with lower oxygen flows, in patients with COVID-19 pneumonia, where acute respiratory distress all too often leads to patient intubation and the genesis of deleterious lung lesions.

International audience; Ribeiro Baptista, Bruno, Morgane Faure, Gimbada Benny Mwenge, Capucine Morelot-Panzini, Christian Straus, Thomas Similowski, and Jésus Gonzalez-Bermejo. Feasibility of a hypoxic challenge test under noninvasive ventilation versus oxygen in neuromuscular patients with chronic respiratory insufficiency. High Alt Med Biol. 22:346–350, 2021.Background: The British Thoracic Society recommendations suggest that all patients with an oxygen saturation (SpO2) 90%) by oxygen therapy (+9 [6–12]%, p = 0.0029). Patient's home ventilator also significantly increased the SpO2 by 8 [7–12]% (p = 0.016). Correction of SpO2 during the HCT was not different between oxygen and NIV. NIV was associated with a significant decrease in pressure, end tidal, carbon dioxide (PetCO2) (−10 [−16 to −7.5] mmHg, p = 0.04).Conclusions: The performance of an adapted HCT in home-ventilated patients with a neuromuscular pathology may be useful in a personalized treatment plan for air travel. NIV can be a new alternative to oxygen therapy for neuromuscular patients planning to take a flight.

Coronavirus disease 2019 (COVID-19) is commonly associated with kidney damage, and the angiotensin converting enzyme 2 (ACE2) receptor for SARS-CoV-2 is highly expressed in the proximal tubule cells. Whether patients with COVID-19 present specific manifestations of proximal tubule dysfunction remains unknown. To test this, we examined a cohort of 49 patients requiring hospitalization in a large academic hospital in Brussels, Belgium. There was evidence of proximal tubule dysfunction in a subset of patients with COVID-19, as attested by low-molecular-weight proteinuria (70-80%), neutral aminoaciduria (46%), and defective handling of uric acid (46%) or phosphate (19%). None of the patients had normoglycemic glucosuria. Proximal tubule dysfunction was independent of pre-existing comorbidities, glomerular proteinuria, nephrotoxic medications or viral load. At the structural level, kidneys from patients with COVID-19 showed prominent tubular injury, including in the initial part of the proximal tubule, with brush border loss, acute tubular necrosis, intraluminal debris, and a marked decrease in the expression of megalin in the brush border. Transmission electron microscopy identified particles resembling coronaviruses in vacuoles or cisternae of the endoplasmic reticulum in proximal tubule cells. Among features of proximal tubule dysfunction, hypouricemia with inappropriate uricosuria was independently associated with disease severity and with a significant increase in the risk of respiratory failure requiring invasive mechanical ventilation using Cox (adjusted hazard ratio 6.2, 95% CI 1.9-20.1) or competing risks (adjusted sub-distribution hazard ratio 12.1, 95% CI 2.7-55.4) survival models. Thus, our data establish that SARS-CoV-2 causes specific manifestations of proximal tubule dysfunction and provide novel insights into COVID-19 severity and outcome., Graphical abstract

Background COVID-19 pandemic resulted in an unprecedented number of hospitalizations in general wards and intensive care units (ICU). Severe and critical COVID-19 patients suffer from extensive pneumonia; therefore, long-term respiratory sequelae may be expected. Research question We conducted a cohort study to determine respiratory sequelae in patients with severe and critical COVID-19. We aimed at evaluating the proportion of patients with persisting respiratory symptoms and/or abnormalities in pulmonary function tests (PFT) or in lung imaging. Study design and methods: This is a single center cohort study including COVID-19 survivors who underwent a three-month follow-up with clinical evaluation, PFT and lung high-resolution computed tomography (HRCT). All clinical, functional, and radiological data were centrally reviewed. Multiple linear regression analysis was performed to identify factors associated with residual lesions on HRCT. Results Full clinical evaluation, PFT and lung HRCT were available for central review in 126, 122 and 107 patients, respectively. At follow-up, 25% of patients complained from dyspnea and 35% from fatigue, lung diffusion capacity (DLCO) was decreased in 45%, 17% had HRCT abnormalities affecting more than 5% of their lung parenchyma while signs of fibrosis were found in 21%. In multiple linear regression model, number of days in ICU were related to the extent of persisting lesions on HRCT, while intubation was associated with signs of fibrosis at follow-up (P = 0.0005, Fisher's exact test). In contrast, the severity of lung imaging or PFT changes were not predictive of fatigue and dyspnea. Interpretation Although most hospitalized COVID-19 patients recover, a substantial proportion complains from persisting dyspnea and fatigue. Impairment of DLCO and signs suggestive of fibrosis are common but are not strictly related to long-lasting symptoms.

