Evaluation à un instant donné de l'opportunité d'hospitalisation à domicile pour les patients hospitalisés en gériatrie ou suivis par l'équipe mobile de gériatrie au cours du mois de décembre 2008, au CHRU de Lille

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Syndrome d’apnées obstructives du sommeil : prévalence et facteurs socio-démographiques et de style de vie associés dans la cohorte Constances

INTRODUCTION - Les données sur la prévalence du syndrome d’apnées obstructives du sommeil (SASO) sont issues de cohortes non européennes, ou de petite taille. Il n’existe pas de données récentes sur la population française. L’objectif de ce travail était l’obtention de données contemporaines françaises sur la prévalence du SASO et une description de son association à des facteurs sociodémographiques et de style de vie. Nous nous sommes également intéressés à la prévalence selon le sexe, l’âge, le niveau d’éducation, le tabagisme, la consommation d’alcool, l’obésité globale ou abdominale. METHODES - La population d’étude a comporté 54 233 participants de la cohorte Constances, âgés de 18 à 69 ans à l’inclusion, recrutés entre 2012 et 2016. À l’inclusion, les sujets ont bénéficié d’un entretien, un examen clinique et une biologie standard. Le dépistage du SASO a été réalisé en 2017 par le questionnaire de Berlin. La prévalence du SASO a été obtenue par des fréquences et pourcentages. RESULTATS - La prévalence totale du SASO était de 14,9 %, plus importante chez les hommes (17,8 %) que chez les femmes (12,2 %). La prévalence était plus importante chez les adultes de 60 ans et plus (21,6 %), les obèses (63,8 %), les personnes avec obésité abdominale (27,6 %). Elle était également plus élevée en cas de forte consommation d’alcool (26,3 %), de tabac (27,2 %) et de faible niveau d’éducation (20,1 %, versus 9,8 % chez les titulaires d’un diplôme universitaire). CONCLUSION - Le SASO affecte 15 % de la population française dans la cohorte Constances, représentant un problème de santé publique. Notre travail permet d’obtenir des données récentes sur le SASO en France et montre une association avec des comportements à risque pour la santé et des conditions socioéconomiques plus défavorables. L’indépendance de cette association sera étudiée au sein de la cohorte et des ajustements permettront une application à la population générale

ASSOCIATION BETWEEN OBSTRUCTIVE SLEEP APNEA SYMPTOMS AND INCIDENCE OF DE NOVO HYPERTENSION IN A LARGE FRENCH POPULATION-BASED EPIDEMIOLOGICAL COHORT

International audienceObjective: There is a strong association between Obstructive Sleep Apnea (OSA) and hypertension but the effects of OSA symptoms on the risk of incident hypertension in previously normotensive individuals are not well documented. The aim of this prospective cohort study was to examine whether OSA symptoms (snoring and sleepiness) are associated with the incidence of hypertension independently of confounding factors including body mass index. Design and method: Data from the French population-based CONSTANCES cohort were analyzed. Participants, aged 18 to 69 years, were included between 2012 and 2016, and screened for OSA in 2017 using the Berlin Questionnaire. Snoring and sleepiness were assessed from the questionnaire, and considered as severe when they were declared to occur at least three times a week. Individuals who had a history of treated OSA, cardiovascular diseases or hypertension (defined either by blood pressure of 140/90 mmHg or more at the inclusion visit, or by self-reported hypertension or antihypertensive drugs delivering until 2017) were excluded from these analyses. We used Cox models, adjusted for age, gender, smoking, alcohol consumption, physical activity, education level, household income and body mass index, to compute hazards ratios (HR) of incident treated hypertension (defined by antihypertensive drugs delivering through linkage to the National Health Data System (SNDS)) until December 2020. Results: Among 36,798 normotensive subjects, the prevalence of high risk of OSA according to Berlin questionnaire was 7.6% and the incidence of treated hypertension was 4.2%. Risk of de novo treated hypertension increased significantly in participants who declared symptoms of severe snoring (adjusted HR [95% CI] = 1.17 [1.04-1.31]), severe sleepiness after sleep (adjusted HR [95% CI] = 1.18 [1.03-1.36]) and severe sleepiness during waking time (adjusted HR [95% CI] = 1.40 [1.23-1.64]), and increased with the weekly frequency of these symptoms with a dose-dependent relationship (p for trend <0.005). Conclusions: Self-declared snoring and sleepiness are associated with an increased risk of developing de novo hypertension. Our results suggest that primary care patients should be routinely screened for these symptoms, not only to identify possible OSA, but also to encourage preventive measures and regular blood pressure monitoring

