Impact of Obstructive Hypopnea Apnea Syndrome on endothelial function

Le Syndrome d’apnées hypopnées obstructives du sommeil (SAHOS) est défini par un collapsus partiel ou total des voies aériennes supérieures à l’origine d’hypopnées ou d’apnées. Ceci va engendrer une hypoxie intermittente (HI) ainsi qu’une fragmentation du sommeil. Le SAHOS est associé à une augmentation de la prévalence des pathologies cardio-vasculaires (CV). Cependant, ce syndrome est très souvent associé à des comorbidités elles-mêmes responsables de complications CV : hypertension artérielle, diabète de type 2 (DT2), obésité… Un des mécanismes communs à l’ensemble de ces maladies CV est la dysfonction endothéliale (DE). Son évaluation in vivo est possible grâce à différentes techniques et notamment l’Endopath. Or, la DE est décrite comme facteur prédictif de complications CV ultérieures. Il a déjà été montré que la DE décrite au cours du SAHOS est médiée par les microvésicules (MV). Il s’agit de petites vésicules ayant un rôle de vecteur, dans la communication inter cellulaire. Ces MV contiennent un certains nombres de molécules tels que les protéines, de l’ADN, des miRNA. Les miRNA sont de simples brins non codant d’ARN qui permettent de réguler la traduction. Certains d’entre eux sont décrits comme impliqués dans les pathologies CV et notamment la DE. Ils pourraient être une cible thérapeutique pour lutter contre les complications CV du SAHOS. L’objectif de ce travail est d’évaluer l’implication réelle du SAHOS sur l’apparition d’une DE notamment en fonction de comorbidités associées telle que le DT2 ; puis de déterminer les miR qui puissent être impliqués dans ce phénomène et de moduler leur action pour lutter contre l’apparition de complications CV.Obstructive Sleep Apnea Syndrome (OSA) is defined as a partial or total collapse of the upper airways leading to hypopneas or apneas.This will lead to intermittent hypoxia (IH) and sleep fragmentation. OSA is associated with an increase in the prevalence of cardiovascular disease (CVD). However, this syndrome is very often associated with comorbidities that are themselves responsible for CVD complications : high blood pressure, type 2 diabetes (T2D), obesity... One of the mechanisms common to all these CVD diseases is the endothelial dysfunction (ED). Its in vivo evaluation is possible thanks to different techniques and in particular Endopath. ED is described as a predictor of subsequent CVD complications. It has already been shown that the ED described during OSA is mediated by microvesicles (MV).These are small vesicles that act as vectors for intercellular communication. These MVs contain a number of molecules such as proteins, DNA, miRNAs. miRNAs are simple, non-coding strands of RNA that regulate translation. Some of them are described as involved in CVD and in particular ED.They could be a therapeutic target to fight against the CD complications of OSA. The objective of this work is to evaluate the real involvement of OSA in the development of ED, particularly in terms of associated co-morbidities such as T2D ; then to determine the miRs that may be involved in this phenomenon and to modulate their action to combat the development of CVD

Impact du Syndrome d’Apnées Hypopnées Obstructives du Sommeil sur la fonction endothéliale

Obstructive Sleep Apnea Syndrome (OSA) is defined as a partial or total collapse of the upper airways leading to hypopneas or apneas.This will lead to intermittent hypoxia (IH) and sleep fragmentation. OSA is associated with an increase in the prevalence of cardiovascular disease (CVD). However, this syndrome is very often associated with comorbidities that are themselves responsible for CVD complications : high blood pressure, type 2 diabetes (T2D), obesity... One of the mechanisms common to all these CVD diseases is the endothelial dysfunction (ED). Its in vivo evaluation is possible thanks to different techniques and in particular Endopath. ED is described as a predictor of subsequent CVD complications. It has already been shown that the ED described during OSA is mediated by microvesicles (MV).These are small vesicles that act as vectors for intercellular communication. These MVs contain a number of molecules such as proteins, DNA, miRNAs. miRNAs are simple, non-coding strands of RNA that regulate translation. Some of them are described as involved in CVD and in particular ED.They could be a therapeutic target to fight against the CD complications of OSA. The objective of this work is to evaluate the real involvement of OSA in the development of ED, particularly in terms of associated co-morbidities such as T2D ; then to determine the miRs that may be involved in this phenomenon and to modulate their action to combat the development of CVD.Le Syndrome d’apnées hypopnées obstructives du sommeil (SAHOS) est défini par un collapsus partiel ou total des voies aériennes supérieures à l’origine d’hypopnées ou d’apnées. Ceci va engendrer une hypoxie intermittente (HI) ainsi qu’une fragmentation du sommeil. Le SAHOS est associé à une augmentation de la prévalence des pathologies cardio-vasculaires (CV). Cependant, ce syndrome est très souvent associé à des comorbidités elles-mêmes responsables de complications CV : hypertension artérielle, diabète de type 2 (DT2), obésité… Un des mécanismes communs à l’ensemble de ces maladies CV est la dysfonction endothéliale (DE). Son évaluation in vivo est possible grâce à différentes techniques et notamment l’Endopath. Or, la DE est décrite comme facteur prédictif de complications CV ultérieures. Il a déjà été montré que la DE décrite au cours du SAHOS est médiée par les microvésicules (MV). Il s’agit de petites vésicules ayant un rôle de vecteur, dans la communication inter cellulaire. Ces MV contiennent un certains nombres de molécules tels que les protéines, de l’ADN, des miRNA. Les miRNA sont de simples brins non codant d’ARN qui permettent de réguler la traduction. Certains d’entre eux sont décrits comme impliqués dans les pathologies CV et notamment la DE. Ils pourraient être une cible thérapeutique pour lutter contre les complications CV du SAHOS. L’objectif de ce travail est d’évaluer l’implication réelle du SAHOS sur l’apparition d’une DE notamment en fonction de comorbidités associées telle que le DT2 ; puis de déterminer les miR qui puissent être impliqués dans ce phénomène et de moduler leur action pour lutter contre l’apparition de complications CV

