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Although regular physical activity improves obstructive sleep apnea (OSA) in the general population, this finding has not been assessed in postmyocardial infarction (MI) patients in a rehabilitation setting (coronary artery disease, CAD). We aimed to determine whether cardiac rehabilitation may benefit post-MI patients in terms of OSA disease and associated autonomic nervous system (ANS) activity.Consecutive post-MI patients participating in the ambulatory cardiac rehabilitation program of St-Etienne University Hospital were included in this study. The apnea-hypopnea index calculated from electrocardiogram (ECG)-derived respiration (AHIEDR) was obtained through nocturnal Holter ECG recordings. According to AHIEDR, patients were classified as normal, mild, moderate, or severe OSA (5, 5-14, 15-29, ≥ 30, respectively). Physiological performance (peak VO2) was established via cardiopulmonary exercise testing. ANS activity was evaluated through spontaneous baroreflex sensibility as well as heart rate variability analysis.Of the 105 patients with CAD and OSA included (95 men, 55.2 ± 12.4 years), 100 had at least 1 cardiovascular risk factor (98%) and 52 patients (50%) had an ANS dysfunction. Surprisingly, 68 of these patients with OSA (65%) were free of classical diurnal symptoms usually associated with sleep apnea. In response to cardiac rehabilitation, AHIEDR decreased significantly (-9.3 ± 9.5,Severe OSA in patients with CAD is significantly improved after 2 months of cardiopulmonary rehabilitation. Reviving ANS activity through physical activity might be a target for complementary therapy of OSA in patients with CAD.

Objectives The aim of this study was to determine whether cognitive reserve in the elderly affects the evolution of cognitive performance and what its relationship is with active lifestyles in later life. Methods Cognitive performance was evaluated at baseline and 8 years later in 543 participants of the PROOF cohort, initially aged 67 years. Subjects were categorized as Cognitively Elite (CE), Cognitively Normal (CN) or Cognitively Impaired (CI) at each evaluation. At follow-up, demographic data and lifestyle, including social, intellectual and physical behaviors, were collected by questionnaires. Results As much as 69% (n = 375) remained unchanged, while 25.5% (n = 138) decreased and 5.5% (n = 30) improved. When present, the reduction in cognitive status was most often limited to one level, but was dependent on the initial level, affecting up to 73% of the initially CN, but only 58% of the initially CE. Cognitive stability was significantly associated with the degree of social engagement at follow-up (CE: P = 0.009; CN: P = 0.025). Conclusion In the healthy elderly, high cognitive ability predicts both cognitive ability and social involvement in later life. Cognitive decline by only one level may also extend the time to reach impairment, underlining the importance of the so-called cognitive reserve.

BACKGROUND AND OBJECTIVE Clinical and epidemiological cohort studies have shown that obstructive sleep apnoea (OSA) is a common but largely undiagnosed disorder in senior subjects, where progressive deterioration of the pathology would be expected as a consequence of the ageing processes. Our study examines the longitudinal progression of OSA over a 7-year period in a community-based sample of healthy subjects. METHODS The sample consisted of 284 volunteers, aged >65 years (52% women, 48% men) accepting clinical and instrumental follow-up at 7 years. OSA was defined as an apnoea-hypopnoea index (AHI) of ≥15. RESULTS Between evaluations in the total sample, AHI slightly decreased from 17.8 ± 14 to 16.7 ± 11 with a decrease affecting more the hypopnoea index (P

Recent studies have suggested that restless legs syndrome is associated with an increased prevalence of cardiovascular diseases mediated by sympathetic activation occurring during periodic limb movements. The aim of this study was to establish which factors affect the degree of sympathetic activation during the basal condition and during periodic limb movements that may contribute to increased vascular risk. Fifty untreated restless legs syndrome patients aged 62.6 &plusmn, 11.1 y, free of cardiovascular diseases, were examined. Heart rate variability was calculated during wakefulness and all sleep stages, during periods with and without periodic limb movements. Heart rate changes before and after periodic limb movement onset were analyzed to assess the arousal response to periodic limb movements. Both analyses took into account the effects of age, gender, periodic limb movement duration, periodic limb movement index, periodic limb movement interval and periodicity, and magnitude of muscular activity (electromyogram power). Compared to periods without periodic limb movements, a significant increase in sympathetic activity occurred in periods with periodic limb movements, independent of age, sex and periodic limb movement characteristics. Data obtained from the cardiac arousal response to periodic limb movements showed that electromyogram power is the factor affecting sympathetic tonus. These results suggest that other factors, such as electromyogram power and individual susceptibility, should be considered in the assessment of the vascular risk related to restless legs syndrome.

Rationale: Patients with obstructive sleep apnea (OSA) experience respiratory events with greater frequency and severity while in the supine sleeping position. Postural preference (associated with the sleep monitoring device) and “first night effect” could explain a night-to-night variability in OSA severity.Objectives: We evaluated the variability of internight polysomnography (PSG) in a large group of OSA patients and explored factors explaining this variability.Methods: 188 patients referred for probable OSA (aged 54.9 ± 11.8 y) underwent two consecutive nights of at-home PSG. The effect of age, gender, obesity, neck circumference, sleep position and sleep parameters were considered to explain changes in respiratory parameters.Main Results: The mean apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) were respectively, 36.3 ± 27.5 and 22.0 ± 22.7 in the first night, with a tendency to decrease during the second night. While in mild cases (5 ≤ AHI < 15) there was a significant increase in AHI related to an increase in dorsal position time during the second night, there were no changes in moderate cases (15 ≤ AHI < 30); and in severe cases (AHI ≥ 30) there was a significant decrease in both AHI and ODI during the second night independent of sleep position.Conclusion: The internight variability in AHI and ODI was related to changes in sleep structure with a contribution of indices of sleep fragmentation and dorsal position. Since the changes were greater in mild OSA cases, a second night could be routinely proposed in cases with relevant clinical uncertainty.

Autonomic nervous system dysfunction has been described in narcolepsy with cataplexy affecting sympathetic functions. In this study we analyzed whether altered diurnal and nocturnal cardiovascular control is present in idiopathic hypersomnia (IH).Fourteen drug-free patients aged 26.2 ± 7 years and 14 age-matched controls were examined. Clinical data, 24-h polysomnography, heart rate (HR) variability, and the HR response to spontaneous arousal were available.Sleep macrostructure was comparable between controls and patients, with the latter having significantly longer sleep time, a higher number of sleep cycles (p 0.0001), and low sleep efficiency (p 0.01). The HR variability indices did not differ between groups, except for the rise of high frequency (HF) and HFnu in patients (p 0.05) associated with blunted sympathetic indices (p 0.01). These parasympathetic alterations were present for light, slow wave, and rapid eye-movement sleep and persisted for all sleep cycles. Compared to controls, the HR arousal response was significantly higher (p 0.01) in patients starting before the arousal onset and persisting into the post-arousal period.In IH patients a dysfunction of the parasympathetic activity during awake and sleep and an altered autonomic response to arousals are present. These findings suggest an impaired parasympathetic function that may explain some vegetative symptoms present in this type of central hypersomnia.