Impact of Sleep Disordered Breathing on the occurrence of arterial hypertension in a large French population-based epidemiological cohort

International audienceBackground: There is a strong association between Sleep Disordered Breathing (SDB) and arterial hypertension but whether the link is causal remains unclear. Many studies, often limited by small sample size, suggested that SDB could induce arterial hypertension. The aim of this study was to assess the impact of SBD on the occurrence of arterial hypertension, and to identify its determinants on the basis of Berlin Questionnaire’s (BQ) components.Methods: Data came from participants of the French population-based CONSTANCES cohort, aged 18 to 69 years, included between 2013 and 2016, screened for SDB in 2017 using BQ who had no history of hypertension and blood pressure <140/90 mmHg at the inclusion visit. Occurrence of arterial hypertension was self-declared in yearly CONSTANCES questionnaires, between 2014 and 2017. Exposure variables were SDB diagnosis on the basis on BQ and its related sleeping symptoms (snoring and sleepiness). Odds Ratios (OR) were computed with their 95% Confidence Interval (95% CI) adjusted for age, sex, alcohol consumption, smoking and body mass index.Results: Among 46,853 participants screened for SDB, 33,528 (71.6%) were considered as normotensive at inclusion. In this population, SDB prevalence on the basis of BQ was 8,0%. During a mean follow up of 2.5 years (SD=1.1), 5.0% of participants screened as SDB positive declared arterial hypertension occurrence vs 1.6% in participants without SDB (OR=1.92, 95% CI [1.52-2.42]). Hypertension occurrence increase with snoring (2,2% in snorers vs 1,3%, OR=1.39, 95% CI [1.16-1.67]), and with sleepiness (2.2% vs 1.5% OR=1.65, 95% CI [1.39-1.85] when fatigue occurred after-sleep and 2.0% vs 1.5% OR=1.47, 95% CI [1.22-1.77] during waking time). These associations were significant as soon as snoring or sleepiness happened at least once or twice a week, tended to increase with symptoms severity and remained significant for snoring regardless of its noise. Conclusion: These results suggest that SDB and its clinical determinants are associated with an increased risk of developing arterial hypertension. These subjects would benefit from intensive lifestyle and dietary measures and from SDB screening to prevent or delay the occurrence of arterial hypertension

Prevalence, treatment and determinants of obstructive sleep apnoea and its symptoms in a population-based French cohort

Background Obstructive sleep apnoea (OSA) is associated with increased morbidity and mortality. Although the disorder has been well studied in selected high-risk populations, few data exist on its prevalence in the general population. We aimed to assess the prevalence and determinants of OSA in France. Methods Data from participants of the French population-based CONSTANCES cohort aged 18–69 years at inclusion and being treated for sleep apnoea or screened for OSA in 2017 using the Berlin Questionnaire were analysed. Weighted analyses were performed to provide recent and representative results in the general population. Results Among 20 151 participants, the prevalence of treated sleep apnoea was 3.5% (95% CI 3.0–3.9%). The prevalence of untreated subjects with a positive Berlin Questionnaire was 18.1% (95% CI 17.3–19.2%) for a total weighted prevalence of treated sleep apnoea or high risk of OSA of 20.9% (95% CI 20.0–21.9%). Regarding prevalence of OSA symptoms, it was 37.2% (95% CI 36.1–38.3%) for severe snoring and 14.6% (95% CI 13.8–15.5%) for hypersomnolence. In multivariable logistic regression analysis, male sex, age, previous cardiovascular events, smoking, low educational level, low physical activity and depressive symptoms were associated with having either treated sleep apnoea or a positive Berlin Questionnaire. Conclusion In this large French population-based cohort, one in five participants had a high likelihood of OSA, whereas only 3.5% were treated for the disorder, suggesting major underdiagnosis in the general population. OSA diagnosis should be considered more often in people with risk factors such as depressive symptoms as well as unhealthy behaviours and socioeconomic conditions

