Sleep continuity: a new metric to quantify disrupted hypnograms in non-sedated intensive care unit patients

Introduction: Sleep in intensive care unit (ICU) patients is severely altered. In a large proportion of critically ill patients, conventional sleep electroencephalogram (EEG) patterns are replaced by atypical sleep. On the other hand, some non-sedated patients can display usual sleep EEG patterns. In the latter, sleep is highly fragmented and disrupted and conventional rules may not be optimal. We sought to determine whether sleep continuity could be a useful metric to quantify the amount of sleep with recuperative function in critically ill patients with usual sleep EEG features. Methods: We retrospectively reanalyzed polysomnographies recorded in non-sedated critically ill patients requiring non-invasive ventilation (NIV) for acute hypercapnic respiratory failure. Using conventional rules, we built two-state hypnograms (sleep and wake) and identified all sleep episodes. The percentage of time spent in sleep bouts (10 and 30 minutes) was used to describe sleep continuity. In a first study, we compared these measures regarding good (NIV success) or poor outcome (NIV failure). In a second study performed on a different patient group, we compared these measurements during NIV and during spontaneous breathing. Results: While fragmentation indices were similar in the two groups, the percentage of total sleep time spent in short naps was higher and the percentage of sleep time spent in sleep bouts was lower in patients with successful NIV. The percentage of total sleep time spent in long naps was higher and the percentage of sleep time spent in sleep bouts was lower during NIV than during spontaneous breathing; the level of reproducibility of sleep continuity measures between scorers was high. Conclusions: Sleep continuity measurements could constitute a clinically relevant and reproducible assessment of sleep disruption in non-sedated ICU patients with usual sleep EEG

Assessment of los sleep restorative function in multiple sclérosis patients with fatigue

Ce travail a consisté premièrement en une étude en cross over comparant l’effet d’une sieste versus une période de repos sur une mesure électrophysiologique de récupération motrice post-exercice chez des patients fatigués atteints de sclérose en plaques (SEP) (n=12) et des témoins sains (n=12). Cette mesure correspondait à l'amplitude des potentiels moteurs évoqués par la stimulation magnétique corticale et enregistrés au niveau de la main effectuant l'exercice. Cette étude a montré que la fonction restauratrice du sommeil sur la récupération de la dépression des potentiels évoqués moteurs post-exercice était altérée chez les patients atteints de SEP et fatigués comparativement à la population témoin. Deuxièmement, une étude comparative de la puissance spectrale de la bande de fréquence delta et sigma dans les différents stades de sommeil puis de la pente des ondes lentes du sommeil lent profond a été effectuée à partir de données polysomnographiques dans une série de patients atteints de SEP et fatigués (n=15) comparés à des sujets sains (n=15). L’hypothèse posée était que la perte de l’effet restaurateur du sommeil sur les performances motrices dans la SEP pouvait être le reflet d’un dysfonctionnement de la synchronisation de certains réseaux neuronaux. Nos résultats ne montrent pas d’altération de la pente des ondes lentes chez les patients atteints de SEP comparativement aux sujets sains, ce qui invalide notre hypothèse. Cependant, une diminution de la puissance spectrale dans les bandes de fréquences sigma et delta a été retrouvée chez les patients atteints de SEP comparativement à la population témoin. Ce résultat pourrait être expliqué par des différences concernant les microéveils corticaux, les mouvements périodiques de jambes éveillants ou le sex-ratio entre les deux groupes. L'implication d'une altération des connexions thalamo-corticales par atteinte myélinique dans la perte de la fonction restauratrice du sommeil reste tout de même une hypothèse à explorer dans le cadre de la SEP.This work consisted first in a crossover study comparing the effect of a nap versus a rest on an electrophysiological measure of post-exercise motor recovery in fatigued patients with multiple sclerosis (MS) (n = 12) and healthy controls (n = 12). This measure corresponded to the amplitude of motor potentials evoked by magnetic stimulation of the cortex, recorded at the hand performing the exercise. This study showed that the restorative function of sleep on the recovery of post-exercise motor evoked potential depression was impaired in fatigued MS patients compared to controls. Second, a comparative study of the spectral power density in the sigma and delta bands at different stages of sleep and of the slope of slow wave during deep sleep was conducted from polysomnographic data in a series of fatigued MS patients (n = 15) compared to healthy subjects (n = 15). The assumption was that the loss of the restorative effect of sleep on motor performance in MS could be due to a dysfunction of synchronization in some neural networks. Our results show no impairment of slow waves slope in patients with MS compared to healthy subjects, which invalidates our hypothesis. However, a decrease in the spectral power density in the sigma and delta bands was found in patients with MS as compared to controls. This result could be explained by differences in micro-arousals, periodic movements of legs or sex-ratio between the two groups. The involvement of an alteration in thalamocortical connections due to myelin damage in the loss of the restorative function of sleep still remains a hypothesis to be explored as part of MS