Obstructive sleep apnoea (OSA) is associated with a rise in cardiovascular risk in which increased sympathetic activity and depressed baroreceptor reflex sensitivity (BRS) have been proposed. We examined this association in a sample of healthy elderly subjects with unrecognised OSA. 801 healthy elderly (aged ≥65 years) subjects undergoing clinical, respiratory polygraphy and vascular assessment were examined. According to the apnoea–hypopnoea index (AHI), the subjects were stratified into no OSA, mild–moderate OSA and severe OSA cases. OSA was present in 62% of the sample, 62% being mild–moderate and 38% severe. No differences were found for BRS value according to sex and OSA severity. 54% of the group had normal BRS value, 36% mild impairment and 10% severe dysfunction. BRS was negatively associated with body mass index (p=0.006), 24-h systolic (p=0.001) and diastolic pressure (p=0.001), and oxygen desaturation index (ODI) (p=0.03). Regression analyses revealed that subjects with lower BRS were those with hypertension (OR 0.41, 95% CI 0.24–0.81; p=0.002) and overweight (OR 0.42, 95% CI 0.25–0.81; p=0.008), without the effect of AHI and ODI. In the healthy elderly, the presence of a severe BRS dysfunction affects a small amount of severe cases without effect on snorers and mild OSA. Hypertension and obesity seem to play a great role in BRS impairment., In the healthy elderly with unrecognised OSA, the risk of blunted baroreceptor sensitivity was low http://ow.ly/kofu302IZWS

Objective Several studies suggest a relationship between bone mineral density (BMD) anthropometric and metabolic variables, and obstructive sleep apnea (OSA); all of these factors have an effect on osteoporosis (OS) risk. This cross-sectional study explores these associations in a large sample of older subjects with and without OSA. Methods Volunteers were recruited from the PROgnostic indicator OF cardiovascular and cerebrovascular events survey. A total of 461 subjects, aged 68.7 ± 0.8 years, were examined, blood samples were taken, and they were subjected to home polygraphy, assessment of daily energy expenditure (DEE), and dual-energy X-ray absorptiometry. Results Osteopenia (OP) was detected in 44% of subjects at the femoral and 39% at the vertebral level, while the prevalence of OS was lower at the femoral (4%) and vertebral (12%) levels. As expected, women had a higher prevalence of OP and OS. Subjects with OP and OS had a tendency to have lower DEE and values of obesity, apnea–hypopnea index (AHI), and indices of hypoxemia (ODI). At the correlation analyses, anthropometric factors and DEE were significantly related to BMD with a slight effect of indices of OSA severity. After adjustment for confounding variables, univariate and multivariate regression analyses showed a strong significant association between femoral and lumbar BMD and T-score and DEE without contribution of metabolic data and with a slight negative effect of respiratory factors. Conclusions In this sample of the elderly, physical activity was the best predictor of OS with a slight effect of body mass index. The indices of OSA confirm their protective effect on bone mineral density.

Obstructive sleep apnea (OSA) is a prevalent sleep disorder considered as an independent risk factor for cardiovascular consequences, such as systemic arterial hypertension, ischemic heart disease, cardiac arrhythmias, metabolic disorders, and cognitive dysfunction. The pathogenesis of OSA-related consequence is assumed to be chronic intermittent hypoxia (IH) inducing alterations at the molecular level, oxidative stress, persistent systemic inflammation, oxygen sensor activation, and increase of sympathetic activity. Overall, these mechanisms have an effect on vessel permeability and are considered to be important factors for explaining vascular, metabolic, and cognitive OSA-related consequences. The present review attempts to examine together the research paradigms and clinical studies on the effect of acute and chronic IH and the potential link with OSA. We firstly describe the literature data on the mechanisms activated by acute and chronic IH at the experimental level, which are very helpful and beneficial to explaining OSA consequences. Then, we describe in detail the effect of IH in patients with OSA that we can consider “the human model” of chronic IH. In this way, we can better understand the specific pathophysiological mechanisms proposed to explain the consequences of IH in OSA.

Idiopathic hypersomnia (IH) is a rare central hypersomnia of unknown physiopathology. In this study, we determine if the presence of infectious mononucleosis evaluated by serological markers of Epstein Barr virus infection plays a role in this hypersomnia. Ten patients with a suspicion of IH underwent to clinical assessment, 24 h polysomnography, and serologic testing for mononucleosis including Viral Capside Antigen (VCA) IgG, the VCA IgM, and the EBV nuclear antigen (EBNA). None of the patients reported neurological inflammatory disease and viral infection prior the onset of the disease. Compared to the laboratory serological reference values, all patients had high levels of VCA IgG and EBNA with lower level of VCA IgM, overall indicating past infection. This study shows that prior infectious mononucleosis may predispose some subjects to idiopathic hypersomnia suggesting the role of inflammatory and immunological processes in this sleep disorder.

Objective Obesity and aging are considered risk factors for developing sleep apnea syndrome (OSA). The aim of this study was to determine the association between body fat composition and OSA in healthy elderly subjects examined in a 7-year longitudinal study. Methods A total of 209 elderly with unrecognized OSA aged 68.3 ± 0.8 years underwent a clinical, ambulatory nocturnal respiratory recording, and anthropometric as well as body fat composition assessment by dual-energy X-ray absorptiometry (DEXA) at baseline and follow-up. Results At study entry, 50.3% of the population showed an apnea+hypopnea index (AHI)

STUDY OBJECTIVES Sleep breathing disorder (SBD) may be an important factor in age-related cognitive decline. In a cohort of healthy elderly subjects, we performed an 8-y longitudinal study to assess whether changes in cognitive function occur in untreated elderly patients with SBD and without dementia and the factors implicated in these changes. DESIGN A population-based longitudinal study. SETTING Clinical research settings. PARTICIPANTS A total of 559 participants of the PROOF study aged 67 y at the study entry and free from neurological disorders were examined. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Abnormal breathing events were defined by an apnea-hypopnea index (AHI) > 15. The raw cognitive data and averaged Z-scores for the attentional, executive, and memory functions were collected at the baseline and follow-up. At baseline, AHI > 15 was found in 54% of subjects with 18% having an AHI > 30. At follow-up, the presence of abnormal breathing events was associated with a slight but significant decline in the attentional domain (P = 0.01), which was more evident in the subjects with an AHI > 30 (P = 0.004). No significant changes over time were observed in the executive and memory functions. Several indices of chronic hypoxemia, defined either as a cumulative peripheral oxygen saturation (SpO2) < 90% or a minimal SpO2, accounted for portions of the variance in the decline in attention. All observed effects were small, accounting for 4-7% of variance in multivariate models. CONCLUSION In healthy elderly subjects, various components of sleep breathing disorder at baseline were associated with small changes in selected cognitive functions specific to the attention domain after controlling for multiple comorbidities, such as sleepiness, hypertension, diabetes, anxiety, and depression. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifiers NCT 00759304 and NCT 00766584.

