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In recent years, several researchers have attempted to identify COPD phenotypes using different cluster analysis. This study aimed to determine the most optimal cluster analysis (supervised vs unsupervised) to robustly identify clinical phenotypes. 2,968 COPD patients have been included from January 2014 until February 2020. General information (age, BMI, smoking, comorbidities), lung function, exacerbations and symptoms were collected. After 5 years of follow-up, vital status was recorded. A hierarchical classification on the principal components (HCPC) was performed, followed by two unsupervised classification algorithms: k-means and PAM (Partition Around Medoids). Robustness was defined according to three different indices of validation (Connectivity, Dunn and silhouette). The mean age was 70 years, 63.7% of males, current smokers: 38.7%, mean FEV1: 61.3% predicted, ≥2 exacerbations: 43.6%, mMRC dyspnea grade≥2: 56.3%, chronic cough: 58%. The 5-year mortality rate was 11.3%. Based on our hypothesis, four phenotypes were described, using the PAM method. The phenotype A (24.2%) consisted of elderly patients with severe airflow limitation, low symptoms, cardiovascular comorbidities, diabetes and a higher mortality. The phenotype B (23.9%) contained more female patients, young patients with moderate airflow limitation and a high rate of current smokers. The phenotype C (25.5%) contained patients with very severe airflow limitation, more symptoms and low BMI. The Phenotype D (26.2%) was composed of patients with mild airflow limitation and low dyspnoea. These results showed the superiority of PAM classification compared with two other algorithms (k-means and HCPC) in terms of the robustness.

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

Objective The earliest possible detection of individuals with COVID-19 has been essential to curb the spread of infection. Existing digital tools have been scaled up to address this issue. Every night telemonitoring data on continuous positive airway pressure (CPAP) device use, the first-line therapy for obstructive sleep apnoea (OSA), is collected worldwide. We asked whether the changes in CPAP adherence patterns of might constitute an alert for COVID-19. Methods We analysed preliminary results of telemonitoring data, recorded between February 1 and April 30, 2020, on OSA patients followed by our sleep clinics and diagnosed with COVID-19. Results CPAP telemonitoring data from the first 19 patients diagnosed with COVID-19 showed a clear decrease or halt in adherence in the 20 days immediately preceding COVID-19 diagnosis compared to an earlier period (p Conclusion Patterns of continuous positive airway pressure device use by obstructive sleep apnoea patients collected through telemonitoring can indicate the onset of COVID-19 symptoms. Existing telemonitoring platforms could be immediately used to screen for COVID-19, and for other respiratory infections, in this large at-risk population.

Background The symptomatic response to continuous positive airway pressure (CPAP) therapy in COPD-obstructive sleep apnea overlap syndrome (OVS) compared to OSA syndrome (OSA) alone has not been well studied so far. The aim of this study is to explore main differences in the clinical response to CPAP treatment in OVS compared to OSA alone. Study design and methods Using prospective data from the French National Sleep Apnea Registry, we conducted an observational study among 6320 patients with moderate-to-severe OSA, available spirometry, and at least one follow-up visit under CPAP therapy. Results CPAP efficacy measured on the residual apnea-hypopnea index and median adherence were similar between OVS and OSA patients. In both groups, the overall burden of symptoms related to sleep apnea improved with CPAP treatment. In a multivariable model adjusted for age, gender, body mass index, adherence to treatment and residual apnea-hypopnea index, OVS was associated with higher odds for persistent morning headaches (OR: 1.37 [95% CI; 1.04; 1.79]; P = 0.02), morning tiredness (OR: 1.33 [95% CI: 1.12; 1.59]; P Interpretation CPAP therapy was effective in normalizing the apnea-hypopnea index and significantly improved OSA-related symptoms, regardless of COPD status. CPAP should be offered to patients with OVS on a trial basis as a significant improvement in OSA-related symptoms can be expected, although the range of response may be less dramatic than in OSA alone.

Background One of the major challenges in treating OSA is to achieve adequate CPAP adherence. Telemonitoring has the potential to provide individualized management and early recognition of problems during treatment. Research Question What is the effect of a multimodal telemonitoring intervention on treatment adherence, quality of life, and functional status in symptomatic patients with OSA and low cardiovascular risk? Study Design and Methods In a multicenter, randomized controlled trial, patients newly diagnosed with OSA were randomly assigned to multimodal telemonitoring for 6 months vs usual care (UC). Telemonitoring consisted of built-in electronic alert algorithms for early adjustment of CPAP treatment in case of side effects, leaks, or persistent residual events. The primary outcome was CPAP adherence (in hours per night). Secondary outcomes included daily symptoms such as fatigue and sleepiness, and quality of life measured by using self-reported questionnaires. Results A total of 206 patients with OSA and a median age of 50.6 years (interquartile range [IQR], 42.1; 58.1 years) were included in the study; they were predominantly male (63%) with a median BMI of 30.6 kg/m2 (IQR, 26.8; 35.1 kg/m2) and a median apnea-hypopnea index of 45.2 events/h (IQR, 34.0; 60.0 events/h). Of these, 102 received UC and 104 received telemonitoring. After 6 months of treatment, CPAP adherence was similar in the two groups when assessed either by mean duration of usage (4.73 ± 2.48 h per night in the telemonitoring group and 5.08 ± 2.44 h per night in the UC group; P = .30) or in percentage of patients adherent to treatment (> 4 h usage per night, > 70% nights; 64% in the telemonitoring group vs 72% in the UC group; P = .24). There was no significant difference between the groups in effect size of improvement in fatigue and sleepiness. Interpretation In patients with severe OSA and low cardiovascular risk, multimodal telemonitoring did not increase CPAP adherence. For both the telemonitoring and UC groups, similar improvements in daytime symptoms were achieved. Trial Registry ClinicalTrials.gov; No.: 01796769; URL: www.clinicaltrials.gov

Obstructive sleep apnoea (OSA) is one of the most prevalent chronic diseases affecting nearly one billion people worldwide [1]. Continuous positive airway pressure (CPAP) is the first-line therapy for obstructive sleep apnoea (OSA) [1] being currently used by over one million people throughout France. A focus on the OSA population during the COVID-19 outbreak is of particular interest for two main reasons: (i) OSA is a multi-morbid disease with up to 70% of patients being obese [3] and exhibiting a high prevalence of cardio-metabolic comorbidities.

Background: One of the major challenges in treating obstructive sleep apnea (OSA) is to achieve adequate continuous positive airway pressure (CPAP) adherence. We determined the effect of a multimodal telemonitoring intervention on CPAP adherence, quality of life and functional status in symptomatic OSA patients with low cardiovascular risk. Study Design and Methods: In a multicenter, randomized controlled trial, newly diagnosed OSA patients were randomly assigned to multimodal telemonitoring(TM) for 6 months vs usual care (UC). TMconsisted ofbuilt-in electronic alert algorithms for early adjustment of CPAP treatment in case of side effects, leaks or persistent residual events.The outcomesincluded CPAP adherence, daily symptoms such as fatigue and sleepiness, and quality of life. Results: Of 206 OSA patients aged 50.6 [42.1;58.1] (median [IQR]) years;predominantly male (63%) with body mass index of 30.6 [26.8;35.1] kg/m2and an AHI of 45.2 [34.0;60.0] events/hour) 102 received UC and 104 TM. After 6 months of treatment, CPAPadherence was similar in the two groups when assessed either by mean duration of usage (4.73±2.48 hours/night in the TM group and 5.08±2.44 hours/night in the UC group, p=0.30) or in % of patients adherent to treatment (over 4 hours usage/night, > 70% nights; 64% in TM vs 72% in UC, p=0.24). There was no significant difference between the groups in effect size of improvement in fatigue and sleepiness. Interpretation: In severe OSA patients with low cardiovascular risk, multimodal telemonitoring did not increase CPAP adherence. For both TM and UC groups similar improvements in daytime symptoms were achieved.