Effets de l'âge et des antidépresseurs sur les mouvements périodiques du sommeil

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Observation and Interview-based Diurnal Sleepiness Inventory for measurement of sleepiness in patients referred for narcolepsy or idiopathic hypersomnia

International audienc

Sleep continuity: a new metric to quantify disrupted hypnograms in non-sedated intensive care unit patients

Introduction: Sleep in intensive care unit (ICU) patients is severely altered. In a large proportion of critically ill patients, conventional sleep electroencephalogram (EEG) patterns are replaced by atypical sleep. On the other hand, some non-sedated patients can display usual sleep EEG patterns. In the latter, sleep is highly fragmented and disrupted and conventional rules may not be optimal. We sought to determine whether sleep continuity could be a useful metric to quantify the amount of sleep with recuperative function in critically ill patients with usual sleep EEG features. Methods: We retrospectively reanalyzed polysomnographies recorded in non-sedated critically ill patients requiring non-invasive ventilation (NIV) for acute hypercapnic respiratory failure. Using conventional rules, we built two-state hypnograms (sleep and wake) and identified all sleep episodes. The percentage of time spent in sleep bouts (10 and 30 minutes) was used to describe sleep continuity. In a first study, we compared these measures regarding good (NIV success) or poor outcome (NIV failure). In a second study performed on a different patient group, we compared these measurements during NIV and during spontaneous breathing. Results: While fragmentation indices were similar in the two groups, the percentage of total sleep time spent in short naps was higher and the percentage of sleep time spent in sleep bouts was lower in patients with successful NIV. The percentage of total sleep time spent in long naps was higher and the percentage of sleep time spent in sleep bouts was lower during NIV than during spontaneous breathing; the level of reproducibility of sleep continuity measures between scorers was high. Conclusions: Sleep continuity measurements could constitute a clinically relevant and reproducible assessment of sleep disruption in non-sedated ICU patients with usual sleep EEG

Vaccination coverage of children with inflammatory bowel disease after an awareness campaign on the risk of infection

International audienceBACKGROUND: Children with inflammatory bowel disease are at risk of vaccine-preventable diseases mostly due to immunosuppressive drugs. AIM: To evaluate coverage after an awareness campaign informing patients, their parents and general practitioner about the vaccination schedule. METHODS: Vaccination coverage was firstly evaluated and followed by an awareness campaign on the risk of infection via postal mail. The trial is a case-control study on the same patients before and after the awareness campaign. Overall, 92 children were included. A questionnaire was then completed during a routine appointment to collect data including age at diagnosis, age at data collection, treatment history, and vaccination status. RESULTS: Vaccination rates significantly increased for vaccines against diphtheria-tetanus-poliomyelitis (92% vs. 100%), Haemophilus influenzae (88% vs. 98%), hepatitis B (52% vs. 71%), pneumococcus (36% vs. 57%), and meningococcus C (17% vs. 41%) (p\textless0.05). Children who were older at diagnosis were 1.26 times more likely to be up-to-date with a minimum vaccination schedule (diphtheria-tetanus-poliomyelitis, pertussis, H. influenzae, measles-mumps-rubella, tuberculosis) (p=0.002). CONCLUSION: Informing inflammatory bowel disease patients, their parents and general practitioner about the vaccination schedule via postal mail is easy, inexpensive, reproducible, and increases vaccination coverage. This method reinforces information on the risk of infection during routine visit

Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients

International audienceThe aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed