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Objectif Les mouvements mandibulaires (MM) sont desormais consideres comme une mesure diagnostique de l’effort respiratoire et pourraient etre utilises comme methode de depistage des patients eligibles a une polysomnographie (PSG). Nous rapportons ici la faisabilite d’un depistage fonde sur la mesure d’un index respiratoire associe a des mouvements mandibulaires (MM-RDI). Methodes Au total, 4231 patients ont effectue en ambulatoire un test de depistage Brizzy (depist-By) a l’aide un capteur magnetique (Nomics©) ; 918 patients ont simultanement beneficie d’une oxymetrie. Le patient etait considere comme positif et necessitant une PSG si le MM-RDI etait > 13,5/h ou si l’indice de desaturation de l’oxygene (IDO) etait > 18,5/h (sous condition d’une estimation du temps de sommeil total [eTST] > 4 heures). Resultats Parmi les tests, 3,9 % etaient non exploitables en raison d’une defaillance technique. Seulement 3,2 % de la population analysable avait une eTST Conclusion Cette etude preliminaire confirme la faisabilite du MM-RDI comme outil de depistage pour les patients candidats a la PSG. Elle suggere une complementarite de l’oxymetrie et du depist-By.

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

Background Mycobacterium abscessus infections remain difficult to manage in both cystic fibrosis (CF) and non-CF patients and reported clinical outcomes are largely unsatisfactory. Clinical trial data are limited and no approved therapies are currently available for the management of M abscessus lung diseases. As an alternative, cohort studies may provide insightful information into the management of M abscessus pulmonary disease. Methods Based on a retrospective observational cohort study, we investigated the safety and efficacy of amikacin liposome inhaled suspension (ALIS) as an adjunct to a standard antibiotic regimen for M abscessus lung infection in both CF and non-CF patients. We also assessed the association of patient drug compliance with culture conversion and clinical outcomes. Results Twenty-six patients had long-term follow-up data available. Culture conversion was achieved in 54% (14/26) of the patients with no difference between CF and non-CF patients after an average treatment duration of 10 months. Patient treatment compliance was significantly better in the converter group compared to nonconverters with an odds ratio of 44.78 associated with good compared to poor patient compliance. Overall, 9 patients (35%) experienced an adverse event that led to treatment discontinuation. Conclusions ALIS appears beneficial in both CF and non-CF populations with M abscessus lung disease.

Introduction To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea–hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. Methods and analysis No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. Ethics and dissemination This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/Trial registration numbers CRD42020159914/NCT04526366; Pre-results

Background: Distal airway metaplasia may precede honeycombing in progressive fibrosing interstitial lung disease (ILD). The SCGB1A1+ bronchiolar-specific club cell may play a role in this aberrant regenerative process.Objective: To assess the presence of club cells in the small airways of patients suffering from ILD.Methods: Small airways (internal diameter Results: Small airways from samples with ILD patterns were significantly less dense in terms of SCGB1A1+ cells [0.064 (0.020–0.172)] as compared to controls' sample's small airways [0.393 (0.082–0.698), p < 0.0001]. Usual interstitial pneumonia (UIP) patterns most frequently contained small airways with limited or absent SCGB1A1 expression (SCGB1A1/EH p < 0.0001. In addition, correlations with HRCT indicated a significant negative relationship between SCGB1A1 and bronchiectasis as a feature of bronchiolization (Rho −0.63, p < 0.001) and a positive relationship with both forced vital capacity (FVC) and Hounsfield unit (HU)-distribution pattern in kurtosis (Rho 0.38 and 0.50, respectively, both p < 0.001) as markers of fibrotic changes.Conclusion: Compared with controls, the small airways of patients with ILD more often lack SCGB1A1, especially so in UIP. Low densities of SCGB1A1-marked cells correlate with bronchiectasis and fibrotic changes. Further research investigating SCGB1A1 staining as a pathological feature of the bronchiolization process is merited.