Objectives To examine whether changes in the cardiac autonomic nervous system (ANS) over time, as expressed by baroreflex sensitivity (BRS), were associated with long-term changes in cognitive performance in elderly individuals without dementia. Design Community-based 8-year longitudinal study. Setting Clinical settings. Participants Individuals aged 66.9 ± 0.9 (N = 425). Measurements At baseline and follow-up, subjects underwent a clinical interview, autonomic and vascular measurements, and a neuropsychological evaluation including attentional, executive, and memory tests using standardized Z-scores. BRS was defined as being normal, moderate, or severe alteration at each evaluation. On the basis of the longitudinal changes subjects were stratified as being stable, moderate or improved. Results Mean attentional, executive, and memory change Z-scores were −0.41 ± 0.9, −0.15 ± 0.7, and −0.14 ± 0.8, respectively. BRS of 56% of the subjects remained unchanged, of 20% decreased, and of 24% improved. After regression analysis, the worsened BRS group was 1.88 times as likely to have greater memory change as the group with stable BRS (P = .02). No significant association was found between longitudinal change in BRS and attentional and executive changes. Conclusion In healthy elderly individuals, BRS decrease was associated with a weak but significant decrease in memory function. The long-term effect of BRS on memory changes may suggest a role of the ANS in cognitive decline.

Several studies suggest in middle-aged subjects a relationship between arterial stiffness, a cardiovascular risk marker, and moderate to severe obstructive sleep apnea (OSA). No extensive data are present in older subjects. This study explores this association in a sample of healthy older subjects suffering OSA. A total of 101 volunteers aged 75.3 ± 0.7 years were examined at the hospital sleep center. Each subject was assessed for medical history, body mass index and 24-h blood pressure measures, biological blood samples, and home polygraphy in 2002–2003 (P2) as well as in 2009–2010 (P4). Arterial stiffness was also assessed using carotid-femoral and carotid-radial pulse wave velocity (cfPWV and crPWV) during P4 examination. The total group consisted of 59 women and 42 men with a mean apnea-hypopnea index (AHI) of 17.8 ± 12.1 and a mean oxygen desaturation index (ODI) of 9.8 ± 8.9. No-OSA (AHI 30) 17%. No significant differences had been founded between men and women for blood pressure, cfPWV, and crPWV. Considering the severity of the AHI, no significant differences between groups were present for PWV and blood pressure values. No difference for PWV was present for subjects with and without hypertension. No correlation was found between PWV value and AHI and ODI values at P2 or between P2 and P4 visits. cfPWV was higher in patients demonstrating incident hypertension during the follow-up. In this sample of older subjects, PWV is not affected by AHI and ODI but was associated with incident hypertension. These results may suggest potential protective and adaptive mechanisms in older sleep apnea patients. NCT 00759304 and NCT 00766584 .

Background Osteoporosis (OP) and obstructive sleep apnea (OSA) are two common serious disorders in the elderly associated. Although clinical studies suggest an association between these two diseases, their co-existence in elderly is controversial. Objectives This study explores the longitudinal changes on bone mineral density (BMD) in a large sample of older subjects with and without OSA. Methods 406 subjects, initially aged 68.8±1 y, were examined at baseline and after 7 y. At baseline they had anthropometric data, home polygraphy, assessment of daily energy expenditure, and dual-energy X-ray absorptiometry (DXA). At follow-up, clinical and DXA data were also collected. Results A significant decrease in prevalence of OP and osteopenia was present both at lumbar and femoral sites. Considering the changes in BMD and T-score according to severity of OSA, there was a significant decrease in cases with OP. After adjustment for gender, anthropometric and metabolic variables, univariate and multivariate regression analyses showed a significant association between changes of BMD and gender without contribution of metabolic and sleep related respiratory factors. Conclusions In older healthy subjects, a reduced prevalence of OP was found in a 7-y follow-up independently of the presence or not of OSA. The impact of chronic intermittent hypoxia on bone mineral loss appears quite limited in such an elderly population.

Background After 15 years of research about the link between sleep apnea and brain structure, no clear evidence can be noticed. In the same way, the influence of treatment is unclear, particularly in elderly. Aims and objectives The aim of this study is to investigate the grey matter differences related to sleep apnea and treatment in elderly subjects. Methods Twenty healthy (HC), 18 treated (TP) and 16 untreated AHI>30 (UP) subjects from the PROOF study were compared by using voxel based-morphometry. If available, the volume of the discovered clustres are calculated for further analyses. Moreover 226 subjects from the same study were evaluated based on their apnea/hypopnea index. Results We did not notice any grey matter difference between HC and UP or between HC and TP. However we observed a higher volume of GM in TP compared to UP in cerebellum ([38 -50 -38], 121 voxels, pFWE(peak)=0.03, pFWE(cluster)=0.02) (Figure 1). When extracted, the volume of this cluster is different between HC and TP (p=0.005), between HC and UP (p=0.036) and between TP and UP (p Conclusions Our study confirm that grey matter decrease in sleep apnea is limited in elderly. The role of cerebellum is unclear, even though some studies observed a similar reduction in apneic subjects. Moreover, in this elderly population, we did not observe any grey matter difference in the hippocampus which is sometimes supposed to be involved in sleep apnea.

Introduction Obstructive sleep apnea (OSA), highly prevalent in the general population, determines a sharp increased in cardiovascular morbi-mortality. While CPAP remains the gold standard treatment, long-term compliance is poor. Aim To evaluate the benefits of a 9-month supervised physical activity program (NeuroGyV program, FFEPGV) on moderate OSA. Method From a group of 63 patients aged 40-80 years with moderate OSA (15≤Apnea Hypopnea Index (AHI)≤30), 30 were randomized in an exercise group including 3x1 hour of physical activity per week (nordic walking, aquagym and gymnastic at their metabolic threshold); 33 participants included in a control group received standard diet and physical activity advices. OSA severity was assessed with ambulatory polygraphy, and a metabolic exercise stress test was systematically performed, before and after 9 months of study. Results At follow-up, exercise group shows a significant 21.6% AHI reduction (from 21.3±5.1 to 16.7±7.5; p max (r= -0.36; p Conclusion Community supervised regular physical activity is effective, reducing significantly AHI, and could thus be considered as an effective treatment in moderate OSA.

Objectives Dyslipidemia, sleep-disordered breathing (SDB) and hypertension are comorbid factors evidenced in adults, but poorly studied in old people. This study aimed to examine the long-term evolution of the serum lipid profile, and its relationships with SDB and blood pressure (BP) in the elderly. Methods A ten-year follow-up of the prospective Prognostic Indicator of Cardiovascular and Cerebrovascular Events (PROOF) and the Autonomic Nervous System Activity, Aging and Sleep Apnea/Hypopnea (SYNAPSE) cohort, which initially included 1011 elderly subjects from the general population, and who were untreated by continuous positive airway pressure (CPAP). Serum lipid profile, respiratory polygraphy for SDB and ambulatory blood pressure monitoring were performed. Results A total of 266 subjects (male/female 150/116; age 66.2 ± 0.8 years) were reassessed after 9.6 ± 0.7 years (age 75.8 ± 1.2 years). The prevalence of high-risk dyslipidemia decreased from 61.3 to 44.4%, and hypertension from 57.9 to 27.4%. The nocturnal oxygen desaturation index increased (mean + 2.3 ± 6.7 events/hour; p 2 and minimal SaO 2 decreased. These variations (Δ) of oxygen desaturation worsened whether or not elderly subjects took anti-hypertensive and lipid-lowering treatments, and were not associated with serum lipid variations. The decrease in diurnal diastolic BP was independently associated with aging, and with the lowering of the waist/hip ratio (ΔW/H) and low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio, while the decrease in diurnal systolic BP only depended on aging and ΔW/H. Conclusions The results suggested that the observed worsening of nocturnal oxygen desaturation after 10 years in the elderly was independent of the change in circulating lipids, and not influenced by lipid-lowering treatments. However, the variation in blood pressure remained associated with aging, waist/hip and LDL-C/HDL-C ratios. Trial registry : NCT00759304 and NCT00766584 at clinicaltrials.gov .