Objectives/Hypothesis This feasibility study was designed to show the preliminary safety and efficacy of targeted hypoglossal neurostimulation (THN), and to identify baseline predictors of successful therapy. Study Design Open-label, prospective, multicenter, single-arm cohort study, conducted at seven centers in the U.S.A. and Europe. Methods Forty-six participants with moderate to severe obstructive sleep apnea (OSA), failing or intolerant of continuous positive airway pressure, were implanted. Primary (Apnea-Hypopnea Index [AHI], Oxygen Desaturation Index [ODI]) and secondary (Arousal Index, Epworth Sleepiness Scale Index, Sleep Apnea Quality of Life Index) outcomes were measured at baseline and compared at 6 months. Data were analyzed to identify participant characteristics that would predict success with therapy. Results Sixty-seven adverse events (AEs) were observed among 36 participants; most of the AEs were related to the implant procedure and resolved without sequelae; one device replacement was necessary. Forty-three participants showed significant (P 10%. Seven participants met these criteria; 86% (6 of 7) were AHI responders and 86% (6 of 7) were ODI responders, indicating that THN therapy can be efficacious in a carefully selected population of OSA patients. Conclusions This feasibility study suggests that THN therapy is likely to be safe and effective in selected patients. Level of Evidence 2b Laryngoscope, 126:2618–2623, 2016

Purpose of the study Periodic leg movements (PLMs) are found in 30% of patients suffering from OSA. Under CPAP, we observed that PLMs can increase, decrease, or remain unchanged. The predictors of these changes are not well established. Objective To determine the predictors of PLMs change under CPAP and its impact on long-term adherence. Materials and method The patients were referred to the sleep laboratory for snoring or sleepiness. A single PSG night has been performed before and after CPAP treatment. Data on medication used, comorbidities and ferritin level were collected. Results A total of 160 patients were recruited with a severe OSA. About 32.5% (52/160) patients had emerging PLM i.e. that appeared after the disappearance of respiratory events. By comparing patients with emerging-PLMs to others, we found that only the blood ferritin level was significantly different between groups. Moreover, after one-year follow-up, a significant difference in adherence and long-term compliance was observed between patients without PLM at both screening and CPAP polysomnographies or emerging PLM at the second study (56%) vs. patients with baseline PLM, whether PLM remained stable or decreased under CPAP treatment (75%) (p-value 0.028). Serum ferritin and presence of diabetes mellitus predicted the evolution of PLM observed. Patients with low ferritin levels demonstrated an increase of PLM after initiation of nasal CPAP treatment. Conclusion The emergence of PLM negatively impacts long-term adherence to nasal CPAP treatment in OSA. Blood ferritin level is a predictor of the evolution of PLM under CPAP therapy.

In Belgium, patients with moderate to severe OSA (AHI 20) who show less than 30 micro-arousals per hour slept (MAI) cannot benefit from CPAP refund by the social security (SS).To assess the influence of reimbursement on CPAP acceptance, and long-term adherence.OSA patients (AHI 20) were included regardless of MAI. All patients were offered a CPAP trial of 3-5 days for habituation. Two groups were defined and compared: «Out of pocket money» patients (OOP) with MAI 30 that were invited to purchase their device and «reimbursed group» that were offered a CPAP reimbursed by the social security.812 patients were found: 59 in the OOP group, mostly females, sleepier and using more hypnotics. Out of the reimbursed group, 183 patients were matched to the OOP patients on the grounds of age, AHI and BMI. 90% of OOP and 94% of reimbursed patients (p 0.379) accepted a CPAP trial; 74% of OOP and 90% of reimbursed patients acquired a CPAP device (p 0.005) thereafter, whereas 82% and, respectively, 84% of those (p 0.254) were still on CPAP after a mean follow-up of 711 and 604 days with a mean ± SD daily compliance of 5.3 ± 3 and 6.1 ± 2 h, respectively (p 0.159). Only fatigue scale seems to influence the purchase of CPAP by OOP patients.CPAP reimbursement influences the purchase of CPAP but once the device becomes available there is no difference with reimbursed patients in long-term adherence.