International audience; Aims Optimizing medical cardiac treatment for sleep apnoea (SA) in patients with chronic heart failure and reduced ejection fraction (HFrEF) is an expert Grade C recommendation based on six studies encompassing a total of 67 patients only. Whether sacubitril-valsartan (SV), a cornerstone of HFrEF medical treatment, impacts SA is unknown and requires evaluation.Methods and results The ENTRESTO-SAS trial is a six-centre, prospective, open-label real-life cohort study (NCT02916160). Ambulatory patients eligible for SV (i.e. HFrEF adults who remain symptomatic despite optimal treatment) were evaluated before and after 3 months of SV (including nocturnal ventilatory polygraphy); 118 patients were final analysed [median age was 66 (IQ 25-75 : 56-73) years, 81.4% male, 36.5% New York Heart Association III-IV, N-terminal pro-B-type natriuretic peptide level of 1564 (701-3376) ng/L, left ventricular ejection fraction of 30 (25-34)%, 60.7% ischaemic HFrEF, 97.5% initially treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, 83.9% with beta-blockers, 64.4% with mineralocorticoid receptor antagonists, and 74.6% with diuretics]. Three groups were defined according to initial central/obstructive apnoea-hypopnoea indices (AHIs): G1 (n = 49, AHI central ≥ 5/h and AHI obstructive < 15/h); G2 (n = 27, AHI obstructive ≥ 15/h); and G3 (n = 42, AHI central < 5/h and AHI obstructive < 15/h). At 3 months, the AHI (main predefined outcome) decreased significantly by À7.10/h (IQ 25-75 : À16.10 to 0.40; P < 0.001) in G1 + G2 without positive airway pressure treatment (45 patients, median initial AHI of 24.20 (IQ 25-75 : 16.40-43.50)/h). Of these, 24.4% presented an AHI decrease ≥50% and 37.78% had a final AHI < 15/h (tendency for improvement from an initial value of 20%: P = 0.0574). For G1 patients (n = 37), AHI significantly decreased from a median of 22.90 (16.00-43.50)/h to 19.20 (12.70-31.10)/h (P = 0.002). For G2 patients (n = 8), AHI decreased from a median of 30.10 (26.40-47.60)/h to 22.75 (14.60-36.90)/h (statistically non-significant, P = 0.059).Conclusions In this real-life population, SV treatment for 3 months in SA patients is associated with a significant decrease in AHI. These results support the current guidelines that recommend first an optimization of the HFrEF treatment in patients with HFrEF and central SA. A potential positive airway pressure sparing effect merits further investigation.

Background For some patients, Continuous Positive Airway Pressure (CPAP) remains an uncomfortable therapy despite the constant development of technological innovations. To date, no real life study has investigated the relationship between mask related side-effects (MRSEs) and CPAP-non-adherence (defined as Methods The InterfaceVent-CPAP study is a prospective real-life cross-sectional study conducted in an apneic adult cohort undergoing at least 3 months of CPAP with unrestricted mask-access (34 different masks). MRSEs were evaluated using visual-analogue-scales, CPAP-data using CPAP-software, sleepiness using ESS. Results 1484 patients were included in the analysis (72.2% male, median age 67 years (IQ25–75: 60–74), initial Apnea–Hypopnea-Index (AHI) of 39 (31–56)/h, residual AHIflow was 1.9 (0.9–4) events/h), CPAP-treatment lasted 4.4 (2.0–9.7) years, CPAP-usage was 6.8 (5.5–7.8) h/day, the prevalence of CPAP-non-adherence was 8.6%, and the prevalence of RES was 16.17%. Leak-related side-effects were the most prevalent side-effects (patient-reported leaks concerned 75.4% of responders and had no correlation with CPAP-reported-leaks). Multivariable logistic regression analyses evaluating explanatory-variable (demographic data, device/mask data and MRSEs) effects on variables-of-interest (CPAP-non-adherence and RES), indicated for patient-MRSEs significant associations between: (i) CPAP-non-adherence and dry-mouth (p = 0.004); (ii) RES and patient-reported leaks (p = 0.007), noisy mask (p Conclusion In long-term CPAP-treated patients, leak-related side-effects remain the most prevalent side-effects, but patient-reported leaks cannot be predicted by CPAP-reported-leaks. Patient-MRSEs can be independently associated with CPAP-non-adherence and RES, thus implying a complementary role for MRSE questionnaires alongside CPAP-device-reported-data for patient monitoring. Trial registration InterfaceVent is registered with ClinicalTrials.gov (NCT03013283).