Sleep duration and sleep quality play important roles in the development of hypertension (HT) in middle-aged subjects, with controversial data in elderly. In this study, we investigated the link between HT and self-reported sleep in non-insomniac elderly subjects.We examined 500 participants without insomnia complaints aged 72 ± 1 years. An extensive instrumental evaluation was carried out, including 24-h blood pressure (BP) monitoring and an assessment of nocturnal BP dipping. Sleep duration and quality were evaluated by the Pittsburgh Sleep Quality Index (PSQI). The subjects were stratified into three groups according to sleep duration: short (6 h), normal (6h to8 h), and long (8 h) sleepers. A PSQI5 defined good sleepers (GS, n = 252), and a PSQI5 (n = 248) defined poor sleepers (PS).PS represented 50% of the subjects, more frequently females. Compared to GS, PS did not differ in terms of HT, BP, baroreflex sensitivity (BRS), and BP dipping. Short, normal, and long sleepers accounted for 28%, 42%, and 30% of subjects, with HT, BP values, BRS, and gender not differing between groups. No relationship was found between nocturnal BP values and self-reported sleep measures. Logistic regression analysis indicated that neither sleep duration nor sleep quality predicts the prevalence of HT, the body mass index being the only factor affecting this association.ClinicalTrials.gov identifiers NCT00759304 and NCT00766584.In a sample of non-insomniac elderly subjects, neither sleep duration nor sleep quality affected the prevalence of HT. These data argue against a relationship between self-reported sleep duration and quality and HT in elderly without insomnia.

Objectif Le but de cette etude etait d’etablir quels facteurs influent le degre d’activation sympathique pendant l’etat basal sans mouvements et pendant les mouvements periodiques des membres inferieurs (MPMI) pouvant contribuer a l’augmentation du risque cardio-vasculaire. Methodes Cinquante patients non traites porteurs du syndrome âges de 62,6 ± 11,1 ans, exempts de maladies cardio-vasculaires, ont ete examines. La variabilite de la frequence cardiaque a ete calculee en veille et durant tous les stades du sommeil pendant les periodes avec et sans mouvements periodiques des membres. Les changements de frequence cardiaque avant et apres le debut des mouvements periodiques ont ete analyses afin d’evaluer la reponse d’eveil aux mouvements periodiques. Les deux analyses ont ete effectuees en tenant compte de l’effet de l’âge, du sexe, de la duree des mouvements, de l’indice de mouvement, de l’intervalle et de la periodicite des mouvements. Resultats Par rapport aux periodes sans MPMI, une augmentation significative de l’activite sympathique se produit pendant les periodes de MPMI, independamment de l’âge et du sexe. Les donnees obtenues a partir de la reponse en variabilite cardiaque lors des MPMI ont montre que la puissance spectrale de l’electromyogramme est le facteur affectant le plus le tonus sympathique cardiaque. Conclusion Ces resultats suggerent que d’autres facteurs, tels que la puissance spectrale de l’electromyogramme, devraient etre pris en compte dans l’evaluation du risque cardio-vasculaire du syndrome de MPMI.

Theprevalenceofsleep-disorderedbreathing(SDB)inchronicheartfailure (CHF) patients exceeds 60%, including both central sleep apnea(CSA)andobstructivesleepapnea(OSA)[1].Asobservedinthegeneralpopulation, SDB in CHF patients is associated with a poor prognosis [2]and a higher risk of nocturnal arrhythmia [3]. Continuous positiveairway pressure or adaptive servo-ventilation treatments might im-provebothLVEFandmortalityandreducetheriskofarrhythmicevents,but this remains debatable [4]. Nevertheless, at least 75% of severe SDBcasesremainundiagnosedanduntreatedduetotheabsenceofdaytimesymptoms, waiting lists in sleep laboratories, and diagnostic costs. Thehigh SDB prevalence in patients referred for cardiologic assessmentcalls for the development of automated screening tools based on ECG-derived parameters for use by cardiologists in routine practice.MethodsbasedonheartratevariabilityanalysisallowdetectingSDBpatients whopresentsinusal rhythm[5] butare not suitable for cardiacfailureordysautonomicpopulations,whofrequentlyexhibitprematureatrial or ventricular beat, are frequently implanted with permanentpacemakers, or present recurrent atrial fibrillation, bundle branchblocks, or flat heart rate variability [6]. ECG-derived respiration (EDR),a method based on the reconstruction of thoracic signals by analysingchangesinECGmorphologythatareinducedbyrespiratorymovements[7], is a promisingalternative,but has not yet been evaluatedincardiacpopulations [8].Werecruited105patientswithLVEFb45%andNYHAclass≥2fromroutine medical follow-ups of stable CHF patients (Saint-Etienne andGrenoble University Hospitals) to test an automated EDR method withreference to visually scored nocturnal in-home ventilatory polygraphy.This study (clinical trial NCT02116686) complies with the DeclarationofHelsinkiandwasapprovedbythelocalethicscommittee.Allpatientsgave their written informed consent to participate.Standard nocturnal in-home ventilatory polygraphy was performedusinganEmbladevice(Embla®,Broomfield,USA)andscoredaccordingto AASM recommendations using RemLogic® software. Based onpreviously published methods [7,9,10] and developed with Matlab®(Mathworks,Natick,USA),anEDRmethodwasusedasfollows:thoracicmovements derived from ECG signals were analysed in order toreconstruct respiratory movements. The two mechanisms involved,changesintheelectricalheartaxisandchangesintransthoracicimped-ance,areeasilyobservedintheQRSheightorarea,allowingreconstruc-tion of the thoracic signal, which is then used to score apnea andhypopnea events [7]. Analyses were performed on the portion of thepolygraphic ECG signal recorded when the light was turned off. TheECG baseline was removed, each R-peak was detected, and R-peakoutliers were excluded. The EDR signal was then calculated as thesuccessive surfaces of each QRS complex under the R-peak. An SDBevent was then scored when the algorithm detected either a 50%decrease in thepeak-to-peak EDR amplitudefor 10 s [9] or an invertedU-shape of the EDR trace corresponding to a baseline drift due torespiratory effort during obstruction [10].ECG results were subjected to automated analysis only, and poly-graph recordings were scored manually and blinded to EDR results. Uni-variate regression analysis for continuous variables and Bland–Altmanplot were used to assess the relationship between the polygraphicapnea/hypopnea index (AHI

To assess the role of the cardiac autonomic nervous system (ANS), as measured according to spontaneous cardiac baroreflex sensitivity (BRS), in the type and degree of cognitive performance in healthy young-elderly individuals, taking into account the presence of other vascular risk factors.Community-based cross-sectional study.In-home and clinical settings.A subset of participants, aged 66.9±0.9, from a prospective study that aimed to assess the influence of ANS activity on cardiovascular and cerebrovascular morbidity and mortality (N=916).All subjects underwent a clinical interview, neuropsychological testing, and autonomic and vascular measurements. Three cognitive domains were defined: attentional (Trail-Making Test Part A, Stroop code and parts III), executive (Trail-Making Test Part B, Stroop part III, verbal fluency and similarity tests), and memory (Benton visual retention test, Grober and Buschké procedure). Subjects were stratified according to their scores into normal, low, and impaired performers.After adjustments to demographic and vascular data, participants with moderate autonomic dysregulation (3BRS≤6) were determined to be 1.82 times as likely to have memory impairment (odds ratio (OR)=1.82, 95% confidence interval (CI)=1.13-3.17, P=.02) and those with severe autonomic dysregulation (BRS≤3) to be 2.65 as likely (OR=2.65, 95% CI=1.40-5.59, P=.006) as participants with normal BRS (6).In older individuals without dementia, autonomic dysregulation seems to have a direct, gradual, and independent effect on memory. Future studies are needed to evaluate the long-term effects of BRS and other markers of the ANS on cognitive decline.

