Publications

• Factors Contributing to Unintentional Leak During CPAP Treatment A Systematic Review

  Chest. Lebret M, Martinot JB, Arnol N, Zerillo D, Tamisier R, Pepin J L and Borel J C, – 2017

  CPAP is the first-line treatment for moderate to severe OSA syndrome. Up to 25% of patients with OSA syndrome discontinue CPAP treatment due to side effects. Unintentional leakage and its associated annoying consequences are the most frequently reported adverse effects of CPAP. Successive technological improvements have not succeeded in addressing this issue. A systematic review was conducted (1) to assess the impact of different technological advances on unintentional leaks and (2) to determine if any patient characteristics have already been identified as determinants of unintentional leakage. No CPAP modality was superior to another in reducing unintentional leaks and, surprisingly, oronasal masks were associated with higher unintentional leaks. Nasal obstruction, older age, higher BMI, central fat distribution, and male sex might be associated with an increased risk of unintentional leakage. Such leaks remain an important problem. Further studies are needed to improve the understanding of underlying clinical factors so that patients at risk of unintentional leaks may be identified and individualized solutions applied.

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• Est-il si facile de faire le diagnostic d’un syndrome d’apnées obstructives du sommeil ?

  La Lettre du Pneumologue. Jaffuel D, Charriot J, Jean R, Alagha K, Palot A, Bourdin A, Mallet JP – 2017

  Le syndrome d’apnées / hypopnées obstructives du sommeil (SAHOS) se caractérise par la survenue, lors du sommeil, d’épisodes d’interruption ou de réduction de la ventilation (appelés respectivement apnées et hypopnées). Le SAHOS est associé anatomiquement à un collapsus répété plus ou moins complet des voies aérodigestives supérieures (VADS). Ces épisodes d’apnées et d’hypopnées peuvent alors entraîner des conséquences ventilatoires (dont une hypoxémie) ou avoir des répercussions sur la qualité du sommeil (dont des microéveils). La prévalence du SAHOS dans la population générale est imprécise, comprise entre 1 et 8 %. La variabilité des définitions du SAHOS et l’hétérogénéité des méthodes diagnostiques utilisées expliquent en partie les différences observées. La Haute Autorité de santé (HAS), dans son rapport de 2014 intitulé “Évaluation clinique et économique des dispositifs médicaux et prestations associées pour la prise en charge du syndrome d’apnées-hypopnées obstructives du sommeil (SAHOS)”, a proposé des fourchettes de prévalence du SAHOS en France. Pour un index d’apnées-hypopnées (IAH) d’au moins 15/h et une somnolence associée, la prévalence est comprise entre 3,0 et 5,5 % chez l’homme et entre 0,8 et 3 % chez la femme. En 2011, cela correspondait, au regard de la population française âgée de plus de 30 ans, à un nombre de cas modérés à sévères compris entre 1 100 000 et 2 400 000. Toutefois, moins de 50 % des patients atteints d’un SAHOS modéré à sévère rapportant une somnolence significative(1), ces fourchettes de prévalence proposées par la HAS sous-estiment la prévalence réelle de la maladie. En 2015, dans une population suisse âgée de 40 à 75 ans, R. Heinzer et al. (2) ont rapporté la prévalence d’un IAH d’au moins 15/h en polysomnographie (PSG) chez 49,7 % des hommes et 23,4 % des femmes. Ces données épidémiologiques imprécises ont le mérite de souligner qu’il est tout aussi difficile de poser un diagnostic de SAHOS pour un épidémiologiste que pour un clinicien au quotidien.

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• Beyond The Thermistor : Novel Technology For The Ambulatory Diagnosis Of Obstructive Sleep Apnoea

  Respirology. Gray EL and Barnes DJ – 2017

  Obstructive sleep apnoea (OSA) is common and is associated with significant pathophysiological consequences. The prevalence is increasing with the rising rates of obesity, the ageing population and the increasing awareness of the condition. An estimated 14% of men and 5% of women have OSA syndrome (apnoea/hypopnoea index (AHI) ≥ 5/h plus symptoms of excessive daytime sleepiness) with upwards of 75% of patients estimated to remain either undiagnosed or untreated. The ‘gold-standard’ diagnostic test is the in-lab full-night polysomnogram (PSG) requiring an overnight stay in a dedicated facility supervised by trained technicians.3 This is then followed by an in-lab continuous positive airway pressure (CPAP) titration. Given the finite number of facilities available and the magnitude of the problem, an ambulatory approach using the unattended portable monitor (PM) followed by an unattended CPAP auto-titration has gained popularity to help meet the growing demand.

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• Validation of midsagittal jaw movements to measure sleep in healthy adults by comparison with actigraphy and polysomnography

  Sleep Science. Chakar B, Senny F, Poirrier A-L, Cambron L, Fanielle J, Poirrier R – 2017

  Objective: In a device based on midsagittal jaw movements analysis, we assessed a sleep-wake automatic detector as an objective method to measure sleep in healthy adults by comparison with wrist actigraphy against polysomnography (PSG).

  Conclusions: Midsagittal jaw movements analysis is a reliable method to measure sleep. In healthy adults, this device proved to be superior to actigraphy in terms of estimation of all sleep parameters and distinction of sleep-wake status.

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• Mandibular Position And Movements : Suitability For Diagnosis Of Sleep Apnoea

  Respirology. Martinot J-B, Borel J-C, Cuthbert V, Guénard H, Denison S, Silkoff P, Gozal D and Pepin J-L – 2016

  Background and objective: Mandibular movements (MMs) and position during sleep reflect respiratory efforts related to increases in upper airway resistance and micro-arousals. The study objective was to assess whether MM identifies sleep-disordered breathing (SDB) in patients with moderate to high pre-test probability.

  Conclusion: RDI assessed by MM is highly concordant with PSG, suggesting a role of ambulatory MM recordings to screen for SDB in patients with moderate to high pre-test probability.

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• Mandibular Movements Identify Respiratory Effort In Pediatric Obstructive Sleep Apnea

  Journal of Clinical Sleep Medicine. Martinot J B, Senny F, Denison S, Cuthbert V, Gueulette E, Guénard H and Pépin J L, – 2015

  Study Objectives: Obstructive sleep apnea-hypopnea (OAH) diagnosis in children is based on the quantifi cation of flow and respiratory effort (RE). Pulse transit time (PTT) is one validated tool to recognize RE. Pattern analysis of mandibular movements (MM) might be an alternative method to detect RE. We compared several patterns of MM to concomittant changes in PTT during OAH in children with adenotonsillar hypertrophy.

  Conclusions: MM > 0.4 mm occurred frequently during periods of OAH and were frequently terminated by MMS corresponding to mouth closure on CAr. The MM findings strongly correlated with changes in PTT. MM analysis could be a simple and accurate promising tool for RE characterization and optimization of OAH diagnosis in children.

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• Nasal obstruction and male gender contribute to the persistence of mouth opening during sleep in CPAP-treated obstructive sleep apnoea

  Respirology. Lebret M, Arnol N, Contal O, Martinot J-B, Tamisier R, Pepin J-L and Borel J-C – 2015

  Background and objective: During continuous positive airway pressure (CPAP) treatment, some patients with obstructive sleep apnoea syndrome (OSAS) require an oronasal mask (ONM) to prevent excessive mouth leakage. Factors contributing to sleep-related mouth opening under CPAP treatment remain known. We compared mouth opening during sleep in patients treated with CPAP by nasal mask (NM) versus ONM. 

  Conclusions: After several months of CPAP treatment, some patients using ONM persist in keeping their mouths open at night. Nasal obstruction and male gender contribute to this phenomenon.