Backgrounds To explain the excess cardiovascular mortality observed in the SERVE-HF study, it was hypothesized that the high-pressure ASV default settings used lead to inappropriate ventilation, cascading negative consequences (i.e. not only pro-arrythmogenic effects through metabolic/electrolyte abnormalities, but also lower cardiac output). The aims of this study are: i) to describe ASV-settings for long-term ASV-populations in real-life conditions; ii) to describe the associated minute-ventilations (MV) and therapeutic pressures for servo-controlled-flow versus servo-controlled-volume devices (ASV-F Philips®-devices versus ASV-V ResMed®-devices). Methods The OTRLASV-study is a cross-sectional, 5-centre study including patients who underwent ASV-treatment for at least 1 year. The eight participating clinicians were free to adjust ASV settings, which were compared among i) initial diagnosed sleep-disordered-breathing (SBD) groups (Obstructive-Sleep-Apnea (OSA), Central-Sleep-Apnea (CSA), Treatment-Emergent-Central-Sleep-Apnea (TECSA)), and ii) unsupervised groups (k-means clusters). To generate these clusters, baseline and follow-up variables were used (age, sex, body mass index (BMI), initial diagnosed Obstructive-Apnea-Index, initial diagnosed Central-Apnea-Index, Continuous-Positive-Airway-Pressure used before ASV treatment, presence of cardiopathy, and presence of a reduced left-ventricular-ejection-fraction (LVEF)). ASV-data were collected using the manufacturer’s software for 6 months. Results One hundred seventy-seven patients (87.57% male) were analysed with a median (IQ25–75) initial Apnea-Hypopnea-Index of 50 (38–62)/h, an ASV-treatment duration of 2.88 (1.76–4.96) years, 61.58% treated with an ASV-V. SDB groups did not differ in ASV settings, MV or therapeutic pressures. In contrast, the five generated k-means clusters did (generally described as follows: (C1) male-TECSA-cardiopathy, (C2) male-mostly-CSA-cardiopathy, (C3) male-mostly-TECSA-no cardiopathy, (C4) female-mostly-elevated BMI-TECSA-cardiopathy, (C5) male-mostly-OSA-low-LVEF). Of note, the male-mostly-OSA-low-LVEF-cluster-5 had significantly lower fixed end-expiratory-airway-pressure (EPAP) settings versus C1 (p = 0.029) and C4 (p = 0.007). Auto-EPAP usage was higher in the male-mostly-TECSA-no cardiopathy-cluster-3 versus C1 (p = 0.006) and C2 (p p = 0.002) and ASV-V (p Conclusions Real-life ASV settings are associated with combinations of baseline and follow-up variables wherein cardiological variables remain clinically meaningful. At the patient level, a hyperventilation risk exists regardless of cluster or ASV-monitoring type, spotlighting a future role of MV-telemonitoring in the interest of patient-safety. Trial registration The OTRLASV study was registered on ClinicalTrials.gov (Identifier: NCT02429986). 1 April 2015.