STUDY OBJECTIVES Chronic intermittent hypoxia (IH) acts as a stimulator of mesenchymal stem cell (MSC) mobilization, intensifying osteoblast formation in animal models. The recurrence of apnea and oxygen desaturation in obstructive sleep apnea (OSA) may mimic experimental models of IH. We hypothesized that in elderly with OSA, apnea-related IH may mobilize MSCs and thereby prevent the age-related decline in osteogenesis. This study explored the relationship between OSA and bone mineral density (BMD), and the effect of IH on BMD, in a large sample of elderly subjects. PARTICIPANTS There were 833 volunteers age 68.6 ± 0.8 y (59% women). INTERVENTION Each participant underwent evaluation of BMD at lumbar spine and femoral sites by dual-energy x-ray absorptiometry (DEXA) as well as clinical and polygraphic examinations. OSA was diagnosed on the basis of an apnea-hypopnea index (AHI) ≥ 15. MEASUREMENTS AND RESULTS There were 55% of the participants who presented with OSA, and these subjects were predominantly male and overweight. Compared with subjects without OSA, those with OSA had a higher femoral and spinal BMD (P < 0.001). Body mass index (BMI), AHI, and oxygen desaturation index (ODI) (P < 0.01) were significantly related to BMD. After adjustment for sex, BMI, metabolic values, and hypertension, multiple regression analysis showed a significant association between femoral and lumbar T scores and both daily energy expenditure (P < 0.001) and ODI (P = 0.007). CONCLUSIONS In elderly subjects, the presence of obstructive sleep apnea is associated with higher bone mineral density, with oxygen desaturation index being a significant determinant of bone metabolism. These results suggest that apnea-related intermittent hypoxia may stimulate the bone remodeling process in older population. CLINICAL TRIAL REGISTRATION NCT 00759304 and NCT 00766584.

Clinical and epidemiological studies suggest a relation between bone mineral density (BMD) and self-assessment of sleep with an effect on bone formation and osteoporosis (OS) risk in short and long sleepers. This study explores this association in a large sample of older subjects.We examined 500 participants without insomnia complaints aged 65.7 ± 0.8 y. Each participant had a full evaluation including anthropometric measurement, clinical examination and measurements of BMD at the lumbar spine and femoral sites by dual-energy X-ray absorptiometry. The daily energy expenditure (DEE) was measured by the Population Physical Activity Questionnaire. Sleep duration and quality were evaluated by the Pittsburgh Sleep Quality Index. The subjects were stratified into three groups according to sleep duration, i.e., short (6 h), normal (6-8 h), and long (≥ 8 h) sleepers.Osteopenia was found in 40% of the subjects at the femoral level and 43% at the vertebral level. The prevalence of OS was lower both at femoral (8%) and vertebral (12%) levels. Short, normal, and long sleepers accounted for 29%, 40%, and 31% of subjects, respectively. After adjustments for metabolic, anthropometric, and DEE, multinomial logistic regression analysis indicated that long sleepers were more likely to have femoral neck OS with a slight effect of DEE at vertebral spine.In a sample of older subjects, self-reported long sleep was the best predictor of OS risk at the femoral level. This finding suggests an association between OS and self-reported sleep duration in older subjects.NCT 00759304 and NCT 00766584.

Clinical and epidemiological cohort studies have shown that obstructive sleep apnoea (OSA) is a common but largely undiagnosed disorder in senior subjects, where progressive deterioration of the pathology would be expected as a consequence of the ageing processes. Our study examines the longitudinal progression of OSA over a 7-year period in a community-based sample of healthy subjects.The sample consisted of 284 volunteers, aged65 years (52% women, 48% men) accepting clinical and instrumental follow-up at 7 years. OSA was defined as an apnoea-hypopnoea index (AHI) of ≥15.Between evaluations in the total sample, AHI slightly decreased from 17.8 ± 14 to 16.7 ± 11 with a decrease affecting more the hypopnoea index (P 0.001) and associated with significant changes (P 0.001) in all indices of hypoxaemia. While in the non-OSA group there was a slight but significant increase of AHI, a significant AHI decrease was noted in mild-moderate patients (P 0.01) and a significant rise of nocturnal hypoxaemia in severe OSA patients (P 0.001). The AHI decrease was not associated with clinical, weight, metabolic and blood pressure changes between the two evaluations; the baseline AHI value being the only factor correlated to the degree of AHI decline.In elderlies, the severity and prevalence of OSA decrease progressively with ageing without effect of factors commonly influencing OSA severity. This trend may support the hypothesis that in healthy elderly, OSA is a phenomenon related to ageing.

Lennox-Gastaut syndrome (LGS) is characterized by interictal epileptiform discharges (IEDs) occurring during sleep. The aim of this study was to determine whether sleep influences not only the frequency of seizures and IEDs, but also the time-dependent evolution that may support the hypothesis of homeostatic influences on epileptic threshold. Video polysomnography data from our database were reviewed to identify adult LGS patients with at least seven hours of nocturnal recording. Thirteen patients were identified and a second polysomnography was available for nine. The number, duration and index of IEDs, relative to total sleep, sleep stages, and time during the night, were calculated. The majority of IEDs occurred during non-rapid eye movement sleep, mainly in stage 2 and slow-wave sleep. Adjusting for time spent in each sleep stage, we found 45 IEDs/hour in stage 1, 123/hour in stage 2, 106/hour in slow-wave sleep, and 26/hour in rapid eye movement sleep. The temporal distribution of IEDs showed a significant rise in the first three hours of sleep, followed by a progressive decrease at the end of the night (F=85.6; p

Some epidemiological data are available on the association between sleep duration and sleep quality, sleep complaints, and the aging related cognitive impairment in the elderly. In this study we examined a large sample of healthy elderly subjects to assess the relationship between sleep quality, subjective cognitive complaints, and neuropsychological performance.A total of 272 elderly subjects (mean age 74.8 ± 1.1 years) were recruited from a population-based cross-sectional study on aging and cardiovascular morbidity. All subjects filled in self-assessment questionnaires evaluating cognitive function, anxiety, depression, sleep-related parameters, and the Pittsburgh Sleep Quality Index (PSQI). Ambulatory polygraphy and extensive neuropsychological tests were also performed. Based on the total PSQI score, subjects were classified as good sleepers (GS, PSQI5, n=116) and poor sleepers (PS, PSQI≥5, n=156).Poor sleep did not affect the subjective cognitive function score, subjective cognitive impairment being mainly related to anxiety, depression, and sleep medication intake. No significant differences were seen between GS and PS in any of the objective cognitive function tests except for the Trail Making Test A (TMA-A), processing speed being longer in the PS group (p0.001). Neither the presence of sleep-related breathing disorders nor gender affected cognitive performance.Our results suggest that in healthy elderly subjects, subjective sleep quality and duration did not significantly affect subjective and objective cognitive performances, except the attention level, for that the interference of sleep medication should be considered.