Objectif La resistance nasale elevee des patients serait un facteur predictif de refus du traitement par CPAP, une fois corrigee elle permettrait d’ameliorer la compliance des patients. La correlation entre la compliance a long terme et les resistances nasales est peu etudiee. Objectif : influence de la mesure initiale des resistances nasales sur la compliance a long terme de la CPAP. Methodes Nous avons analyse de maniere retrospective, l’examen ORL et la rhinomanometrie initiale de tous les patients diagnostiques de janvier 2015 a decembre 2016 pour un SAS severe et traites par CPAP. Les patients qui ont arrete le traitement par CPAP ont ete apparies selon BMI, AHI, Epworth, index d’insomnie et l’âge. Resultats Trois cent sept patients ont ete traites par CPAP, 25 (7 femmes) patients ont arretes leur traitement (groupe 1). Ces patients ont ete compares a 53 (10 hommes) patients apparies et compliants (groupe 2). Nous ne constatons aucune difference dans les proportions des scores de Mallampati (p-valeur 0,099), la proportion des resistances nasales normal (> 200 mL/sec) (p-valeur 0,598) et des effets secondaires (p-valeur 0,156), entre les groupes. Les effets secondaires sont identiques dans les deux groupes et ne sont pas correles a la rhinomanometrie. L’analyse de regression multiple nous revele que les variables âge, rhinomanometrie, BMI, pression, ne constituent pas des facteurs predictifs aux effets secondaires ORL. Conclusion La mesure des resistances nasales initiales n’est pas correlee aux effets secondaires ORL et la compliance a long-terme du traitement par CPAP.

Objectif Le Questionnaire de Nijmegen (QNIJ) reflete une dysfonction subjective de la respiration chez les patients lorsqu’il est > 22. Une proportion de ces patients rapporte des troubles liees au sommeil. Nous souhaitons en connaitre la prevalence et caracteriser les symptomes evocateurs de syndrome d’apnee du sommeil (SAS) chez ces patients. Methodes Analyse retrospective de patients consecutifs adresses au laboratoire du sommeil pour ronflement ou afin d’exclure un SAS. Les scores Nijmegen (QNIJ), Epworth (ESS), Beck depression (BDI), fatigue (Pichot) ont ete realises chez tous les patients. Les patients ont ete divises en deux groupes selon un QNIJ > 22 ou non (QNIJ + et QNIJ − respectivement). Les patients atteints de SAS avec un index d’apnees-hypopnees (IAH) > 15 (SAS + ) ont ete compares aux patients sans SAS. Resultats Sur un total de 534 patients, 124 (69f) patients soit 23 % avaient un score de Nijmegen > 22 (31 + 7). Trente-huit patients sur 124 avec un IAH > 15 (32 + 18 vs 3 + 3 p-value Conclusion 30 % des patients qui rapportent une dysfonction subjective de la respiration ont un SAS severe caracterise par des index eleves d’anxiete, de depression et de fatigue.

La prevalence du syndrome d’apnees hypopnees du sommeil augmente avec l’âge, sans qu’on ait une explication claire du pourquoi de cette evolution. Ce chapitre passe en revue les modifications liees a l’âge survenant dans l’anatomie et la physiologie des voies aeriennes superieures, ainsi que dans la physiologie du sommeil, la fonction de l’appareil musculaire ou l’exposition a des medicaments hypnotiques ou antalgiques qui peuvent rendre compte de la plus forte prevalence de ce syndrome chez le sujet âge.

Objectif La formule predictive de la pression de therapeutique de la CPAP a demontre une bonne correlation avec la PSG de titration. Cependant, dans la pratique, celle-ci doit souvent etre adaptee. Nous emettons l’hypothese la difference entre la pression calculee et la pression requise est influencee par les phenotypes. Methodes De maniere retrospective nous avons repris les donnees de 92 patients consecutifs diagnostiques pour un SAS severe. La pression de la CPAP calculee selon la formule a ete adaptee en fonction de la PSG de titration. Les patients ont ete groupes selon la predominance des evenements respiratoires ; en decubitus dorsal (phenotype positionnel), en sommeil paradoxal (phenotype paradoxal) ou indifferencie (phenotype indifferencie). Une analyse de regression multiple a ete realisee afin de determiner les predicteurs du changement de pression. Resultats Les groupes Ppo, Ppa, Pi etaient composees respectivement de 50 (9F), 18 (3F), 24 (2F). Aucune difference n’est retrouvee dans l’âge, le tour de cou et l’IMC. Le phenotype indifferencie a IAH de depart plus elevee. Tous les groupes necessitent une augmentation moyenne respectivement de 1,23 ± 2, 1,8 ± 1,4, 1 ± 0,8 cm d’eau, p = 0,349. L’analyse de regression multiple revele que le facteur qui influence le changement de pression est la persistance d’evenements en sommeil paradoxal. Conclusion La formule predictive est autant efficace dans les differents phenotypes du SAS. Cependant une majoration de la pression de 1 cm d’eau est necessaire, dependante de la persistance de l’index apnee residuel en sommeil paradoxal.