Polyphenols impact on vascular dysfunction associated with obstructive sleep apnea: a randomized controlled trial

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Polyphenols impact on vascular dysfunction associated with obstructive sleep apnea: a randomized controlled trial

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β Agonist Delivery by High-Flow Nasal Cannula During COPD Exacerbation

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Chlorhexidine plus alcohol versus povidone iodine plus alcohol, combined or not with innovative devices, for prevention of short-term peripheral venous catheter infection and failure (CLEAN 3 study): an investigator-initiated, open-label, single centre, randomised-controlled, two-by-two factorial trial

International audienceBackground: Two billion peripheral venous catheters are sold globally each year, but the optimal skin disinfection and types of devices are not well established. We aimed to show the superiority of disinfection with 2% chlorhexidine plus alcohol over 5% povidone iodine plus alcohol in preventing infectious complications, and of closed integrated catheters, positive displacement needleless-connectors, disinfecting caps, and single-use prefilled flush syringes used in combination (innovation group) over open catheters and three-way stopcocks for treatment administration (standard group) in preventing catheter failure.Methods: We did an open-label, randomised-controlled trial with a two-by-two factorial design, for which we enrolled adults (age ≥18 years) visiting the emergency department at the Poitiers University Hospital, France, and requiring one peripheral venous catheter before admission to the medical wards. Before catheter insertion, patients were randomly assigned (1:1:1:1) using a secure web-based random-number generator to one of four treatment groups based on skin preparation and type of devices (innovative devices or standard devices; 2% chlorhexidine plus alcohol or 5% povidone iodine plus alcohol). Primary outcomes were the incidence of infectious complications (local infection, catheter colonisation, or bloodstream infections) and time between catheter insertion and catheter failure (occlusion, dislodgment, infiltration, phlebitis, or infection). This study is registered with ClinicalTrials.gov, NCT03757143.Findings: 1000 patients were recruited between Jan 7, and Sept 6, 2019, of whom 500 were assigned to the chlorhexidine plus alcohol group and 500 to the povidone iodine plus alcohol group (250 with innovative solutions and 250 with standard devices in each antiseptic group). No significant interaction was found between the two study interventions. Local infections occurred less frequently with chlorhexidine plus alcohol than with povidone iodine plus alcohol (0 [0%] of 496 patients vs six [1%] of 493 patients) and the same was observed for catheter colonisation (4/431 [1%] vs 70/415 [17%] catheters among the catheters cultured; adjusted subdistribution hazard ratio 0·08 [95% CI 0·02-0·18]). Median time between catheter insertion and catheter failure was longer in the innovation group compared with the standard group (50·4 [IQR 29·6-69·4] h vs 30·0 [16·6-52·6] h; p=0·0017). Minor skin reactions occurred in nine (2%) patients in the chlorhexidine plus alcohol group and seven (1%) patients in the povidone iodine plus alcohol group.Interpretation: For skin antisepsis, chlorhexidine plus alcohol provides greater protection of peripheral venous catheter-related infectious complications than does povidone iodine plus alcohol. Use of innovative devices extends the catheter complication-free dwell time.Funding: Becton Dickinson

Impact of mandibular advancement therapy on endothelial function in severe obstructive sleep apnea.

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Impact of mandibular advancement therapy on endothelial function in severe obstructive sleep apnea.

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Sleep apnoea and endothelial dysfunction: An individual patient data meta-analysis

International audienceWe performed an individual patient data meta-analysis to investigate the association between obstructive sleep apnoea (OSA) severity and the reactive hyperaemia index (RHI) measured by peripheral arterial tonometry (PAT), a validated measurement of endothelial function, and a strong predictor of late cardiovascular (CV) events. Patients from 12 studies underwent PAT and overnight polysomnography or respiratory polygraphy for suspected OSA. Endothelial dysfunction was defined by a log-transformed RHI20 min with oxygen saturation <90% (OR: 1.83 [1.22e2.92]; p ¼ 0.004) or mean oxygen saturation <92% (OR: 1.52 [1.17e1.96]; p ¼ 0.002). On subgroup analyses, the association between severe OSA and endothelial dysfunction was not significant in patients with hypertension, obesity and/or diabetes. Among adults without overt CV disease, severe OSA is independently associated with an increased risk of endothelial dysfunction that may predispose to late CV events

Reply: The Choice of Indicators for Obstructive Sleep Apnea Treatment Outcome Evaluation: A Matter of Time-Dependent Response?

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