Limited and controversial data exist on the natural evolution of sleep disordered breathing (SDB) in untreated individuals. This study examines the evolution of SDB over a 3-yr period in a community-based sample of elderly subjects. From the initial cohort of 854 healthy subjects aged mean ± SD 68.4 ± 0.8 yrs, 519 untreated subjects accepted clinical and instrumental follow-up 3.6 ± 1.6 yrs later. SDB was defined as a respiratory disturbance index (RDI) >15 events · h(-1). At baseline, 202 (39%) subjects had an RDI ≤ 15 events · h(-1) and 317 (61%) had an RDI >15 events · h(-1). 3 yrs later, 280 (54%) subjects were non-SDB and 239 (46%) had SDB. Between evaluations, the RDI decreased from 22.3 ± 16.2 to 16.4 ± 13.0 events · h(-1), with a greater decrease in the number of cases with an RDI >30 events · h(-1) that in those with RDI ≥ 30 events · h(-1). In the non-SDB group, 81% had a stable RDI and 19% increased their RDI by a mean of 13.7 events · h(-1). In the SDB group, the RDI decreased to values ≤ 15 events · h(-1) in 36.6% of cases, 63.4% still having SDB. The RDI changes did not depend on weight changes. In healthy elderly subjects, the prevalence and severity of SDB did not show a tendency toward natural worsening, some cases having improvement or a remission independent of weight changes. These findings also suggest that in the elderly, natural SDB progression is still hypothetical.

Sympathetic "overactivity" during night is a well recognized factor of hypertension development in adults. However, the deleterious effect of nocturnal autonomic activation in elderly remains controversial.Subjects, all aged 65 years at baseline, were selected from the PROOF cohort study, a prospective observational cohort of subjects. Exclusion criteria were previous myocardial infarction, stroke, heart failure, type-1 diabetes, atrial fibrillation or anti-arrhythmic drug. Normotensive subjects were selected according to: 24-h ambulatory blood pressure (BP) measurements135/85 mm Hg, absence of self-report antihypertensive treatment. Autonomic activation during sleep was evaluated from night-time ECG Holter recording. According the %VLFI (Very-Low Frequency component of Interbeat Interval Increment evaluated from heart rate variability analysis). Subjects with new-onset ambulatory hypertension were identified after two years when daytime ambulatory blood pressure was higher than 135/85 mm Hg or when they used an antihypertensive treatment.Among 428 normotensive subjects at inclusion, 62 (14.5%) were considered as hypertensives after two years. Univariate logistic regression model showed a significant association between abnormal %VLFI (4%) and new-onset hypertension: OR = 1.78 (1.03-3.07). Male gender, increased body mass index and ambulatory systolic BP were also associated with increased risk of hypertension. After adjustment in the stepwise logistic regression, abnormal %VLFI was associated with an 82% increase in odds of new-onset hypertension, independently of systolic ABPM and body mass index.Repeated autonomic activation during sleep, whatever the origin of the phenomenon, may trigger hypertension development in the elderly.

Restless genital syndrome refers to excessive and persistent sensations of genital and clitoral arousal with the absence of conscious feeling of sexual desire. These sensations have been linked to symptoms of restless legs syndrome (RLS) or an overactive bladder. Restless genital syndrome may be related to small fiber sensory neuropathy of the dorsal nerve of the clitoris, so it more frequently occurs in women. The association with RLS suggests a possible dopaminergic mechanism. We report a case of a 74-year-old woman who presented restless genital symptoms every night in association with RLS symptoms. During polysomnography she reported 3 awakenings from rapid eye movement sleep with associated genital symptoms followed by a period of insomnia with RLS symptoms and sexual activity. The frequency and the intensity of the symptoms were responsive to treatment by pramipexole after 1 week of treatment and the efficacy was maintained at follow-up.

Objectif Une dysfonction du systeme nerveux autonome affectant le systeme nerveux orthosympathique a ete decrite dans la narcolepsie avec cataplexie. Nous avons etudie si une alteration du controle cardiovasculaire nocturne et diurne etait presente dans l’hypersomnie idiopathique. Methodes Quatorze sujets âges de 26,2 ± 7 ans ne recevant aucun traitement et quatorze sujets apparies pour l’âge ont ete etudies. Les donnees cliniques, une polysomnographie de 24 h, les indices de variabilite de frequence cardiaque et la reactivite cardiaque en reponse aux micro-eveils spontanes ont ete analyses. Resultats La macrostructure du sommeil etait comparable dans les deux groupes, avec une duree de sommeil plus importante (p Conclusion Ces resultats suggerent une dysfonction du systeme parasympathique qui pourrait expliquer certains symptomes vegetatifs presents dans ce type d’hypersomnie centrale.

Objectif Les troubles respiratoires du sommeil (TRS) et les dyslipidemies aggravent l’hypertension chez l’adulte, mais leur impact reste a demontrer chez le sujet âge. L’objectif est d’etudier l’evolution a long terme du profil lipidique, des TRS et du profil tensionnel chez le sujet âge. Methodes Etude prospective sur 10 ans de la cohorte PROOF-SYNAPSE incluant initialement 1011 sujets âges issus de la population generale, non traites par PPC. Les parametres mesures : bilan lipidique serique, polygraphie du sommeil et MAPA. Resultats Au total, 266 sujets (H/F = 150/116 ; âge initial 66,2 ± 0,8 ans) ont ete reevalues apres 9,6 ± 0,7 ans (âge 75,8 ± 1,2 ans). A l’issue de cette periode, la prevalence des dyslipidemies a diminue de 12,8 a 6,4 % ( p = 0,004), et celle de l’hypertension de 57,9 a 27,4 % ( p 2 min –1,4 ± 4,4 % ; SaO 2 moy –0,7 ± 2,0 % ; p p = 0,011), de la PAD-24 h ( p = 0,041) et diurne ( p = 0,021). La ΔLDL etait independamment associee au traitement anti-dyslipidemiant ( p = 0,005) et a la ΔPAD-diurne ( p = 0,048). Conclusion Ces resultats suggerent qu’il n’y a pas, chez le sujet âge, de liens entre l’evolution des troubles respiratoires du sommeil et du profil lipidique, mais que l’impact et le controle du LDL sur la pression arterielle demeure.

Objectif Il est etabli que les pathologies respiratoires du sommeil (PRDS) sont a l’origine d’accidents vasculaires cerebraux severes. La mise au point de methodes diagnostiques en e-sante permettrait de detecter ces PRDS avant la survenue des graves complications. Dans cette perspective nous voulons valider la mesure des apnees a partir d’un simple electrocardiogramme nocturne. Methodes Nous avons compare deux methodes de diagnostic des PRDS basees sur des enregistrements classiquement utilises en ambulatoire. La population etait composee de 1046 patients hospitalises a l’UNV du CHU de Saint-Etienne pour un AVC. La methode classique consistait en la mesure de l’oxymetrie arterielle et du flux ventilatoire (AHI) par le Holter Vista O2 (oxymetrie et impedance thoracique). La nouvelle mesure evaluee consistait en une methode de diagnostic originale basee sur l’analyse de la morphologie de l’ECG enregistre simultanement : Electrocardiogram Derived Respiration (EDR). Resultats Les PRDS etaient tres frequentes dans cette population, atteignant 73,3 % des patients avec un seuil d’AHI a 15. La correlation entre l’AHI et l’EDR etait tres significative avec un p inferieur a 0,0001 mais presentait un R2 limite a 0,28. Il en est de meme pour la correlation entre EDR et des evenements hypoxiques. Conclusion Nous avons trouve un faible correlation entre EDR et AHI. Nous pensons que l’EDR est different de l’AHI car il est sensible a la duree et a la profondeur des evenements apneiques alors que l’AHI ne fait que compter ces evenements. Des etudes ulterieures seront necessaires pour evaluer le pouvoir predictif de l’EDR.

Idiopathic hypersomnia is an uncommon sleep disorder characterized by prolonged sleep time and excessive daytime sleepiness without cataplexy. This study concerned a case of familial occurrence. The proband expressed an idiopathic hypersomnia with long sleep time at the age of 12 years. Clinical interview and ad libitum polysomnographic study did not reveal any symptoms of narcolepsy or other sleep disorders. Family history revealed that a 20-year-old sister had experienced symptoms of hypersomnia from the age of 16 and their mother had been diagnosed with idiopathic hypersomnia previously. The diagnosis of idiopathic hypersomnia with long sleep time was confirmed in the sister by clinical interview and ad libitum polysomnography. Human leukocyte antigen (HLA) did not reveal the DQB1-0602 phenotype in the proband and relatives. This report confirms the hypothesis of a genetic predisposition in idiopathic hypersomnia.

Study Objectives: Sleep related breathing disorders (SRBD) are risk factors for cognitive dysfunction in middle-aged subjects, but this association has not been observed in the elderly. We assess the impact of SRBD on cognitive performance in a large cohort of healthy elderly subjects. Design: Cross-sectional study examining the association between subjective memory test, neuropsychological battery testing and SRBD in the elderly. Setting: Community-based sample in home and research clinical settings. Participants: 827 subjects, 58.5% women, aged 68 y at study entry, participated in the study. All were free of previously diagnosed SRBD, coronary heart disease, and neurological disorders, including stroke and dementia. Clinical interview, neurological assessment, polygraphy, and extensive cognitive testing were conducted for all participants. Intervention: N/A Measurement and Results: SRBD (apnea-hypopnea index (AHI) > 15 events/h) was diagnosed in 445 (53%) subjects, 167 (37%) of them with AHI > 30. Minimal daytime sleepiness was found in the group; 9.2% of the population had an Epworth Sleepiness Scale score > 10. No significant association was found between AHI, nocturnal hypoxemia, and cognitive scores. Comparison of mild vs severe cases showed a trend toward lower cognitive scores with AHI > 30, affecting delayed recall and Stroop test. Conclusions: The impact of undiagnosed SRBD on cognitive function appeared quite limited in a generally older healthy population, and only slightly affected severe cases. The implication of undiagnosed SRBD on the cognitive impairment in elderly subjects remains hypothetical and needs to be prospectively studied. Clinical Trial Information: Autonomic Nervous System Activity, Aging and Sleep Apnea/Hypopnea (SYNAPSE); Registration #NCT 00766584 (This study is ongoing, but not recruiting participants.); URL - http://clinicaltrials.gov/ct2/show/NCT00766584?term=NCT+00766584&rank=1

Background. The occurrence of restless legs syndrome (RLS) in elderly individuals is well known but the incidence and the clinical correlates in these subjects are still unclear. The present study explores the prevalence of and assesses symptoms associated with RLS in an older French population. Methods. The study sample for this study comprised 318 subjects (219 women and 99 men), aged 68.6 ± 0.8 years. All subjects underwent clinical assessment, nocturnal polygraphy, and cognitive and mood disorders evaluation. RLS was assessed with the standard validated criteria and severity was evaluated by the use of International Restless Legs Syndrome Study Group (IRLS) questionnaire. Results. RLS was present in 24.2% of the sample, prevalence being greater in women (29.7%) than in men (12.1%). The mean IRLS score was 16.6 ± 4.8, 67% of cases having mild to moderate range. Participants with RLS reported greater hypnotic ( p < .001) and antidepressant medication intake ( p < .001) and had higher anxiety ( p < .001) and depression ( p < .001) scores. Participants with RLS had lower cognitive performances at Stroop and Verbal fl uency tests than participants without RLS ( p < .05 and p = .002, respectively). These associations remained signifi cant after multivariate adjustment for medication, depression, and subjective sleep. Conclusions. Presence of undiagnosed RLS is higher in healthy elderly participants without previously diagnosed sleep disorders, affecting women more often than men. The presence of RLS increased the risk of anxiety and mood disorders and predispose to preclinical cognitive decline independently of anxiety, mood disorders, duration and quality of sleep, and medication.

Magnetic resonance imaging studies using voxel-based morphometry (VBM) have been inconsistent in demonstrating volumetric differences in patients with restless legs syndrome (RLS). Since treatment, age and selection of patients may introduce a methodological bias, we conducted optimized VBM analyses in unmedicated elderly subjects reporting RLS. Two hundred-four voluntaries, 65.9 +/- 0.6 year-old, free of any significant medical condition and without previous neurological or psychiatric medication, participated at the study. After exclusion of subjects having sleep-related breathing disorders and previous silent infarct, 71 subjects, 54 without RLS (RLS-) and 17 having RLS (RLS+) were analyzed. No structural change in gray matter density was found in RLS+ subjects compared to RLS- subjects. Subjects with RLS+ symptoms showed a small gray matter volume in the left occipital region without, however, statistical significance. VBM analysis did not show any significant change in subcortical and cortical gray matter in unmedicated elderly subjects with RLS symptoms. These results confirm the lack of specificity of thalamic and subcortical changes in restless legs syndrome.

Elevated levels of C-reactive protein (CRP) have been reported in patients with sleep-disordered breathing (SDB) and may represent an inflammatory marker of cardiovascular risk. However, the association of CRP with SBD in presumed healthy elderly subjects is unknown. In total, 851 (58.5% females) 68-yr-old subjects, who were free of any known cardiac or sleep disorders, were prospectively examined. Subjects underwent unattended polygraphy, and the apnoea/hypopnoea index (AHI) and oxyhaemoglobin desaturation index (ODI) were assessed. Elevated levels of CRP were found on the morning after the sleep study in patients with more severe SDB. A significant correlation was found between CRP levels, time spent at night with arterial oxygen saturation90% and ODI. No association was found between CRP levels and AHI. After adjustments for body mass index, smoking status, hypertension, diabetes and dyslipidaemia, a significant association remained between CRP levels and ODI10 events.h(-1). CRP levels were frequently increased in a large sample of elderly subjects free of major cardiovascular disease. CRP levels were not correlated with the AHI and the indices of sleep fragmentation; the ODI10 events.h(-1) was the strongest predictor of raised CRP level. The present results suggest that, in the elderly, intermittent hypoxaemia may underlie inflammatory processes leading to cardiovascular morbidity.