Objective: There are a number of factors that go into a recommendation to treat non-tuberculous mycobacterial lung infection (NTM-LI). The purpose of the study is to validate consensus recommendations on clinical considerations before treating a NTM-LI. Methods: We engaged respiratory physicians of the "Mycobacterioses" working group, part of the research and teaching group in pulmonology and infectious diseases (GREPI), on behalf of the SPLF (Societe de Pneumologie de Langue Francaise) in a Delphi survey concerning three areas of interest for physicians before they had to decide to treat (Diagnosis, Definition of the level of severity and Clinical assessment before deciding to treat) in order to create a decision algorithm. Each assertion was subjected to rating and free comments by these experts via an online questionnaire. The scores were weighted by the number of patients seen each year by the experts. The assertions having obtained a weighted average greater than 9/10 were validated. Otherwise they were subject to re-evaluation during round 2 until reaching 9/10. Results: A total of 37 experts responded. At first round, 9/38 assertions obtained a strong agreement (median ≥7 and 80% of responses >7). Other assertions from all domains, in particular the definition of the level of severity, were revised and new assertions added for submission to scoring in round 2. Fifty-one assertions were finally assessed. Agreement was strong in 78% of the assertions (40/51); moderate in 22% (11/51). There was no disagreement. Conclusion: We obtained a consensus from physicians about clinical considerations before deciding to treat NTM-LI and we propose a decision algorithm to guide a treatment decision.

Lung surface photos show wounds/haemorrhages caused by transbronchial lung cryobiopsy (TBLC). TBLC bleeding can extensively soil airways with consequences for lung function, stressing the need for bleeding prevention and more research via registries.https://bit.ly/34wWAeR

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

Aims Sleep-disordered breathing (SDB) is a highly prevalent co-morbidity in patients with chronic heart failure (CHF) and can play a detrimental role in the pathophysiology course of CHF. However, the best way to manage SDB in CHF remains a matter of debate. Sacubitril-valsartan has been included in the 2016 European Society of Cardiology guidelines as an alternative to angiotensin-converting enzyme inhibitors to further reduce the risk of progression of CHF, CHF hospitalization, and death in ambulatory patients. Sacubitril and valsartan are good candidates for correcting SDB of CHF patients because their known mechanisms of action are likely to counteract the pathophysiology of SDB in CHF. Methods and results The ENTRESTO-SAS trial is a 3-month, multicentric, prospective, open-label real-life cohort study. Patients eligible for sacubitril-valsartan treatment (i.e. adults with left ventricular ejection fraction ≤35%, who remain symptomatic despite optimal treatment with an angiotensin-converting enzyme inhibitor, a beta-blocker, and a mineralocorticoid receptor antagonist) will be evaluated before and after 3 months of treatment (nocturnal ventilatory polygraphy, echocardiography, laboratory testing, and quality-of-life and SDB questionnaires). The primary outcome is the change in the Apnoea-Hypopnoea Index, before and after 3 months of treatment. One hundred twenty patients are required to detect a significant 20% improvement of the Apnoea-Hypopnoea Index with a power of 90% at an alpha risk of 5%. Conclusions In the context of the SERVE-HF study, physicians are waiting for new trials and alternative therapies. We sought to assess in the ENTRESTO-SAS trial whether sacubitril-valsartan could improve the outcome of SDB in CHF patients.