The main factors that increase the mortality risk of COPD patients are age, comorbidities and the severity of airflow obstruction. This study aimed to validate the clinically relevant COPD phenotypes found by Burgel P-R et al [1] and analyzed their impact on 5-year mortality in the PALOMB cohort. COPD patients (post-BD FEV1/FVC 2,653 patients (66 years old, 64.27% males) were included. Application of the CART-based algorithm to Palomb cohort confirmed that it identified 5 COPD phenotypes with different clinical characteristics. In addition: The high proportion of FEV1 decline (≥100 ml/yr) belongs to phenotype 1 and 4; the majority of patients in these phenotypes were under oxygen therapy and they were associated with higher rates of exacerbation, lung cancer, anxiety and depression. These results confirmed the identification of five clinically relevant COPD phenotypes. A novel finding of this study is that FEV1 decline, frequency of exacerbations and other comorbidities were associated with the more severe phenotypes. Fundings: Bordeaux Univ Foundation, Novartis, Isis Medical, GSK, BI, Chiesi.

BackgroundMore advanced knowledge is needed on how COPD alters the clinical presentation of obstructive sleep apnea (OSA) and how the association of both diseases, known as 'overlap syndrome' (OVS), impacts on cardiovascular health.ObjectiveTo investigate differences between patients with OVS and those with moderate-to-severe OSA alone.MethodsA cross-sectional study conducted in the French National Sleep Apnea Registry between January 1997 and January 2017. Univariable and multivariable logistic regression models were used to compare OVS versus OSA alone on symptoms and cardiovascular health.Results46,786 patients had moderate-to-severe OSA. Valid spirometry was available for 16,466 patients: 14,368 (87%) had moderate-to-severe OSA alone and 2098 (13%) had OVS. A lower proportion of OVS patients complained of snoring, morning headaches and excessive daytime sleepiness compared to OSA alone (median Epworth Sleepiness Scale score: 9 [interquartile range (IQR) 6-13] versus 10 (IQR 6-13), respectively; P ConclusionsIn adults with moderate-to-severe OSA, OVS was minimally symptomatic, but exhibited higher odds for prevalent coronary heart disease, heart failure and peripheral arteriopathy.

Background: Growth hormone (GH) stimulates the production of insulin-like growth factor 1 (IGF-1) in most tissues and together GH and IGF-1 profoundly impact adipose tissue deposition, glucose metabolism and cardiovascular function. A low serum IGF-I level has been reported as being associated with obstructive sleep apnea (OSA) and might be one of the mechanisms underlying cardio-metabolic risk in OSA patients.Methods: In a multicenter national study, 817 patients consulting for suspicion of OSA (OSA confirmed for 567 patients) underwent serum IGF-1 measurements. We analyzed the association between an IGF-1 level below the median value of the population and variables related to cardio-metabolic risk: body mass index (BMI) and waist circumference, apnea hypopnea index (AHI), cholesterol and triglycerides (expressed as median and divided into quartiles for continuous variables).Results: After adjustment for age and gender, low IGF-1 levels were associated with increased BMI and AHI (Odds ratios (OR) = 2.83; p < 0.0001 and OR = 3.03, p < 0.0001 for Quartile 4 vs. Quartile1, respectively), with elevated cholesterol levels (OR = 1.36, p = 0.0444), and elevated triglyceride levels (OR = 1.36; p = 0.0008).Conclusions: Both adiposity and sleep apnea synergistically predict low levels of IGF-1 and thus could together contribute toward cardio-metabolic risk. Further work are needed to confirm whether IGF-1 levels allow grading severity and predicting response to treatments to aim at a personalized medicine for patients suffering from OSA.

Introduction L’identification de sous-groupes de patients atteints de BPCO et partageant des caracteristiques cliniques et/ou paracliniques communes est a l’origine du concept de phenotypes dans cette pathologie. De nombreuses etudes de cohortes observationnelles sont en cours, pour tenter d’identifier de nouveaux phenotypes de patients BPCO. L’objectif de cette etude est de determiner l’analyse en cluster la plus optimale (supervise vs non-supervise) pour identifier de facon robuste les phenotypes cliniques dans le cadre de la cohorte PALOMB. Methodes Les patients BPCO (VEMS/CVF Resultats 2968 patients (70 ans, 63,7 % d’hommes, 38,7 % de fumeurs actuels) ont ete inclus ( Tableau 1 ). Parmi eux, 43,6 % ont eu au moins deux exacerbations au cours des 12 derniers mois, 58 % avaient de la toux chronique et 56,3 % avaient une dyspnee plus severe. Selon GOLD 2007, la severite de la BPCO etait representee par le stade I (18,2 %), le stade II (51,7 %), le stade III (24,1 %) et le stade IV (6 %). Le taux de la mortalite a 5 ans est de 11,3 %. Sur la base de notre hypothese, nous avons pu determiner quatre phenotypes, a l’issu de la methode PAM (k-medoides: partition Around Medoids): le phenotype A (24,2 %), B (23,9 %), C (25,5 %), et D (26,2 %). Le phenotype (A) etait constitue de patients âges, comorbides (cardiovasculaire et de diabete), peu symptomatiques, severe sur le VEMS. Le phenotype (B) etait tres severe, plus symptomatique, avec un IMC faible, plus de comorbidite metabolique, osteo-articulaire et neuropsychiatrique. Conclusion Ces Resultats illustrent l’aspect plurifactoriel des differents phenotypes identifies chez les patients BPCO. Parmi toutes les mesures de classification, la methode PAM (Machine Learning) apparait la plus valide.

Objectif Comparaison des resultats de polygraphie analyses par lecture manuelle effectuee par des experts et par lecture automatique utilisant l’algorithme Somnolyzer™ validee par des experts. Methodes Les traces de 19 patients ont ete lus manuellement selon les RPC francaises. Les enregistrements ont ete anonymises pour etre ensuite analyses par l’algorithme Somnolyzer, un logiciel de lecture utilisant les reseaux neuronaux. Enfin, une correction/validation de l’analyse de Somnolyzer etait faite par l’expert. Une etude comparative des resultats de chaque analyse a ete realisee. Nous rapportons dans cette etude uniquement les resultats de l’analyse ventilatoire. Resultats L’analyse manuelle a detecte 3421 evenements (24,5 % apnees) avec un IAH moyen de 25,4 ± 16,4. L’analyse automatique Somnolyzer a detecte 3424 evenements (42,7 % apnees) avec un IAH moyen de 27,8 ± 21,1. L’analyse Somnolyzer validee par un medecin a detecte 3383 evenements (38,7 % apnees) avec un IAH moyen de 25,4 ± 16,4. Entre l’analyse manuelle et l’analyse Somnolyzer validees, 3 patients changent de classe de severite en passant de moderee a legere. Les correlations entre l’analyse manuelle et l’analyse Somnolyzer validees etaient de R2 = 0,89 pour l’IAH. Enfin, l’utilisation de l’analyse Somnolyzer a permis une reduction du temps de lecture de 45 %. Conclusion L’evaluation de l’IAH par l’algorithme automatique Somnolyzer validee par le medecin est pertinente et permet de reduire le temps de lecture des enregistrements. Cependant, l’analyse des traces EEG par Somnolyzer reste a evaluer.