In the last two decades quantitative electroencephalogram (EEG) analysis has been widely used to investigate the neurophysiological characteristics of insomnia. These studies provided evidence in support of the hypothesis that primary insomnia is associated with hyperarousal of central nervous system and altered sleep homeostasis. However, we have here underlined that these results have intrinsic methodological problems, mainly related to constraints of standard assessment in clinical research. We have proposed that future studies should be performed on larger samples of drug-free patients, using within-subjects designs and longitudinally recording patients adapted to sleep laboratory. All these methodological improvements will allow to partial out the contribution of individual differences, pharmacological influences and first-night effects on EEG frequencies. Moreover, we have discussed the potential relevance of recent findings from basic research concerning local changes during physiological sleep, which could be extended to the study of insomnia. We have suggested that, if normal sleep exhibits specific regional characteristics, also disorders in initiating and maintaining sleep should be characterized by local changes. The extension of this theoretical framework to the study of insomnia could provide new insights on the underlying pathophysiological mechanisms. As a first step toward the integration of knowledge from basic and clinical research focused on local sleep changes, here we showed some preliminary data from sleep onset recordings of patients with paradoxical insomnia. This approach supports the heuristic potential of our proposal, pointing to a local functional impairment in the process of synchronization in insomniac patients compared to normal subjects, the former exhibiting more beta and less delta and sigma power on anterior scalp locations than the latter.

Background The obesity-hypoventilation syndrome (OHS), commonly defined as a combination of obesity and diurnal hypercapnia, is efficiently treated using nasal positive pressure ventilation (NPPV). The present study aimed to determine whether nocturnal polysomnography allows detection of respiratory disturbances occurring in patients with OHS treated with NPPV that may interfere with the quality of sleep and of ventilatory support, and are not detected by nocturnal pulse oximetry and capnography. Methods Twenty OHS patients in stable clinical condition treated by NPPV for at least 3 months with a bilevel pressure support ventilator were studied. All patients underwent single-night polysomnography under NPPV including transcutaneous measurement of P co 2 (TcP co 2 ). Four types of respiratory events were defined and quantified: patient/ventilator desynchronization, periodic breathing (PB), autotriggering, and apnea-hypopneas. Results Eleven patients (55%) exhibited desynchronization occurring mostly in slow-wave sleep and rapid eye movement sleep and associated with arousals but not inducing significant changes in TcP co 2 or oxygen saturation using pulse oximetry (Sp o 2 ). Eight patients (40%) showed a high index of PB, mostly occurring in light sleep and associated with more severe nocturnal hypoxemia. Autotriggering was sporadic and usually limited to one or two breaths, although prolonged and asymptomatic autotriggering occurred in one patient during 10.6% of total sleep time. Conclusions Patient/ventilatory asynchrony and PB are respiratory patterns occurring frequently in OHS patients treated using NPPV. Nocturnal monitoring of Sp o 2 and TcP co 2 , commonly used to assess the efficacy of ventilatory support, do not adequately explore this aspect of therapy that might influence its efficacy as well as sleep quality.

Objective Previous studies have suggested an association between obstructive sleep apnea (OSA) and anxiety and depression, but it remains unclear as to whether this is due to OSA or other factors. The aim of this study was to evaluate this association in a large sample of healthy elderly with unrecognized OSA. Methods 825 healthy elderly (aged ≥65 years) undergoing clinical, respiratory home polygraphic study and completion of questionnaires related to depression, anxiety and sleepiness were examined. According to the apnea–hypopnea index (AHI), the subjects were stratified into no-OSA, mild–moderate and severe OSA cases. Results Anxiety was present in 38% of the sample and depression in 8%. Anxiolytic treatment was reported by 9% of the population and antidepressant treatment in 5%. Women had high scores for anxiety and depression and they were more frequently taking anxiolytic and antidepressant medications. No differences were found for anxiety and depression scores and medication intake in the three groups of subjects stratified according to the AHI. Regression analyses adjusted for age, gender, body mass index, hypertension (HT), AHI, and indices of hypoxemia revealed that females were 5.44 times more likely to have depression with a low contribution of the time with SaO 2 Conclusions In a large sample of healthy elderly with OSA, neither the existence nor the severity of the OSA was associated with anxiety and depression score, with women having higher anxiety and depression scores. This finding supports the hypothesis that depressive symptoms originate from factors other than measures of OSA severity.

Obesity and aging are considered risk factors for developing sleep apnea syndrome (OSA). The aim of this study was to determine the association between body fat composition and OSA in healthy elderly subjects examined in a 7-year longitudinal study.A total of 209 elderly with unrecognized OSA aged 68.3 ± 0.8 years underwent a clinical, ambulatory nocturnal respiratory recording, and anthropometric as well as body fat composition assessment by dual-energy X-ray absorptiometry (DEXA) at baseline and follow-up.At study entry, 50.3% of the population showed an apnea+hypopnea index (AHI)15 with a mean AHI of 16.8 ± 11. At follow-up, a reduction of OSA cases (42%) was evident with a mean AHI of 14.6 ± 10.2. The DEXA data demonstrated that body mass and total lean mass were reduced at follow-up, while central and peripheral fat mass showed a slight increase. Correlation analysis between the changes in DEXA measurements versus the changes in AHI and the indices of nocturnal hypoxemia showed an absence of a statistical correlation.The lack of correlation between the DEXA measurement changes and the changes in the AHI confirm our previous data on the absence of a central fat mass effect on OSA in the elderly.

Objective: The existence of a rapid eye movement (REM)-specific sleep-disordered breathing (SDB) has been suggested based on the finding of an association between sleepiness and respiratory disturbances confined primarily to REM sleep. The aim of the study was to define the frequency and the clinical and polysomnographic features of REM SDB in a large clinical population. Methods: Anthropometric, clinical, and polysomnographic characteristics of 415 patients undergoing polysomnography for SDB were examined. For all patients the apnea-hypopnea index (AHI) during total sleep time, the AHI during REM (AHI-REM), and the AHI during non-REM sleep (AHI-NREM) were calculated. REM SDB was defined as an AHI-REM/AHI-NREM ratio >2. Patients were stratified according to the severity of disease in mild, moderate, and severe cases. Daytime sleepiness was assessed subjectively by the Epworth sleepiness scale (ESS), and objectively, in a subgroup of 228 patients, by the maintenance wakefulness test (MWT). Results: Of the initial sample, 36.4% of cases (n = 151) fulfilled the REM SDB criteria. No significant differences in subjective complaints, medical history, and drug intake were present between REM and non-REM SDB patients, and no significant differences were found in ESS scores and mean sleep latency of the MWT between groups. A high occurrence of REM SDB was found in mild (73.1%) and moderate cases (47.2%). While in the entire group and in non-REM SDB patients a strong male prevalence was found, the incidence of REM SDB was similar in men and women. Conclusion: Our results show that neither clinical history nor daytime sleepiness differentiate patients with REM SDB from non-REM SDB patients. The disorder is more common in mild and moderate cases; there is an equal incidence in women and men. These findings may suggest that REM-related SDB is a part of the spectrum of SDB.