Obstructive sleep apnea (OSA) is a very frequent affliction that affects about 1-5% of the adult population in its severe form. Continuous positive airway pressure (CPAP) is the most commonly used treatment and is highly effective, but its use is limited by low long-term adherence rates and overall poor acceptance among the patients. Therefore, there is a need for developing alternative approaches to OSA treatment, including a more 'natural' concept of maintaining an open airway through neuromodulation. Here we review the concept, scientific rationale, and technical details of hypoglossal nerve stimulation. We also review results of published clinical studies with several hypoglossal stimulation devices that are being investigated today. Hypoglossal nerve stimulation appears to be a very promising treatment for patients with moderate-to-severe OSA. If its efficacy is confirmed, it will probably be complementary with CPAP therapy and initially aimed at patients unable or unwilling to use CPAP. Once it becomes a standard therapy, its advantages might prove sufficient to challenge CPAP as the first-line therapy.

Objectif Evaluer l’efficacite et l’adherence sur le long terme du traitement anti-positionnel « Pasuldo » dans le syndrome des apnees hypopnees obstructives du sommeil positionnel (SAOSP) chez des patients moderes a severes. Methodes Nous avons inclus, entre le 30/04/2013 et le 30/12/2014, les patients diagnostiques SAOSP par PSG. Nous n’avons pas enrole, les patients pouvant beneficier d’une intervention ORL ou d’une CPAP. Apres 7 a 15 jours d’habituation a domicile, une PSG de controle a ete effectuee afin de verifier l’efficacite. L’adherence a ete mesuree par un agenda du sommeil et un suivi telephonique. Resultats Parmi 46 patients, 37 (80 %) ont accepte d’utiliser le dispositif. Nous avons observe la co-morbidite des patients : 48 % d’entre eux souffrent d’hypertension arterielle, 74 % d’hypercholesterolemie, 45 % de diabete et 11 % de trouble du rythme. La PSG sous Pasuldo montre une reduction significative du AHI (20 ± 7,3 a 12,3 ± 12,1, p = 0,0012) et du temps passe sur le dos durant le sommeil (164,2 ± 87,8 a 26,1 ± 45,7, p Conclusion Le Pasuldo est efficace car il diminue significativement l’AHI et le temps passe sur le dos, meme chez les patients moderes a severes. Peu de patients adherent au traitement sur le long terme et abandonnent a cause des effets secondaires (mal de dos, inconfort,…) et car ils pensent apprendre a dormir sur le dos.

Objective: Airway management is the standard approach for the treatment of obstructive sleep apnea (OSA). CPAP remains the gold standard to treat OSAS, but about one-quarter of the patients are poorly compliant or tolerant to the mask. The aim of the study was to evaluate the safety and efficacy of targetted neurostimulation of the hypoglossal nerve (THN Sleep Therapy) in CPAP non-compliant subjects using the aura6000™ System from ImThera Medical Inc. Method: The study was a single arm, prospective feasibility study on 13 OSA subjects. Apnea-hypopnea indices (AHI) were measured at 3 and 12 months. A multi-contact cuff electrode was implanted unilaterally on the proximal hypoglossal nerve and an implantable pulse generator placed subcutaneously in the ipsilateral upper chest wall. Results: Significant improvement was found in the apnea hypopnea index: baseline 45.2 ± 17.8, 3 months 21.7 ± 19.9, and 12 months 21.0 ± 16.5 calculated for the 13 patients. Ten patients were classified as responders (76.92%) with a 65.55% improvement in the AHI at 3 months and 68.19% at 12 months and with a 67.09% improvement in the ODI at 3 months and 66.23% at 12 months. Conclusion: THN Sleep Therapy™ proved to be a feasible and effective procedure for the treatment of the moderate to severe CPAP noncompliant OSA subjects.

Continuous positive airway pressure (CPAP) is an effective but cumbersome treatment for obstructive sleep apnoea (OSA). Noncompliant patients need alternative therapies. We studied a tongue neurostimulation approach: targeted hypoglossal neurostimulation (THN) therapy with the aura6000™ System. A multi-contact electrode positioned around the main trunk of the twelfth nerve connected to an implanted pulse generator stimulates segments of the nerve, activating dilator muscles. The primary objective was to improve the polysomnographically determined apnoea/hypopnoea index (AHI) at 3 months, and maintain the improvement after 12 months of treatment. 13 out of 14 operated patients were successfully implanted. At 12 months, the AHI decreased from 45±18 to 21±17, a 53% reduction (p