Introduction Les signes d’insuffisance cardiaque droite sont frequents dans l’evolution de la bronchopneumopathie chronique obstructive (BPCO) avec emphyseme sans que les mecanismes en cause soit clairement precises. Notre hypothese de travail est que l’emphyseme en majorant la pression intrathoracique provoque une dysfonction diastolique cardiaque droite a l’exercice en limitant l’expansion ventriculaire. Ainsi, une reduction d’emphyseme pourrait ameliorer la fonction diastolique ventriculaire droite. Methodes Lors du screening des patients BPCO avec emphyseme severe adresses pour une reduction endoscopique d’emphyseme, une evaluation hemodynamique invasive classique et avec un catheter a conductance permettant d’obtenir des boucles Pression/Volume au repos, a l’exercice et durant un test de lever de jambe, etait realise en cas de suspicion d’hypertension pulmonaire. Cette exploration etait repetee apres reduction d’emphyseme. La precharge, la fonction diastolique, la contractibilite, la fonction systolique, la postcharge et le couplage ventriculo-arteriel etaient ainsi enregistrees. Le critere de jugement principal est la compliance ventriculaire apres reduction d’emphyseme qui se traduit par une diminution de la pente relation pression volume telediastolique. Nous ne presentons ici que des donnees preliminaires. Resultats Nous avons pu obtenir la caracterisation hemodynamique de cinq patients dont trois ont eu une evaluation avant et apres reduction d’emphyseme. Concernant notre critere de jugement principal nos resultats preliminaires montrent une diminution de la pente relation pression volume telediastolique de respectivement 0,85 % et 0,95 % chez les deux patients ayant eu une reduction d’emphyseme versus une augmentation de 0,25 % chez le patient controle. Nos resultats secondaires montrent qu’apres reduction d’emphyseme on observe une augmentation de l’index cardiaque a l’effort rapporte a la valeur de repos (+ 55,4 % en post reduction versus + 3,4 % en pre reduction), du volume telediastolique (+ 28,5 % en post reduction versus − 2,3 % en pre reduction) tout en annulant l’augmentation de pression telediastolique a l’effort. Nous n’observons pas d’amelioration de la fonction systolique ni du couplage ventriculo-arteriel. Conclusion Ces premieres donnees permettent d’evaluer grâce a la technique de reference l’hemodynamique des patients BPCO avec emphyseme severe. Nos Resultats preliminaires vont dans le sens d’une amelioration de la fonction diastolique cardiaque droite par augmentation de compliance apres reduction d’emphyseme.

Introduction To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea–hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. Methods and analysis No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. Ethics and dissemination This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/Trial registration numbers CRD42020159914/NCT04526366; Pre-results

Backgrounds As a consequence of the increased mortality observed in the SERVE-HF study, many questions concerning the safety and rational use of ASV in other indications emerged. The aim of this study was to describe the clinical characteristics of ASV-treated patients in real-life conditions. Methods The OTRLASV-study is a prospective, 5-centre study including patients who underwent ASV-treatment for at least 1 year. Patients were consecutively included in the study during the annual visit imposed for ASV-reimbursement renewal. Results 177/214 patients were analysed (87.57% male) with a median (IQ25–75) age of 71 (65–77) years, an ASV-treatment duration of 2.88 (1.76–4.96) years, an ASV-usage of 6.52 (5.13–7.65) hours/day, and 54.8% were previously treated via continuous positive airway pressure (CPAP). The median Epworth Scale Score decreased from 10 (6–13.5) to 6 (3–9) (p p 45% in 92.7% of patients. Associated comorbidities/etiologies were cardiac in nature for 75.7% of patients (neurological for 12.4%, renal for 4.5%, opioid-treatment for 3.4%). 9.6% had idiopathic central-sleep-apnea. 6.2% of the patients were hospitalized the year preceding the study for cardiological reasons. In the 6 months preceding inclusion, night monitoring (i.e. polygraphy or oximetry during ASV usage) was performed in 34.4% of patients, 25.9% of whom required a subsequent setting change. According to multivariable, logistic regression, the variables that were independently associated with poor adherence (ASV-usage ≤4 h in duration) were TECSA group versus CSA group (p = 0.010), a higher Epworth score (p = 0.019) and lack of a night monitoring in the last 6 months (p Conclusions In real-life conditions, ASV-treatment is often associated with high cardiac comorbidities and high compliance. Future research should assess how regular night monitoring may optimize devices settings and patient management. Trial registration The OTRLASV study is registered on ClinicalTrials.gov (Identifier: NCT02429986) on 1 April 2015.

