2008–2018: Ten years of gradual changes in the sedation guidelines for critically ill patients

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

EVALUATION NEUROPHYSIOLOGIQUE DE LA STIMULATION DU CORTEX MOTEUR A VISEE ANTALGIQUE

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Automated EEG sleep spindles detection and modelization using Empirical Mode Decomposition

International audienceSleep Spindles (SS) are transients important in evaluation of sleep EEG. They may be defined by a group of rather broad frequency oscillations with evidence for heterogeneity and variability. Empirical Mode Decomposition (EMD) is a recently introduced auto-adaptive time-frequency method of nonstationary signal analysis. An iterative algorithm extracts the local signal structures waveforms without any knowledge or a priori about the spectral contents of the signal. Two channels records of 8 healthy subjects' overnight EEG recording were subjected to the EMD method. We show that structures corresponding to SS are well detected using EMD. The AM-FM appearance of SS is then described in terms of natural parameters, i.e. not only position and width in time, but also instantaneous frequency, amplitude and phase. Comparison of this automatic detection with visual analysis showed concordance decreasing with threshold amplitude. Such characteristics of SS in times were evaluated

2008–2018: Ten years of gradual changes in the sedation guidelines for critically ill patients

International audienc

Sleep disorders in neurology French consensus. Management of patients with hypersomnia: Which strategy?

International audienceAvailable online xxx Keywords: Narcolepsy Idiopathic hypersomnia Cataplexy Excessive daytime sleepiness Treatment Stimulant Sodium oxybate Antidepressants a b s t r a c t Central hypersomnias principally involves type 1 narcolepsy (NT1), type 2 narcolepsy (NT2) and idiopathic hypersomnia (IH). Despite great progress made in understanding the phy-siopathology of NT1 with low cerebrospinal fluid hypocretin-1 levels, current treatment remains symptomatic. The same applies to NT2 and IH, for which the physiopathology is still largely unknown. Controlling excessive daytime sleepiness (EDS), cataplexy, hypnago-gic hallucinations, sleep paralysis and disturbed night-time sleep are key therapeutic targets in NT1. For IH and NT2, reducing EDS is the main objective. Based on European and American directives for the treatment of narcolepsy, we propose French recommendations for managing central hypersomnias as well as strategies in the case of drug-resistance. Stimulating treatments target EDS, and Modafinil is the first-line treatment. Other stimulants such as methylphenidate, pitolisant, and exceptionally dextro-amphetamine can be prescribed. Selective serotonin and noradrenaline reuptake inhibitor antidepressants are effective for the management of cataplexy in NT1. Sodium oxybate is an effective treatment for several symptoms, including EDS, cataplexy and disturbed night-time sleep. Treatment of central hypersomnia must also take into consideration frequent cardiovascular, metabolic and psychiatric comorbidities, particularly in NT1. New therapies are currently under study with the development of new stimulants and anti-cataplectics. The next few years will see innovative emerging therapies, based on a physiopathological approach, aiming to restore hypocretinergic transmission or to interrupt the autoimmune processes causing the loss of hypocretin neurons

Sleep in the Vegetative and Minimally Conscious State

Présentation des résultats de l'étude du sommeil chez les patients cérébrolésés en état de conscience altéré

A gyro-kinetic model for trapped electron and ion modes

Équipe 107 : Physique des plasmas chaudsInternational audienceIn tokamak plasmas, it is recognized that ITG (ion temperature gradient instability) and trapped electron modes (TEM) are held responsible for turbulence giving rise to anomalous transport. The present work focuses on the building of a model including trapped kinetic ions and trapped kinetic electrons. For this purpose, the dimensionality is reduced by averaging the motion over the cyclotron motion and the ``banana'' orbits, according to the fact that the instabilities are characterized by frequencies of the order of the low trapped particle precession frequency. Moreover, a set of action-angle variables is used. The final model is 4D (two-dimensional phase space parametrized by the two first adiabatic invariants namely the particle energy and the trapping parameter). In this paper, the trapped ion and electron modes (TIM and TEM) are studied by using a linear analysis of the model. This work is currently performed in order to include trapped electrons in an existing semi lagrangian code for which TIM modes are already taken into account. This study can be considered as a first step in order to include kinetic trapped electrons in the 5D gyrokinetic code GYSELA