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• Mandible behaviour interpretation during wakefulness, sleep and sleep-disordered breathing

  Journal of Sleep Research. Maury G, Senny F, Cambron L, Albert A, Seidel L and Poirrier R – 2014

  SUMMARY
  The mandible movement (MM) signal provides information on mandible activity. It can be read visually to assess sleep–wake state and respiratory events. This study aimed to assess (1) the training of independent scorers to recognize the signal specificities; (2) intrascorerreproducibility and (3) interscorer variability. MM was collected in the midsagittal plane of the face of 40 patients. The typical MM was extracted and classified into seven distinct pattern classes: active wakefulness (AW), quiet wakefulness or quiet sleep (QW/S), sleep snoring (SS), sleep obstructive events (OAH), sleep mixed apnea (MA), respiratory related arousal (RERA) and sleep central events (CAH). Four scorers were trained; their diagnostic capacities were assessed on two reading sessions. The intra- and interscorer agreements were assessed using Cohen’s j. Intrascorer reproducibility for the two sessions ranged from 0.68 [95% confidence interval (CI): 0.59–0.77] to 0.88 (95% CI: 0.82–0.94), while the between-scorer agreement amounted to 0.68 (95% CI: 0.65–0.71) and 0.74 (95% CI: 0.72–0.77), respectively. The overall accuracy of the scorers was 75.2% (range: 72.4–80.7%). CAH MMs were the most difficult to discern (overall accuracy 65.6%). For the two sessions, the recognition rate of abnormal respiratory events (OAH, CAH, MA and RERA) was excellent: the interscorer mean agreement was 90.7% (Cohen’s j: 0.83; 95% CI: 0.79–0.88). The discrimination of OAH, CAH, MA characteristics was good, with an interscorer agreement of 80.8% (Cohen’s j: 0.65; 95% CI: 0.62–0.68). Visual analysis of isolated MMs can successfully diagnose sleep–wake state, normal and abnormal respiration and recognize the presence of respiratory effort.

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• Mandibular Movements Identify Respiratory Efforts Due to Obstructive Sleep Apnoea in a Pre-school Child

  The Open Sleep Journal. Martinot J-B, Denison S, Senny F, Robillard TA, Khatwa U and Guénard H – 2014

  INTRODUCTION
  Mouth-opening and oral breathing are common clinical features during sleep in children particularly in the presence of upper airway obstruction e.g. related to adenotonsillar hypertrophy. The increased upper airway resistance results in increased respiratory effort (RE) and respiratoryeffort-related arousals (RERAs). Periods of increased RE while difficult to assess are critical in identifying OSAS in children. EEG-arousal leads to relief of upper airway obstruction and termination of the obstructive event and this arousal has
  been shown to be accompanied by jaw closure in adults with OSAS. Moreover, an abrupt decrease in pulse transit time (PTT) of at least 10 ms is recognized as a surrogate for EEGarousal at the end of RE in adults and in children. We present here the temporal association between mandibular movements (MMs) and the changes in PTT in response to OSAS events followed by EEG-arousals during PSG in a pre-school child with upper airway obstruction who was referred for preoperative evaluation. The effects of adenotonsillectomy on MMs and PTT are shown.

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• Detection of sleep apnea by case-finding and home monitoring with Somnolter®: a pilot study

  BMC Research Notes. Cattrysse F, Peeters M, Calaerts S, Ferson K and Degryse J-M – 2014

  Background: Obstructive sleep apnea and hypopnea syndrome (OSAHS) is a disorder that causes clinical symptoms (e.g. snoring, excessive daytime sleepiness and impaired concentration) that may increase the risk of traffic accidents, cardiovascular disease, type 2 diabetes and reduce the quality of life. A recently developed device (Somnolter®) detects apneas and hypopneas in a home setting, allowing to detect OSAHS in a more comfortable environment compared to the gold standard polysomnography. The aim of our study was to investigate whether the Somnolter® is useful in family practice to identify patients with OSAHS.

  Conclusion: The proposed case-finding strategy still needs optimization, but is considered helpful in selecting patients at high risk of OSAHS. OSAHS was detected in 14 out of 18 patients tested with the Somnolter®. In the future the Somnolter® might be a feasible alternative to diagnose OSAHS.
   

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