One of the major challenges in treating OSA is to achieve adequate CPAP adherence. Telemonitoring has the potential to provide individualized management and early recognition of problems during treatment.What is the effect of a multimodal telemonitoring intervention on treatment adherence, quality of life, and functional status in symptomatic patients with OSA and low cardiovascular risk?In a multicenter, randomized controlled trial, patients newly diagnosed with OSA were randomly assigned to multimodal telemonitoring for 6 months vs usual care (UC). Telemonitoring consisted of built-in electronic alert algorithms for early adjustment of CPAP treatment in case of side effects, leaks, or persistent residual events. The primary outcome was CPAP adherence (in hours per night). Secondary outcomes included daily symptoms such as fatigue and sleepiness, and quality of life measured by using self-reported questionnaires.A total of 206 patients with OSA and a median age of 50.6 years (interquartile range [IQR], 42.1; 58.1 years) were included in the study; they were predominantly male (63%) with a median BMI of 30.6 kg/mIn patients with severe OSA and low cardiovascular risk, multimodal telemonitoring did not increase CPAP adherence. For both the telemonitoring and UC groups, similar improvements in daytime symptoms were achieved.ClinicalTrials.gov; No.: 01796769; URL: www.clinicaltrials.gov.

Introduction & background: Residual events during CPAP contribute to increase treatment drop-outs. Clinical scenarios triggering residual events during CPAP use are poorly described. Aims & objectives: Underlying comorbidities, especially cardiovascular diseases, lifestyle factors, OSA characteristics at baseline and type of mask are suggested as potential contributors. Methods: Patients from the prospective national French sleep apnea registry with apnea-hypopnea index (AHI) = 15/h and CPAP indication were included. A logistic regression analysis was used to identify factors associated with the probability of exhibiting a residual AHI > 5/h whilst on CPAP. Results: 12,285 OSA patients predominantly men (N=8715, 70.9%), middle aged (median [IQR]: 58.2 [49.8;66.1] years) and obese (median body mass index: 31.3 [27.7;35.6] kg/m²) were included. Most had an AHI=5/h (N=9,573, 77.9%) versus 22.1% exhibited an AHI>5/hour. The latter group was significantly less adherent to CPAP (5.75 [4.01;7.00] vs 6.00 [4.53;7.00] h/night). In multivariable analysis, factors associated with a high residual AHI were male gender, age and sedentary lifestyle, OSA severity, cardiovascular comorbidities and interface (orofacial versus nasal mask: OR = 2.15 [CI: 1.95;2.37]). Conclusions: The knowledge of at-risk clinical scenarios predicting more frequent residual events will help in the timely provision of personalized care including type of PAP therapy, attention to comorbidity care and interfacechoice

Among patients with confirmed obstructive sleep apnoea the prevalence of acromegaly was 0.35% http://ow.ly/eyrq302v4AI

Introduction Alliance Apnees du Sommeil (A2SA) mene des enquetes pour mieux comprendre le vecu des patients et ameliorer leur parcours de soins. Ce travail a ete mene afin d’evaluer l’impact de la pandemie COVID-19 et du confinement sur le vecu et les comportements des patients vis-a-vis de la prise en charge par PPC d’un syndrome d’apnees hypopnees obstructif du sommeil (SAHOS). L’enquete a aussi permis de collecter du verbatim. Methodes Un questionnaire auto-administre Survey-Monkey a ete mis en ligne sur le site d’A2SA entre le 27/04 et le 17/05/20. Il a ete diffuse aupres des patients via A2SA et avec le soutien de societes prestataires de sante a domicile. Resultats Au total, 13 994 patients avec un SAHOS ont repondu (SAHOS severe dans 46 % des cas). Parmi les patients, 67,1 % sont des hommes, 61,9 % ont plus de 60 ans. Parmi les patients interroges, 99,3 % utilisent une machine a pression positive continue (PPC). La crise a eu peu d’impact sur les habitudes des patients pour l’utilisation de la PPC : la quasi-totalite (95,6 %) declare ne pas avoir arrete le traitement, ni avoir modifie sa duree d’utilisation (85,8 %). Parmi les patients, 11,8 % seulement ont beneficie d’une consultation medicale a distance pour leur SAHOS. Si 3,3 % des interroges declarent avoir contracte le virus (ayant necessite une hospitalisation dans 8,8 % des cas), la prevalence ne parait pas plus importante que dans la population generale. Le confinement en lui-meme a impacte significativement les reperes chrono-biologiques des patients: 69 % ont constate une modification de leurs horaires de sommeil et 24,5 % de leurs habitudes alimentaires. L’enquete revele un fort besoin d’information des patients au cours de cette periode. On notera le role important des prestataires de sante a domicile. Plusieurs autres acteurs, par ailleurs tres mobilises pendant la crise, ont aussi contribue a la diffusion d’information (pneumologues, medecins traitants). Les differents temoignages revelent qu’un accompagnement renforce au cours de la crise aurait ete necessaire : 15,2 % seulement affirment avoir beneficie d’informations suffisantes. Ils auraient voulu recevoir plus d’informations sur l’usage du traitement, des techniques pour mieux gerer le stress et l’anxiete lies a la pandemie, ou pour faciliter l’endormissement. Conclusion Cette enquete montre une observance remarquable du traitement malgre la perte de rythmes sociaux (sommeil, alimentation) due au confinement. La richesse des verbatim revele un fort besoin d’accompagnement des patients, besoin permanent exacerbe par le contexte.

Introduction Diuretics have been reported as effective for reducing obstructive sleep apnea (OSA) severity by preventing fluid retention and reducing rostral fluid shift. The benefit of diuretics might vary depending upon the OSA clinical phenotype and comorbidities. Objective To test this hypothesis, we conducted a propensity score-matched cohort analysis of data from the French national sleep apnea registry “Observatoire Sommeil de la Federation de Pneumologie” (OSFP). Method A propensity score analysis was used to determine the impact of diuretics on OSA severity. Matching (ratio 1:4) was performed by using a 0.1 collider for propensity score. Severe OSA was defined as an apnea-hypopnea index (AHI) > 30 events/h and the usefulness of diuretics was assessed using a logistic regression model. Results The 69,564 OSA patients studied in the OSFP prospective observational cohort had a median age of 56.9 years [Interquartile range (IQR): 47.4; 65.6], 67% were men, and the median AHI was 28 [14; 43] events/h. Among them, 9783 (14.1%) were treated with diuretics. Diuretics reduced OSA severity in overweight or moderately obese patients (P = 0.03) and in patients with hypertension (P Conclusion Diuretics appear to have a positive impact on OSA severity in overweight or moderately obese patients with hypertension. Diuretics might be prioritized in combined therapies for hypertensive patients with OSA.

Background and objective Continuous positive airway pressure (CPAP) is the first-line therapy for obstructive sleep apnoea (OSA). Residual apnoea and/or hypopnoea events, that is an apnoea-hypopnoea index (AHI) > 5, during CPAP contribute to treatment drop-out. The clinical scenarios triggering residual events during CPAP use are poorly described. Underlying co-morbidities, especially cardiovascular diseases, lifestyle factors, OSA characteristics at diagnosis and type of mask have been suggested as potential contributors. Methods Patients from the prospective French sleep apnoea registry diagnosed with OSA (AHI ≥ 15 events/h) treated with CPAP were included. Logistic regression analysis identified factors associated with a risk of residual AHI > 5 events/h on CPAP. Results The 12 285 OSA patients were predominantly men (n = 8715, 70.9%), middle-aged (58.2 (49.8; 66.1) years) and obese (median body mass index: 31.3 (27.7; 35.6) kg/m2 ). Most had an AHI ≤ 5 events/h (n = 9573, 77.9%) versus 22.1% with AHI > 5/h. The latter were less CPAP adherent (5.75 (4.01; 7.00) vs 6.00 (4.53; 7.00) h/night). In multivariable analysis, factors associated with residual AHI >5/h were male sex, age, sedentary lifestyle, OSA severity, cardiovascular co-morbidities (heart failure and arrhythmia) and type of interface (orofacial mask versus nasal mask: OR = 2.15 (95%CI: 1.95; 2.37)). A subgroup analysis found that patients using pressures above 10 cm H2 O were 1.43 (95% CI: 1.3; 1.57) times more likely to have residual AHI > 5/h. Conclusion Knowing about risk factors for residual apnoeic-hypopnoeic events may assist in the timely provision of personalized care including the type of PAP therapy, attention to co-morbidities and choice of interface.