International audience; Rationale: The diagnostic concordance between transbronchial lung cryobiopsy (TBLC)—versus surgical lung biopsy (SLB) as the current gold standard—in interstitial lung disease (ILD) cases requiring histology remains controversial.Objectives: To assess diagnostic concordance between TBLC and SLB sequentially performed in the same patients, the diagnostic yield of both techniques, and subsequent changes in multidisciplinary assessment (MDA) decisions.Methods: A two-center prospective study included patients with ILD with a nondefinite usual interstitial pneumonia pattern (on high-resolution computed tomography scan) confirmed at a first MDA. Patients underwent TBLC immediately followed by video-assisted thoracoscopy for SLB at the same anatomical locations. After open reading of both sample types by local pathologists and final diagnosis at a second MDA (MDA2), anonymized TBLC and SLB slides were blindly assessed by an external expert pathologist (T.V.C.). Kappa-concordance coefficients and percentage agreement were computed for: TBLC versus SLB, MDA2 versus TBLC, MDA2 versus SLB, and blinded pathology versus routine pathology.Measurements and Main Results: Twenty-one patients were included. The median TBLC biopsy size (longest axis) was 7 mm (interquartile range, 5–8 mm). SLB biopsy sizes averaged 46.1 ± 13.8 mm. Concordance coefficients and percentage agreement were: TBLC versus SLB: κ = 0.22 (95% confidence interval [CI], 0.01–0.44), percentage agreement = 38% (95% CI, 18–62%); MDA2 versus TBLC: κ = 0.31 (95% CI, 0.06–0.56), percentage agreement = 48% (95% CI, 26–70)%; MDA2 versus SLB: κ = 0.51 (95% CI, 0.27–0.75), percentage agreement = 62% (95% CI, 38–82%); two pneumothoraces (9.5%) were recorded during TBLC. TBLC would have led to a different treatment if SLB was not performed in 11 of 21 (52%) of cases.Conclusions: Pathological results from TBLC and SLB were poorly concordant in the assessment of ILD. SLBs were more frequently concordant with the final diagnosis retained at MDA

International audience

Objectif Pour expliquer la surmortalite cardiovasculaire associee a la Ventilation Auto-Asservie (VAA) de l’etude SERVE-HF, il a ete evoque que les reglages de la VAA auraient induit une hyperventilation. Les objectifs de cette etude sont de decrire: – les reglages de la VAA et, – la ventilation minute (VM) en fonction de l’algorithme de la VAA (VAA-volume ResMed® et VAA-debit Philips®). Methodes Etude « vie reelle » transversale multicentrique incluant des patients traites par VAA depuis plus de 1 an, aucune consigne de reglage n’etant donnee aux 8 experts investigateurs. L’analyse des donnees est realisee: – en fonction du diagnostic initial du SAS (central, obstructif, emergent sous traitement), – en fonction de 5 clusters non supervises (partitionnement en K moyennes). Resultats 177 patients sont analyses avec une mediane (IQ25–75) d’IAH initial de 50 (38-62)/h, une duree de VAA de 2.88 (1.76–4,96) ans, 61,58 % traites par VAA-volume. Seule l’analyse basee sur les 5 clusters permet de mettre en evidence des differences entre clusters et/ou type de machine: – reglage d’une pression expiratoire (EPAP) fixe plus faible dans le groupe des patients obstructifs et a fraction d’ejection ventriculaire gauche reduite, – l’usage plus frequent de l’auto-EPAP chez les patients non cardiopathes, – des VM differents entre clusters, ces differences variant en fonction du type de VAA, – un risque d’hyperventilation quel que soit le cluster et le type de VAA. Conclusion Dans l’attente des etudes en cours, il serait prudent de telesuivre les donnees de VM des patients sous VAA.