Incidence of, risk factors for and impact of readmission for heart failure after successful transcatheter aortic valve implantation

International audienceBackground: The incidence of and risk factors for readmission for heart failure after successful transcatheter aortic valve implantation (TAVI) are unclear.Aims: We sought to evaluate the incidence of, risk factors for and clinical impact of readmission for heart failure after successful TAVI in an unselected patient population.Methods: All patients who underwent successful TAVI in two high-volume French tertiary centres from February 2010 to December 2016 were included prospectively and followed up for 1 year. A Cox multivariable model was used to assess risk factors for readmission for heart failure and mortality.Results: A total of 1139 patients (mean age 82.4±7.7years; 52.2% male sex) were included. Readmission for heart failure occurred in 99 (9.2%) patients. Risk factors for readmission for heart failure were previous atrial fibrillation (adjusted hazard ratio [adjHR] 1.62, 95% confidence interval [CI] 1.09-2.40), diabetes mellitus (adjHR 1.67, 95% CI 1.11-2.50), chronic kidney disease (adjHR 1.72, 95% CI 1.13-2.62), chronic pulmonary disease (adjHR 1.81, 95% CI 1.17-2.81) and left ventricular ejection fraction after TAVI ≤ 35% (adjHR 2.12, 95% CI 1.20-3.75). Readmission for heart failure was strongly associated with mortality (adjHR 3.11, 95% CI 1.95-4.94), along with increased Society of Thoracic Surgeons' score (adjHR 1.07, 95% CI 1.03-1.12), chronic pulmonary disease (adjHR 1.45, 95% CI 1.00-2.09), previous atrial fibrillation (adjHR 2.11, 95% CI 1.52-2.93) and shock during the index hospitalization (adjHR 2.56, 95% CI 1.41-4.65).Conclusions: Readmission for heart failure occurs in one in 10 patients after successful TAVI, and is a strong risk factor for mortality. Co-morbidities and left ventricular ejection fraction after TAVI≤35% are the main risk factors for readmission for heart failure

Hyperventilation as one of the mechanisms of persistent dyspnoea in SARS-CoV-2 survivors

Conflict of interest statementConflict of interest: E. Vidal-Petiot reports personal fees and non-financial support from Servier, outside the submitted work. A. Cohen-Solal has received grants or honoraria from Novartis, Servier, Daiichi Sankyo, Vifor, Menarini and Cardiorentis, outside of the submitted work. J. Frija-Masson reports non-financial support from Vitalaire, Boehringer Ingelheim, Oxyvie and LVL Medical, outside the submitted work. All other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.International audienceInadequate exercise hyperventilation should not be overlooked while exploring the causes of exertional dyspnoea in SARS-CoV-2 survivors https://bit.ly/3AxOiD

Impact du traitement anticoagulant oral dans le devenir clinique et l’évolution des paramètres hémodynamique après un remplacement valvulaire aortique percutanée