Introduction Les diuretiques sont presupposes efficaces pour reduire la severite du syndrome d’apnees obstructives du sommeil (SAOS) en prevenant la retention des fluides et en reduisant le deplacement rostral des fluides ou « fluid shift ». L’impact des diuretiques pourraient varier selon les phenotypes cliniques des patients apneiques et leurs comorbidites. Pour tester cette hypothese, nous avons realise une analyse par score de propension, en utilisant le registre national des apnees du sommeil « Observatoire sommeil de la federation de pneumologie » (OSFP). Methodes Une methode de score de propension a ete utilisee pour determiner l’impact des diuretiques sur la gravite du SAOS. Un appariement 1 :4 a ete effectue en utilisant un collisionneur 0,1 pour le score de propension. L’impact des diuretiques sur la gravite du SAOS definie par l’indice d’apnees-hypopnees (IAH) > 30 evenements/h, a ete evalue a l’aide d’un modele de regression logistique. Resultats Les 69 564 patients SAOS etudies dans la cohorte observationnelle prospective de l’OSFP avaient un âge median de 56,9 ans [interquartile : 47,4 ; 65,6], 67 % etaient des hommes, avec un IAH median de 28 [14 ; 43] evenements/h. Parmi eux, 9783 (14,1 %) etaient traites par des diuretiques. Les diuretiques reduisaient la gravite du SAOS chez les patients en surpoids ou moderement obeses (p = 0,03) et chez les patients souffrant d’hypertension arterielle (p Conclusion Ces resultats suggerent un impact positif des diuretiques sur la gravite du SAOS chez les patients en surpoids ou moderement obeses souffrant d’hypertension arterielle. Ces medicaments pourraient etre priorises comme therapie combinee, associee a la pression positive continue chez les patients apneiques hypertendus.

Introduction: Asthme & Allergies Helpline regularly receives asthma patients’ testimonies describing problems in their care pathway. Asthme & Allergies decided to carry out a survey to verify the information and to collect patients quotes. Method: A 10 question questionnaire self-administered via Survey Monkey was proposed to patients on Asthme & Allergies website between 29/05 & 7/07/2017 Results: 246 answers were collected. 79.7% of respondents are women. 32.9% are under 30, 45.9% between 31 and 50, and 21.2% over 50 years old. 65% report a follow-up by a GP, 34% by a pulmonologist in private practice, 29% by a hospital pulmonologist, 26% by an allergist. The frequency of visits is every 3 months for 32.5%, twice a year for 25.6%, once a year for 21.1%, every month for 10.1%. 79.3% got lung function tests and 78.9% allergy tests. 49.6% received an emergency action plan. 44.9% were hospitalized for their asthma, and only 51% of them left hospital with an appointment with a pulmonologist. Medical follow-up for asthma is considered as non-existent for 9.7%, insufficient for 29.54%, correct for 32.07%, satisfactory for 18.57%, very satisfactory for 10.13% Conclusion: The quotes show that respondents are mainly people with severe asthma, which explains the high rate of lung function & allergy tests and hospitalizations. Patients express their difficulty in getting a diagnosis, they specify that the appointment with a pulmonologist was often taken at their own initiative, and the delays for an appointment are too long. They also say that asthma is not taken seriously enough. This survey drew our attention on the need to develop adapted tools to optimize diagnosis, patient pathway and access to specialists.

Objectif La pression positive continue (PPC), traitement de reference du syndrome d’apnees obstructives du sommeil (SAOS) a une efficacite demontree sur les symptomes du SAOS, cependant son impact sur les comorbidites semble plus limite. Les differents contextes cliniques associes a la persistance d’evenements residuels sous PPC (index d’apnees hypopnees (IAH) > 5/ h) sont peu decrits. Nous faisons l’hypothese que les comorbidites, le mode de vie, le type d’interfaces ou encore la severite du SAOS lors du diagnostic pourraient expliquer la survenue d’evenements respiratoires persistants sous PPC. Methodes Inclusion des patients ayant un SAOS modere (IAH > 15/ h) avec une visite de suivi sous PPC datant de 1 mois a 3 ans dans le registre prospectif national « Observatoire Sommeil de la Federation de Pneumologie ». La determination des facteurs associes a une probabilite d’avoir un IAH > 5/h sous PPC a ete effectuee par un modele de regression logistique. Resultats La population de l’etude comprend 12 285 patients inclus entre janvier 2005 et mai 2018. Elle est composee majoritairement d’hommes (71 %), ayant une mediane d’âge de 58,2 ans (Intervalle interquartile : [49,8 ; 66,1]) ans, avec un indice de masse corporelle median de 31,3 [27,7 ; 35,6] kg/m2 et un IAH initial median de 38 [30 ; 55]/ h. L’IAH residuel median observe sous PPC lors de la visite de suivi est de 2,7 [1,2 ; 5,0] evenements/h. La majorite des patients ont un IAH ≤ 5/ h (9 573 (78 %)) et 22 % de patients ont un IAH > 5/h. Les patients avec un IAH > 5/h sont significativement moins adherents a la PPC (5,75 [4,01 ; 7,00] versus 6,00 [4,53 ; 7,00] heures p 5/ h sont : l’âge, le sexe, la sedentarite, la severite du SAOS au diagnostic, les comorbidites cardiovasculaires (insuffisance cardiaque, arythmies), et le type d’interface (masque oro-facial vs masque nasal : OR = 2,15 [1,95 ; 2,37]). Il existe une relation dose-reponse entre l’IAH au diagnostic (> 30/h) et le risque d’avoir un IAH > 5/h. Conclusion Lors de l’instauration d’un traitement par PPC, il est essentiel d’identifier les contextes cliniques predictifs de survenue d’evenements residuels afin de personnaliser les soins, la prise en charge des comorbidites, le type de pression positive (PPC versus ASV) et le choix de l’interface.

Background: OSA management must target not only increasing adherence to continuous positive airway pressure (CPAP) but should also include strategies aimed at reducing blood pressure and increasing physical activity. Objective: To evaluate the effectiveness of an integrated intervention using remote patient monitoring (telemonitoring) in reducing arterial blood pressure (BP) in high cardiovascular risk OSA patients. Methods: In a multicenter, open, randomized trial, OSA patients were randomly assigned at time of CPAP initiation to usual care vs multimodal telemonitoring for 6 months. Telemonitoring used electronic equipment that collected information about BP, symptoms, CPAP side effects, oximetry and steps per day. Home care providers conducted telemonitoring reviews and protocolized actions. The primary effectiveness outcome was assessed using home self-measured BP (HBP) (3 consecutive days, 10 to 18 measurements). Secondary outcomes included CPAP compliance, symptoms and steps per day. Results: Of 306 patients (mean age 60 [SD, 9.5] years; 227 [74 %] men; mean BMI 33 [SD, 6.3] kg/m2; mean AHI 50/hour [SD, 20]), 149 received usual care and 157 telemonitoring. The intervention and usual care groups did not differ significantly in 6 months home self-measured BP. In secondary analyses, there were no significant differences in steps per day or symptoms, but there was a significant difference in CPAP compliance in favor of the telemonitoring arm (-0.53 hour (95% CI: -1.05; 0.00), p=0.05). Conclusion: In OSA patients with high cardiovascular risk, multimodal telemonitoring did not improve HBP but increase CPAP adherence.

Objective Several reports suggest that glaucoma may be linked to obstructive sleep apnea (OSA). Herein, we investigated this hypothesis in the largest reported sample to date. Methods Data were from the French multicenter prospective cohort study including OSA-suspected patients from private practice, general and teaching hospitals. Demographics, history, comorbidities and sleep studies from patients aged >50years were analyzed. Univariate and multivariate logistic regression were used to predict the odds ratio of prevalent glaucoma depending on sleep apnea status and other potential anthropometric, metabolic, cardiovascular and respiratory confounders. Results A total of 9580 patients aged >50years were included. Among these patients, 6754 had sleep apnea and 330 had glaucoma. Glaucoma prevalence was 3.55% in patients with OSA and 3.14% in patients without OSA. OSA diagnosis did not significantly influence the risk of glaucoma in univariate analysis (odds ratio [OR], 1.13; 95% confidence interval [CI], 0.87–1.47). The variables significantly influencing the odds of glaucoma with multivariate regression were age >61.4years (OR, 1.55; 95% CI, 1.23–1.95), body mass index 2 (OR, 1.58; 95% CI, 1.26–1.99), female gender (OR, 1.40; 95% CI, 1.11–1.78), arterial hypertension (OR, 1.32; 95% CI, 1.05–1.67), high triglyceride levels (OR, 2.03; 95% CI, 1.43–2.88) and thyroid dysfunction (OR, 1.52; 95% CI, 1.09–2.11). Conclusions When confounders are taken into account, patients with OSA do not have higher odds of glaucoma compared with patients who do not have OSA in a large multicenter prospective cohort.

Objectif Les troubles du sommeil et en particulier le syndrome d’apnees obstructives du sommeil (SAOS) sont lies a un risque eleve d’accidents de la route. L’objectif etait d’evaluer le role respectif de l’index d’apnees hypopnees (IAH) compare a la somnolence au volant rapportee par les patients, sur le risque d’accidents chez les patients SAOS. Methodes A partir du registre national prospectif de l’Observatoire Sommeil de la Federation de Pneumologie (OSFP), une analyse transversale des donnees de somnolence au volant et d’accidents lies a la somnolence chez 58 815 sujets suspectes de SAOS a ete realisee. Resultats Au total, 58 815 patients d’âge median 55,6 [45,3 ; 64,6] ans, 65 % d’hommes, avec un IAH median de 22 [8 ; 39]/h et un score d’Epworth de 9 [6 ; 13]. Au total, 20 310 (35 %) patients rapportent de la somnolence au volant, 4 588 (8 %) rapportent un presque accident et 1 313 (2 %) rapportent un accident lie a la somnolence. Les patients rapportant une somnolence au volant quel que soit leur statut apneique ou non et la severite du SAOS ont un risque 10 a 20 fois plus eleve d’accidents de la route lies a la somnolence. En analyse multivariee les predicteurs d’accidents sont : le sexe (homme), le score d’Epworth (une augmentation de 3 points est associee a une augmentation du risque de 23 %), antecedent de presque accident (risque multiplie par 7), les mouvements periodiques de jambes, les troubles de memoire et la transpiration nocturne. Conclusion La somnolence au volant rapportee par les patients est un meilleur predicteur d’accident de la route. L’IAH n’a pas de contribution significative.

Introduction: Insulin-like growth factor-1 (IGF-1) is the main growth factor associated with growth hormone (GH). IGF-1curbs endothelial function and prevents early atherosclerosis by promoting insulin sensitivity and by preventing postprandial dyslipidemia. Low serum IGF-1 levels have been reported to be associated with SAS and might be one of the mechanisms underlying the increased cardiometabolic risk in SAS. We studied IGF-1 levels in a large prospective cohort of patients referred for suspicion of SAS. Methods: In a multicenter study, serum IGF-1 levels were obtained for 817 patients consulting for suspicion of SAS (SAS confirmed for 567 patients). We analyzed the association between serum IGF-1 level below the median value of the general population and variables related to cardiometabolic risk: BMI, apnea hypopnea index (AHI), cholesterol and triglycerides (TG). Results: In our cohort, IGF-1 level below the median (138 ng/ml) was associated with increased BMI and AHI (respectively OR = 2.83; p Conclusion: There is a relationship between low levels of IGF-1 and predictors of cardiovascular risk in SAS. IGF-1 is a potential prognostic biomarker in SAS patients. Our results also provide insights regarding the mechanisms of co-morbidities in these patients.

Introduction: Acromegaly has a prevalence about 0.01% in general population. SAS is experienced by up to 80% of those with acromegaly. The high frequency of acromegaly-related co-morbidities and late diagnosis make screening for acromegaly advisable in at risk populations such as SAS. Aims: To determine the prevalence of undiagnosed acromegaly in patients referred for SAS, using a standardized questionnaire and systematic measurement of serum insulin-like growth factor-1 (IGF-1). Methods: Patients referred for SAS to one University Hospital or to 10 participating private practices. Clinical data, co-morbidities and medications were recorded via the French Sleep Observatory. Included patients underwent polysomnography or respiratory polygraphy. When IGF-1 levels were elevated for age, a second measurement was made and combined with GH levels obtained during an Oral Glucose Tolerance Test. If necessary the patient underwent pituitary MRI and was examined by an endocrinologist for definite diagnosis of acromegaly. Results: Of 873 patients prospectively included, 817 had a measurement of serum IGF-I. 2 patients with acromegaly caused by pituitary adenoma were diagnosed and treated; both had severe SAS. The prevalence of acromegaly in our cohort was 0.25%. 567 patients had moderate to severe SAS with an apnea-hypopnea index>15; in this group the prevalence of acromegaly was 0.35% (27 fold the prevalence in the general population). Conclusion: The prevalence of acromegaly in patients with SAS is very high. Further studies are needed to evaluate the cost-effectiveness of systematic screening in patients presenting with SAS to diagnose acromegaly earlier and prevent complications and comorbidities.

Objectif Chez les patients SAOS, la prevalence de l’hypertension arterielle est elevee et la prise en charge therapeutique est similaire a celle des patients non SAOS, alors que leur reponse au traitement est potentiellement differente. L’objectif est d’identifier la strategie anti-hypertensive la plus appropriee chez les patients SAOS, a partir des donnees d’un essai randomise de tele-suivi des patients SAOS (OPTISAS 2 [NCT01505959] : 213 patients sous antihypertenseurs). Methodes Selection des patients avec traitement anti-hypertenseur et repartition en 3 categories (mono-, bi- ou tri-therapie). Analyses en sous-groupes en considerant (1) les differentes mono-therapies, (2) parmi les bi-therapies, celles associant au moins un diuretique. Une approche d’inference causale multivariee basee sur l’inverse de la probabilite de recevoir le traitement a ete utilisee. La pression arterielle (PA) est mesuree par le patient en auto-mesure (sur 3 jours consecutifs). Resultats Parmi les mono-therapies, aucun traitement particulier n’entraine de baisse significative de la PA ni de superiorite par rapport aux autres. Les patients sous bi-therapie comprenant ou non un diuretique (71 [33 %]) ont une PA systolique mieux controlee (−2,2 [−7,26–2,85] mmHg ; p = 0,07) compare aux patients sous mono-therapie (99 [46 %]) ou tri-therapie (43 [21 %]). Conclusion Nous confirmons que le taux de reponse aux mono-therapies anti-hypertensives est faible chez les patients SAOS. Les bi-therapies sont les plus adaptees pour reguler la PA et la tri-therapie n’apporte pas de reduction supplementaire. Ceci souligne la resistance des patients SAOS aux antihypertenseurs. Une strategie particuliere combinee doit donc etre developpee associant pression positive continue, anti-hypertenseurs et activite physique.

Objectif Une prise en charge integree du SAOS necessite d’obtenir une bonne observance de la PPC, mais aussi une reduction de la pression arterielle (PA) et une augmentation de l’activite physique quotidienne. L’objectif de cet essai randomise etait d’evaluer l’efficacite d’un tele-monitoring multimodal (PPC, PA, activite physique) sur l’evolution de la PA de SAOS a haut-risque cardiovasculaire par comparaison a un bras soins usuels. Methodes Essai multicentrique en ouvert, randomise lors de la mise sous PPC : suivi usuel versus tele-monitoring durant 6 mois. Le tele-monitoring est realise a l’aide d’equipements electroniques collectant des donnees de PA, symptomes, effets indesirables de la PPC, oxymetrie et nombre de pas par jour. Objectif primaire : suivi de la PA a domicile (3 jours consecutifs, 10 a 18 mesures). Objectifs secondaires : adherence a la PPC, symptomes et nombre de pas. Resultats Trois cent six patients (âge moyen 60 ans [SD, 9,5] ; 227 hommes [74 %] ; IMC moyen 33 kg/m2 [SD, 6,3] ; IAH moyen 50/heure [SD, 20]), 149 dans le groupe suivi usuel et 157 tele-monitores. Il n’y avait aucune difference sur la PA mesuree a domicile, le nombre de pas ou encore les symptomes a 6 mois. Cependant, on observait une difference significative en faveur du groupe tele-monitore sur l’observance de la PPC (−0,53 heure [95 % CI : −1,05 ; 0,00], p = 0,05). Conclusion Le tele-monitoring des patients SAOS a haut risque cardiovasculaire ameliore l’observance de la PPC mais pas la PA.

COPD is known as a major cause of morbidity and mortality around the world. However, in France epidemiological data regarding COPD management in real life are scarce. The objective of our study was to analyze COPD management by pulmonologists in an observational cohort with a follow-up of three years in South-West of France. Pulmonologists included n=757 patients with COPD using a web-site questionnaire. Diagnosis of COPD was made using spirometry (FEV1/CVF 29 kg/m2) was higher in GOLD I-II (25% vs 12% in GOLD III-IV) whereas underweight was significantly higher in GOLD III-IV (22% vs 13% in GOLD I-II; p=0.0036). In our cohort, comorbidities differ according to COPD severity, and gender. Follow-up of these patients will provide interesting information to compare real-life management and guidelines implementation. Funding: Foundation of Bordeaux University, Novartis Pharma, Isis Medical.

Objectif L’acromegalie est une maladie rare (prevalence de 0,008 a 0,013 %) due a l’hypersecretion d’hormone de croissance. Le syndrome d’apnees du sommeil (SAS) a une prevalence de 45 a 80 % chez les patients acromegales. Le but de cette etude multicentrique nationale etait de determiner la prevalence de l’acromegalie non diagnostiquee chez les patients consultants pour une suspicion de SAS. Methodes Les patients consultants pour une suspicion de SAS, au CHU de Grenoble ou chez l’un des 10 pneumologues liberaux participants, ont ete recrutes consecutivement de novembre 2013 a octobre 2014. Les donnees cliniques etaient renseignees sur le CFR electronique de l’OSFP, une polysomnographie/polygraphie (PSG) etait realisee ainsi qu’un dosage sanguin d’IGF-1. En cas de taux d’IGF-1 eleve, le patient etait oriente vers un endocrinologue pour confirmer une eventuelle acromegalie. Resultats Au total, 873 patients ont ete inclus. Deux cas ont ete diagnostiques, chez des patients ayant un SAS severe. De plus, 817 patients ont realise le dosage d’IGF-1, la prevalence de l’acromegalie est de 0,245 % pour l’ensemble des patients ayant consultes. Parmi eux, 567 patients ont un Index Apnee-Hypopnee > 15 parmi les 755 patients ayant des resultats de PSG et un dosage d’IGF-1 : la prevalence chez les patients apneiques est donc de 0,353 % (27 fois la population generale). Conclusion Les patients apneiques representent un groupe particulierement a risque pour le diagnostic d’acromegalie, qui necessite de valider des strategies specifiques de depistage, afin de prevenir les complications et comorbidites de l’acromegalie.

Hypoxic brain damage might explain persistent sleepiness in some continuous positive airway pressure-compliant obstructive sleep apnea called residual excessive sleepiness. Although continuous positive airway pressure may not be fully efficient in treating this symptom, wake-promoting drug prescription in residual excessive sleepiness is no longer allowed by the European Medicines Agency. The aim of this study is to describe residual excessive sleepiness phenotypes in a large prospective sample of patients with obstructive sleep apnea. Residual excessive sleepiness was defined by an Epworth Sleepiness Scale score ≥ 11. Eligible patients from the French National Sleep Registry attending follow-up continuous positive airway pressure visits numbered 1047. Patients using continuous positive airway pressure3 h (n = 275), with residual apnea-hypopnea index15 h⁻¹ (n = 31) or with major depression were excluded (n = 150). Residual excessive sleepiness prevalence in continuous positive airway pressure-treated obstructive sleep apnea was 13% (18% for those with an initial Epworth Sleepiness Scale score11), and significantly decreased with continuous positive airway pressure use (9% in ≥ 6 h night⁻¹ continuous positive airway pressure users, P0.005). At the time of diagnosis, patients with residual excessive sleepiness had worse subjective appreciation of their disease (general health scale, Epworth Sleepiness Scale and fatigue score), and complained more frequently of continuous positive airway pressure side-effects. Residual excessive sleepiness prevalence was lower in severe obstructive sleep apnea than in moderate obstructive sleep apnea (11% when AHI30 h⁻¹ versus 18% when AHI 15-30, P0.005). There was no relationship between residual excessive sleepiness and body mass index, cardiovascular co-morbidities or diabetes. Continuous positive airway pressure improved symptoms in the whole population, but to a lower extent in patients with residual excessive sleepiness (fatigue scale: -5.2 versus -2.7 in residual excessive sleepiness- and residual excessive sleepiness+ patients, respectively, P0.001). Residual excessive sleepiness prevalence decreased with continuous positive airway pressure compliance. Hypoxic insult is unlikely to explain residual excessive sleepiness as obstructive sleep apnea severity does not seem to be critical. Residual symptoms are not limited to sleepiness, suggesting a true 'continuous positive airway pressure-resistant syndrome', which may justify treatment by wake-promoting drugs.

Objectif L’acromegalie est une affection endocrinienne rare (prevalence 45–125 cas/million) due a l’hypersecretion de GH par un adenome hypophysaire. Parmi les acromegales, 65 a 80 % ont un SAS au diagnostic. Un depistage de l’hypersecretion somatotrope semble necessaire parmi les patients consultant pour un SAS. Patients et methodes Patients vus pour une suspicion de SAS au CHU de Grenoble et chez 10 pneumologues liberaux de novembre 2013 a octobre 2014. Les donnees cliniques et co-morbidites etaient renseignees, une polysomnographie/polygraphie et un dosage de l’IGF-1 etaient realises. Lorsque l’IGF-1 etait eleve (fonction de l’âge et du sexe), un dosage de GH au cours de l’HGPO etait realise. Une hypersecretion somatotrope imposait une IRM hypophysaire et une consultation endocrinologique afin d’affirmer une acromegalie. Resultats Parmi 873 patients vus pour suspicion de SAS, 817 ont eu un dosage d’IGF-1 et 755 une polysomnographie/polygraphie. Cinq cent soixante-sept avaient un SAS+ (index apnee/hypopnee > 15) : il s’agissait d’hommes (68 %), plus âges (54 ± 12 vs 48 ± 13 ans, p 2 , p Conclusion Parmi les patients SAS+, la prevalence de l’acromegalie est superieure a 35/10 000, et est plus importante que dans la population generale. Des etudes ulterieures doivent evaluer le cout/efficacite du depistage de l’acromegalie par le dosage de l’IGF-1 chez les patients presentant un SAS.