International audience

Mandibular movement tests have demonstrated potential as screening tools for polysomnography candidates http://ow.ly/iu2430fZk2u

Aims Sleep‐disordered breathing (SDB) is a highly prevalent co‐morbidity in patients with chronic heart failure (CHF) and can play a detrimental role in the pathophysiology course of CHF. However, the best way to manage SDB in CHF remains a matter of debate. Sacubitril–valsartan has been included in the 2016 European Society of Cardiology guidelines as an alternative to angiotensin‐converting enzyme inhibitors to further reduce the risk of progression of CHF, CHF hospitalization, and death in ambulatory patients. Sacubitril and valsartan are good candidates for correcting SDB of CHF patients because their known mechanisms of action are likely to counteract the pathophysiology of SDB in CHF. Methods and results The ENTRESTO‐SAS trial is a 3‐month, multicentric, prospective, open‐label real‐life cohort study. Patients eligible for sacubitril–valsartan treatment (i.e. adults with left ventricular ejection fraction ≤35%, who remain symptomatic despite optimal treatment with an angiotensin‐converting enzyme inhibitor, a beta‐blocker, and a mineralocorticoid receptor antagonist) will be evaluated before and after 3 months of treatment (nocturnal ventilatory polygraphy, echocardiography, laboratory testing, and quality‐of‐life and SDB questionnaires). The primary outcome is the change in the Apnoea–Hypopnoea Index, before and after 3 months of treatment. One hundred twenty patients are required to detect a significant 20% improvement of the Apnoea–Hypopnoea Index with a power of 90% at an alpha risk of 5%. Conclusions In the context of the SERVE‐HF study, physicians are waiting for new trials and alternative therapies. We sought to assess in the ENTRESTO‐SAS trial whether sacubitril–valsartan could improve the outcome of SDB in CHF patients.

Introduction Peu de donnees sur l’usage de la Ventilation Auto-Asservie (VAA) en vie reelle existent. Dans ce contexte post SERVE-HF, les cliniciens sont dans l’attente de nouvelles donnees. Le but de cette etude est de decrire les caracteristiques cliniques des patients traites actuellement en conditions de vie reelle par VAA. Methodes L’etude OTRLASV (NCT02429986) est une etude prospective observationnelle multicentrique concernant des patients traites par VAA depuis au moins 1 an. Les donnees sont collectees consecutivement lors des consultations annuelles imposees pour le renouvellement de la prise en charge de la VAA, chacun des 5 centres restant ouvert 14 mois (1ere inclusion en mars 2015 pour le premier centre, derniere inclusion en decembre 2016 pour le dernier centre, 11 patients de phenotype SERVE-HF sont exclus). Resultats Au total, 177 patients sont inclus dans l’analyse finale (87,57 % d’hommes avec une mediane (IQ 25–75) d’âge de 71 (65–77) ans, une duree de traitement par VAA de 2,88 (1,76–4,96) annees, une utilisation de la VAA de 6,52 (5,1–7,6) heures/jour, 54,8 % des patients ayant ete prealablement traites par CPAP). La mediane de score d’Epworth est passee de 10 (6–13,5) a 6 (3–9) sous VAA (p 45 % dans 92,6 % des cas), neurologique dans 12,4 % des cas, renale dans 4,5 % des cas, 3,4 % des patients consomment des opiaces (14,12 % avec deux comorbidites). Au total, 13,5 % des patients presentaient une forme centrale idiopathique. Seulement 6,21 % des patients sont hospitalises pour raison cardiologique l’annee precedant leur inclusion. Le delai entre la derniere consultation cardiologique et l’inclusion dans l’etude est de 183 (70–365) jours, 97,97 % des patients ont beneficie d’une echocardiographie avec un delai de 263 (116–529) jours avant inclusion dans l’etude. Dans les 6 derniers mois precedant l’inclusion, 31 % des patients ont beneficie d’une polygraphie (PV) ou d’une oxymetrie (oxy) ayant conduit a une modification des reglages (9 patients) ou de l’interface (7 patients). Ce suivi cardiologique ou PV/oxy ne dependant pas de la date de mise en place de la VAA, il est peu probable qu’il ait pu etre influence par les resultats de l’etude SERVE-HF. Conclusion En conditions de vie reelle, a la difference des derniers essais randomises publies, la VAA est associee a une tres bonne observance et un suivi PV/oxy frequent.