International audienceBackgroundThe effect of oral anticoagulation on clinical and haemodynamic outcomes following successful transcatheter aortic valve implantation is unclear.AimsTo evaluate the effect of oral anticoagulation within the first year after transcatheter aortic valve implantation.MethodsAll patients undergoing transcatheter aortic valve implantation in two French tertiary centres from 2010 to 2016 were included prospectively. The composite outcome of death, stroke, readmission for heart failure or major/life-threatening bleeding according to Valve Academic Research Consortium 2 criteria within 1 year was evaluated. Valvular haemodynamic deterioration was defined as mean transprosthetic gradient ≥ 20 mmHg or an increase of ≥ 10 mmHg during echocardiographic follow-up.ResultsOf the 1139 patients included, 400 (35.1%) were discharged on oral anticoagulation. The primary endpoint was more frequent in the group with versus without oral anticoagulation (29.4% vs. 17.3% 21.5%; hazard ratio 1.83, 95% confidence interval 1.42–2.35). Composite endpoint risk factors were chronic pulmonary and kidney diseases, previous atrial fibrillation, left ventricular ejection fraction ≤ 30% at discharge and no femoral vascular approach, but not oral anticoagulation prescription at discharge. Conversely, 58 patients were identified with valvular haemodynamic deterioration, including 11 (19%) in the group with oral anticoagulation and 47 (81%) in the group without oral anticoagulation. Valvular haemodynamic deterioration risk factors were absence of oral anticoagulation exposure, increased body mass index, use of a balloon-expandable bioprosthesis and use of a bioprosthesis with diameter ≤ 23 mm. Antithrombotic treatment crossover (i.e. oral anticoagulation interruption or introduction during follow-up) occurred in 9.6% of patients, and was a risk factor for death (adjusted hazard ratio 3.39, 95% confidence interval 1.63–7.07).ConclusionsBaseline characteristics, rather than oral anticoagulation prescription at discharge, were associated with adverse outcomes following successful transcatheter aortic valve implantation. Conversely, oral anticoagulation was associated with reduced valvular haemodynamic deterioration.ContexteL’impact du traitement anticoagulant oral (TAO) sur les paramètres cliniques et hémodynamiques après TAVI demeure incertain.ObjectifsÉvaluer l’impact du TAO dans l’année suivant un TAVI.MéthodesTous les patients traités par TAVI dans deux centres français entre 2010 et 2016 furent prospectivement inclus. Le critère de jugement principal (CJP) était composé de la mortalité, accident vasculaire cérébrale, hospitalisation pour insuffisance cardiaque ou hémorragie sévères, défini selon les critères VARC-2. Une détérioration hémodynamique valvulaire prothétique (DHV) était définie par un gradient moyen transprothétique ≥ 20 mmHg ou par une majoration ≥ 10 mmHg durant le suivi échocardiographique.RésultatsUn TAO fut prescrit à 400 patients soit 35,1 % des 1139 patients inclus dans le registre. Le CJP est survenu plus fréquemment en cas de TAO post-TAVI qu’en son absence (29,4 % vs 17,3 % %; HR 1,83, IC à 95 % 1,42–2,35). Les facteurs de risque (FdR) du CJP étaient une pneumopathie chronique, une insuffisance rénale chronique, une fibrillation atriale, une FEVG ≤ 30 % après TAVI et un abord vasculaire extrafémoral. La prescription de TAO après un TAVI n’était pas un FdR indépendant du CJP. Une DHV fut relevée chez 58 patients, dont 11 (19 %) traités par TAO et 47 (81 %) non traités par TAO. Les FdR de DHV étaient l’absence de TAO après TAVI, un IMC augmenté, l’utilisation de bioprothèse expansible au ballon et un diamètre de bioprothèse ≤ 23 mm. Un crossover de TAO (défini comme un arrêt ou une initiation de TAO au cours du suivi) survenu chez 9,6 % des patients et était associé à la mortalité (HR ajusté 3,39, IC à 95 % 1,63–7,07).ConclusionsLes antécédents médicaux et non la prescription de TAO sont associés au devenir clinique après un TAVI. A l’inverse, la prescription de TAO est associée à une moindre survenue de DHV. Previous article in issu