Objectif Le syndrome d’apnees du sommeil obstructif est frequemment associe a une hypertension arterielle (HTA) qui est souvent mal controlee ou resistante. L’automesure a domicile est la methode de reference pour le diagnostic de l’HTA. Evaluer l’interet d’un dispositif d’automesure a domicile de la pression arterielle (PA) integre dans une plateforme de telemedecine de suivi de patients porteurs d’un SAOS pour le diagnostic et/ou juger du controle de l’efficacite du traitement medicamenteux de l’hypertension arterielle. Methodes OPTISAS2 est un essai multicentrique, randomise en groupes paralleles comparant l’efficience d’une plateforme integree de telemedecine versus un suivi standard chez des patients a haut risque cardiovasculaire nouvellement traites par pression positive continue (PPC) pour un syndrome d’apnees du sommeil obstructif (SAOS). L’automesure de la tension arterielle a domicile a ete realisee a l’inclusion pendant une periode de 4 jours consecutifs. Les seuils definissant une hypertension arterielle en automesure sont : PA systolique/PA diastolique > 125/80 mmHg pour les patients diabetiques et > 135/85 mmHg pour les patients non diabetiques. Resultats Trois cent six patients SAOS (âge : 60 ± 9 ans ; indice de masse corporelle : 32,9 ± 6,3 kg/m2 ; 74 % d’hommes ; index d’apnees + hypopnees : 50,9 ± 19,2/h ; PA systolique/PA diastolique : 137,7 ± 17,9/81,1 ± 12,5 mmHg) ont ete randomises. Les automesures de PA realisees a l’inclusion ont permis de diagnostiquer une hypertension chez 64,2 % des patients sans antecedent connu d’hypertension arterielle ; 44,8 % des patients inclus avaient un antecedent connu d’hypertension arterielle ; 78,4 % de ces patients etaient mal controles malgre un traitement medicamenteux (PAS/PAD : 136,2 ± 14,7/83,9 ± 10,4 mmHg). Conclusion L’hypertension arterielle chez des patients SAOS severes a haut risque cardiovasculaire est frequemment sous-diagnostiquee et mal controlee. Ceci justifie d’integrer aux plateformes de telemedecine de suivi de ces patients les capteurs appropries pour le diagnostic et le suivi sous PPC.

Rationale: Both obesity and obstructive sleep apnea (OSA) are risk factors for hypertension (HT) and chronic heart failure (CHF). The association between OSA and COPD (overlap syndrome) and the obesity hypoventilation syndrome (OHS) have been proposed as leading to enhanced cardiovascular risk. Methods: 3093 obese subjects (IMC>30kg/m2) referred for suspicion of OSA were prospectively assessed by sleep studies, lung function tests and blood gazes. For the whole group, mean age was 57±13 years with 66% of men, mean BMI: 36.8±6.2 kg/m2, 52.8% of the subjects being hypertensive and 3.23% suffering from CHF. 926 of the 3093 did not exhibit OSA or COPD. Results: In multivariate analysis, prevalent hypertension was associated with OSA (Odd ratio (OR): 1.23 (confidence intervals (CI): 1.04-1.45), p=0.015), ≥2 nocturia episodes per night (OR: 1.295 (CI: 1.10-1.52), p

age, 55 11 years; mean body mass index, 31 6 kg/m 2 ; mean apnea-hypopnea index, 44 21 events/h) were randomly assigned to receive 3 months of treatment with CPAP (108 patients) or C-Flex (110 patients). Objective compliance, generic quality-of-life questionnaire (SF-36) scores, disease-specific quality-of-life questionnaire (Grenoble Sleep Apnea Quality of Life [GrenobleSAQOL]) scores, and visual analog scales for CPAP comfort and side effects were determined at baseline and after 3 months. After 3 months, patients in the CPAP arm were moved to the C-Flex arm for 3 additional months (open study). Results: An intention-to-treat analysis demonstrated that there were no differences at 3 months between C-Flex and CPAP use in terms of compliance, the rate of side effects, and comfort. Low compliers receiving CPAP therapy (< 4 h of use) significantly improved this outcome during the open study (p 0.04). There was a significant improvement in six of eight of the SF-36 domain scores and in all of the domains of the GrenobleSAQOL scores in both groups using either CPAP or C-Flex. Conclusion: In unselected sleep apnea patients, C-Flex was associated with similar outcomes to standard CPAP. Low compliers receiving CPAP therapy improved their adherence when moving to C-Flex. Trial registration: ISRCTN Register Identifier: 08065291 (CHEST 2009; 136:490–497) Abbreviations: AHI apnea-hypopnea index; CPAP continuous positive airway pressure; ESS Epworth sleepiness scale; GrenobleSAQOL Grenoble Sleep Apnea Quality of Life; OSA obstructive sleep apnea syndrome; PAP positive airway pressure; Sao2 arterial oxygen saturation; SF-36 Medical Outcomes Study 36-item short form

The percentage of compliant continuous positive airway pressure (CPAP)-treated apnoeic patients that continue to experience residual excessive sleepiness (RES) is unknown. RES was defined by an Epworth Sleepiness Scale (ESS) score of >or=11. In total, 502 patients from 37 French sleep centres using CPAP >3 h night(-1) attending their 1-yr follow-up visit were eligible. ESS and polysomnographic data as well as symptoms, quality of life, depression scores and objective CPAP compliance at 1 yr were collected. Overall, 60 patients remained sleepy on CPAP (ESS 14.3+/-2.5) leading to a prevalence rate of RES of 12.0% (95% confidence interval (CI) 9.1-14.8). After having excluded associated restless leg syndrome, major depressive disorder and narcolepsy as confounding causes, the final prevalence rate of RES was 6.0% (95% CI 3.9-8.01). Patients with RES were younger and more sleepy at diagnosis. The relative risk of having RES was 5.3 (95% CI 1.6-22.1), when ESS before treatment was >or=11. Scores of emotional and energy Nottingham Health Profile domains were two times worse in patients with RES. As 230,000 obstructive sleep apnoea patients are currently treated in France by continuous positive airway pressure, more than 13,800 of them might suffer from residual excessive sleepiness.

Objectif L’insulin-like growth factor-1 (IGF-I) est le principal facteur de croissance lie a l’hormone de croissance (GH). Des etudes suggerent que l’IGF-I est un facteur protecteur vasculaire, participant au maintien de la fonction endotheliale, augmentant la vasodilatation NO-dependante et associe a la sensibilite a l’insuline. Une baisse des niveaux d’IGF-I a ete retrouvee au cours du SAS. Les variations du taux d’IGF-1 en fonction du risque cardiometabolique sont etudiees dans une large cohorte prospective de patients consultants pour une suspicion de SAS. Methodes Au cours d’une etude nationale multicentrique, 817 patients consultants pour suspicion de SAS (SAS confirme chez 567 patients) ont realise un dosage sanguin d’IGF-1. Nous avons analyse le risque d’avoir un IGF-1 inferieur a la mediane pour differentes variables liees au risque cardio-metabolique : index de masse corporelle (IMC), index apnee + hypopnee (IAH), cholesterolemie, triglyceridemie (codees en quartile, a la mediane ou en continu en fonction de l’information apportee). Resultats La mediane d’IGF-1 est de 138 ng/mL. Le risque d’avoir un IGF-1 inferieur a la mediane est associe, apres ajustement pour l’âge et le sexe, a l’augmentation de l’IMC et de l’IAH (avec respectivement : OR = 2,83 ; p Conclusion L’IGF-1 a un role important comme biomarqueur pronostique des patients porteurs d’un syndrome d’apnees du sommeil.