Introduction Les traitements medicaux de l’emphyseme ont une efficacite limitee. L’objectif de cette etude est d’evaluer l’efficacite, la securite et le cout de la reduction volumique par spirales endobronchiques dans le traitement de l’emphyseme severe. Methodes Etude multicentrique randomisee (1:1) de superiorite comparant la reduction volumique par spirales ( n = 50) au traitement medical standard seul ( n = 50) avec un suivi pendant un an. Le critere d’evaluation principal est l’amelioration du test de marche de six minutes a six mois (comparaison intergroupe du pourcentage de patients ayant une augmentation d’au moins 54 m de la distance parcourue). Les criteres secondaires sont les modifications a 6 et 12 mois de la fonction respiratoire, de la dyspnee, de la qualite de vie, la mortalite et le cout global. Resultats Soixante et onze hommes et 29 femmes, d’âge moyen de 62 ans ont ete inclus. A 6 mois, une amelioration du test de marche de 6 minutes de plus de 54 m etait observee chez 16 patients (32 %) dans le groupe spirales contre 8 patients (16 %) dans le groupe temoin ( p = 0,03). Les modifications a 6 et 12 mois dans le groupe spirales et le groupe temoin etaient respectivement de +9 % [IC 95 %, +4 ; +14] et +8 % [+3 ; +13] vs –3 % [–6 ; +1] et –3 % [–8 ; +2] pour le VEMS ( p p p Conclusion La reduction volumique par spirales est associee a une augmentation des capacites a l’exercice a 6 mois et a une amelioration de la fonction respiratoire et de la qualite de vie a 6 et 12 mois.

IMPORTANCE: Therapeutic options for severe emphysema are limited. Lung volume reduction using nitinol coils is a bronchoscopic intervention inducing regional parenchymal volume reduction and restoring lung recoil. OBJECTIVE: To evaluate the efficacy, safety, cost, and cost-effectiveness of nitinol coils in treatment of severe emphysema. DESIGN, SETTING, AND PARTICIPANTS: Multicenter 1:1 randomized superiority trial comparing coils with usual care at 10 university hospitals in France. Enrollment of patients with emphysema occurred from March to October 2013, with 12-month follow-up (last follow-up, December 2014). INTERVENTIONS: Patients randomized to usual care (n = 50) received rehabilitation and bronchodilators with or without inhaled corticosteroids and oxygen; those randomized to bilateral coil treatment (n = 50) received usual care plus additional therapy in which approximately 10 coils per lobe were placed in 2 bilateral lobes in 2 procedures. MAIN OUTCOMES AND MEASURES: The primary outcome was improvement of at least 54 m in the 6-minute walk test at 6 months (1-sided hypothesis test). Secondary outcomes included changes at 6 and 12 months in the 6-minute walk test, lung function, quality of life as assessed by St George's Respiratory Questionnaire (range, 0-100; 0 being the best and 100 being the worst quality of life; minimal clinically important difference, ≥4), morbidity, mortality, total cost, and cost-effectiveness. RESULTS: Among 100 patients, 71 men and 29 women (mean age, 62 years) were included. At 6 months, improvement of at least 54 m was observed in 18 patients (36%) in the coil group and 9 patients (18%) in the usual care group, for a between-group difference of 18% (1-sided 95% CI, 4% to ∞; P = .03). Mean between-group differences at 6 and 12 months in the coil and usual care groups were +0.09 L (95% CI, 0.05 L to ∞) (P = .001) and +0.08 L (95% CI, 0.03 L to ∞) (P = .002) for forced expiratory volume in the first second, +21 m (95% CI, -4 m to ∞) (P = .06) and +21 m (95% CI, -5 m to ∞) (P = .12) for 6-minute walk distance, and -13.4 points (95% CI, -8 points to ∞) and -10.6 points (95% CI, -5.8 points to ∞) for St George's Respiratory Questionnaire (1-sided P

International audience

International audience