Background and Objectives The national French Registry to evaluate sleep breathing disorders (OSFP Registry: Observatoire sommeil de la Federation de Pneumologie) is intended to collect updated information about current practices of respiratory physicians managing sleep apnoea patients. Methods, Program Description and Follow-up The main goal of the Internet-based registry (www.osfp.fr) is to improve clinical management quality by offering respiratory physicians a complete and systematically organised online evaluation of patients referred for sleep disorders. The content of the registry addresses four goals: (1) to improve physician9s knowledge not only of sleep apnoea but also of alternative diagnosis by the systematic use of validated clinical scales for sleepiness, fatigue, depression and restless legs syndrome, (2) to increase awareness of comorbidities and cardio-metabolic risk associated with sleep apnoea, by suggesting measurements of waist circumference, blood pressure, fasting lipids and fasting glucose, (3) to identify subgroups of at-risk patients (ie obesity hypoventilation and a combination of chronic obstructive pulmonary disease and sleep apnoea, the so-called overlap syndrome), and (4) to suggest appropriate follow-up and treatments for these specific subgroups of patients according to national guidelines. Information from the database is available at anytime and data can be extracted for statistical analysis. Participating physicians can compare their practices with others’ in the registry and with the guidelines established with the French High Health authority (HAS: Haute Autorite de Sante). Results in terms of clinical impact More than 560 centres were involved and between January 2007 and November 2009, more than 22 000 suspected sleep apnoea patients were enrolled. These centres included varied clinical practices, reflecting real life sleep apnoea clinical management in France. The majority of centres were private practices (74% of the patients) whilst others were public hospital practices, either teaching university hospitals (4% of the patients) or district hospitals (22% of the patients). Patients from all regions of France were included and constitute a representative sample in terms of places of residence, rural/urban ratio and socio-professional groups. Sleep apnoea was diagnosed in 80% of referred patients and CPAP prescribed in 70% of them, with a mean CPAP usage of 5.7 h/night which is higher than the usually reported compliance in clinical studies (Cochrane 2009: 5.5 h/night). Significant improvement occurred with reduction in the sleepiness, fatigue and depression scales (from 12 to 8, 14 to 9 and 6 to 4.5, respectively). Appropriate characterisation of the patients at baseline allowed the identification of cardiovascular comorbidities in 45% of the patients. A significant percentage of patients (11%) were referred to cardiologist or other specialists after associated or alternative diagnosis had been appropriately recognised. To date, 50% of obese patients underwent blood gases and pulmonary function testing. Obesity hypoventilation syndrome was then diagnosed in 11.8 % of these obese subjects, leading to a prescription of CPAP or noninvasive ventilation in the most severe cases. Abnormal pulmonary function tests during the baseline evaluation led to implement bronchodilator medications in 2.8% of the investigated patients. Discussion and Conclusion This quality control program using an Internet-based registry allows the description of key demographic characteristics of patients referred for sleep disorders as well as an evaluation of current practices and treatment management of sleep apnea patients by respiratory physicians in France. This system aims to prompt respiratory physicians to use wide-ranging diagnostic tools when evaluating and following sleep disorder patients. Caregivers can compare their own practices and current guidelines. For the patients, comorbidities, both respiratory and nonrespiratory, are more systematically identified and appropriately addressed. Finally, the registry is an appropriate tool to assess the usefulness of guidelines across the country and improve patient care. Contexte Et Objectifs L9Observatoire sommeil de la Federation de Pneumologie (OSFP) collecte, a partir d9une saisie internet, des informations sur les pratiques des pneumologues en termes de diagnostic et de gestion therapeutique du syndrome d9apnees du sommeil. Programme Description, mise En oeuvre, suivi L9objectif principal de ce registre via internet (www.osfp.fr) est d9ameliorer la qualite de la prise en charge des patients en proposant aux pneumologues participants de realiser une evaluation plus complete et systematiquement organisee de leurs patients. L9observatoire poursuit quatre objectifs permettant une amelioration de la qualite : (i) Augmenter la connaissance des praticiens non seulement concernant le syndrome d9apnees du sommeil mais aussi concernant les diagnostics differentiels ou associes. Pour cela il leur est propose une utilisation systematique d’echelles cliniques validees de somnolence, de fatigue, de depression et de severite du syndrome des jambes sans repos. (ii) Elargir le bilan a la recherche de co-morbidites de la maladie et documenter le risque cardiovasculaire en realisant une mesure de la pression arterielle, du perimetre ombilical et un bilan biologique. (iii) Inciter a l9identification des sous groupes de patients a risque eleve de complications et de mortalite (Obeses hypoventilateurs ou association entre une BPCO et un syndrome d9apnees du sommeil) , (iv) proposer et organiser un suivi et un traitement approprie pour ces differents sous-groupes de patients en accord avec les recommandations nationales. A partir d9analyses statistiques disponibles en permanence, les praticiens participants a l9observatoire peuvent a tout moment comparer leurs pratiques avec celles des autres centres et avec les recommandations de pratique clinique en cours d’elaboration avec la Haute Autorite de Sante. Resultats En Termes D9impact clinique Plus de 560 centres participent a l9observatoire et entre 01/2007 et 11/2009 plus de 22 000 patients suspects d’etre porteurs d9un syndrome d9apnees du sommeil ont ete inclus dans le registre. Les centres participants correspondent a des modes d9exercice varies refletant la « vrai vie » de la prise en charge du syndrome d9apnees du sommeil en France (Pratique liberale, hopitaux generaux et universitaires pour respectivement 74, 22 et 4% des patients). Les patients proviennent de toutes les regions francaises et constituent un echantillon representatif en terme de lieu de residence, habitat rural/urbain et repartition des categories socioprofessionnelles. Un syndrome d9apnees du sommeil a ete diagnostique chez 80% des patients et une pression positive continue proposee a 70% d9entre eux avec une utilisation moyenne de 5,7 heures/nuit ce qui est superieur a l9observance rapportee dans les etudes cliniques (Cochrane 2009: 5,5 heures/nuit). Des ameliorations cliniques etaient constatees avec une reduction significative des scores de somnolence, fatigue et depression (de 12 a 8, 14 a 9 et 6 a 4,5 respectivement). Caracteriser precisement les patients lors de l’evaluation initiale a permis de retrouver des comorbidites cardiovasculaires dans 45% des cas. 11% des patients ont ete adresses au cardiologue ou a un autre specialiste car le bilan initial avait permis d9identifier des diagnostics associes. Un syndrome obesite hypoventilation a ete diagnostique chez 11,8 %, ceci permettant dans les cas les plus severes d9orienter les patients vers une ventilation non-invasive. Les tests fonctionnels respiratoires ont conduit a debuter un traitement bronchodilatateur chez 2,8% des patients. Discussion-conclusions Ce programme d’evaluation des pratiques reposant sur un registre internet permet d9ameliorer la qualite de gestion du syndrome d9apnees du sommeil directement profitable au malade tout en disposant de donnees epidemiologiques. Ce mode de fonctionnement invite les praticiens a utiliser des outils diagnostiques et d’evaluation au-dela de leur propre specialite. L9impact pour les patients est une meilleure reconnaissance des co-morbidites, des pathologies associees ceci permettant une prise en charge plus efficiente.