Impact of short-acting vs. standard anaesthetic agents on obstructive sleep apnoea: a randomised, controlled, triple-blind trial.

Sleep apnoea is associated with negative outcomes following general anaesthesia. Current recommendations suggest using short-acting anaesthetic agents in preference to standard agents to reduce this risk, but there is currently no evidence to support this. This randomised controlled triple-blind trial tested the hypothesis that a combination of short-acting agents (desflurane-remifentanil) would reduce the postoperative impact of general anaesthesia on sleep apnoea severity compared with standard agents (sevoflurane-fentanyl). Sixty patients undergoing hip arthroplasty under general anaesthesia were randomised to anaesthesia with desflurane-remifentanil or sevoflurane-fentanyl. Respiratory polygraphy was performed before surgery and on the first and third postoperative nights. The primary outcome was the supine apnoea-hypopnoea index on the first postoperative night. Secondary outcomes were the supine apnoea-hypopnoea index on the third postoperative night, and the oxygen desaturation index on the first and third postoperative nights. Additional outcomes included intravenous morphine equivalent consumption and pain scores on postoperative days 1, 2 and 3. Pre-operative sleep study data were similar between groups. Mean (95%CI) values for the supine apnoea-hypopnoea index on the first postoperative night were 18.9 (12.7-25.0) and 21.4 (14.2-28.7) events.h <sup>-1</sup> , respectively, in the short-acting and standard anaesthesia groups (p = 0.64). Corresponding values on the third postoperative night were 28.1 (15.8-40.3) and 38.0 (18.3-57.6) events.h <sup>-1</sup> (p = 0.34). Secondary sleep- and pain-related outcomes were generally similar in the two groups. In conclusion, short-acting anaesthetic agents did not reduce the impact of general anaesthesia on sleep apnoea severity compared with standard agents. These data should prompt an update of current recommendations

Prevalence and management of chronic insomnia in Swiss primary care: Cross-sectional data from the “Sentinella” practice-based research network

We investigated the prevalence and treatment of patients with chronic insomnia presenting to Swiss primary care physicians (PCPs) part of “Sentinella”, a nationwide practice-based research network. Each PCP consecutively asked 40 patients if they had sleep complaints, documented frequency, duration, comorbidities, and reported ongoing treatment. We analysed data of 63% (83/132) of the PCPs invited. The PCPs asked 76% (2,432/3,216) of included patients about their sleep (51% female); 31% (761/2,432) of these had had insomnia symptoms; 36% (875/2,432) had current insomnia symptoms; 11% (269/2,432) met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for chronic insomnia (61% female). In all, 75% (201/269) of patients with chronic insomnia had comorbidities, with 49% (99/201) reporting depression. Chronic insomnia was treated in 78% (209/269); 70% (188/268) took medication, 38% (102/268) benzodiazepines or benzodiazepine receptor agonists, 32% (86/268) took antidepressants. Only 1% (three of 268) had been treated with cognitive behavioural therapy for insomnia (CBT-I). A third of patients presenting for a non-urgent visit in Swiss primary care reported insomnia symptoms and 11% met the DSM-5 criteria for chronic insomnia. Hypnotics were the most common treatment, but almost no patients received first-line CBT-I. Reducing the burden of insomnia depends on disseminating knowledge about and access to CBT-I, and encouraging PCPs to discuss it with and offer it as a first-line treatment to patients with chronic insomnia

Treating insomnia in Swiss primary care practices: A survey study based on case vignettes

Guidelines recommend cognitive behavioural therapy for insomnia (CBT-I) as first-line treatment for chronic insomnia, but it is not clear how many primary care physicians (PCPs) in Switzerland prescribe this treatment. We created a survey that asked PCPs how they would treat chronic insomnia and how much they knew about CBT-I. The survey included two case vignettes that described patients with chronic insomnia, one with and one without comorbid depression. PCPs also answered general questions about treating chronic insomnia and about CBT-I and CBT-I providers. Of the 820 Swiss PCPs we invited, 395 (48%) completed the survey (mean age 54 years; 70% male); 87% of PCPs prescribed sleep hygiene and 65% phytopharmaceuticals for the patient who had only chronic insomnia; 95% prescribed antidepressants for the patient who had comorbid depression. In each case, 20% of PCPs prescribed benzodiazepines or benzodiazepine receptor agonists, 8% prescribed CBT-I, 68% said they knew little about CBT-I, and 78% did not know a CBT-I provider. In the clinical case vignettes, most PCPs treated chronic insomnia with phytopharmaceuticals and sleep hygiene despite their lack of efficacy, but PCPs rarely prescribed CBT-I, felt they knew little about it, and usually knew no CBT-I providers. PCPs need more information about the benefits of CBT-I and local CBT-I providers and dedicated initiatives to implement CBT-I in order to reduce the number of patients who are prescribed ineffective or potentially harmful medications

SAS CARE 1: Sleep architecture changes in a cohort of patients with Ischemic Stroke/TIA.

OBJECTIVE Changes in sleep architecture following ischemic stroke have been poorly investigated. Our objective was to explore changes of sleep structure in patients with ischemic stroke or transient ischemic attack in order to verify a possible predictive value of sleep with respect to clinical outcome. METHODS Patients recruited in the prospective SAS-CARE study received two polysomnographies (PSG) in the acute and chronic phases after stroke/TIA. Sleep parameters were compared between the two time-points and matched with a non-stroke population randomly selected from the HypnoLaus cohort. RESULTS Of the 169 patients investigated with PSG in the acute phase, 104 were again studied 3 months after stroke symptom onset and compared with 162 controls. The acute phase of stroke/TIA was associated with sleep disruption, which significantly improved in the chronic phase, but remained worse than controls (total sleep time improve from 318.8 ± 90.8 to 348.4 ± 81.5 min, compared to 388.2 ± 71.3 in controls, sleep latency from 49.9 ± 58.4 to 27.9 min, compared to 20.2 ± 22 in controls, sleep efficiency from 58.2 ± 18.1% to 27.9 ± 36.4 min, compared to 83.4 ± 10.3% in controls, wakefulness after sleep onset percentage from 36.5 ± 17.3 to 29.3 ± 15.6, compared to 13.2 ± 9.2 in controls). The percentage of REM sleep was negatively associated with stroke severity, whereas stroke topography did not correlate with sleep parameters. CONCLUSIONS This study confirmed a severe sleep disruption in the acute phase of stroke. Although a significant improvement of sleep quality was observed during the three months after stroke, sleep architecture did not normalize. In particular, sleep efficiency and REM sleep seem to be particularly affected by stroke in the acute phase, with a relative preservation of NREM sleep. We suggest that these sleep architecture changes represent a persistent marker of brain damage due to stroke. Further studies are needed to assess the relationship with stroke topographic and outcome

The mediating role of mood in the relationship between perseverative cognition, sleep and subjective health complaints in music students.

Subjective health complaints (SHC) are frequent in musicians. These complaints may be particularly distressing in this population because they are performance relevant. This paper aims at testing a model positing that (a) perseverative cognition (PC) predicts sleep duration/quality, (b) sleep duration/quality predicts SHC and (c) mood is a mediator of these associations. Participants were 72 music students (mean age (SD): 22.7 (3.0) years), and the assessment period consisted of seven consecutive days, with a solo performance on the fifth day. Self-reported total sleep time (TST) and sleep quality were assessed 30 min after wake-up, and objective TST/sleep quality were assessed with an actigraphy watch. PC and mood were measured five times a day. Daily SHC were assessed at 9 p.m. PC did not significantly predict sleep duration/quality. Self-reported and objective TST and sleep quality were all significantly associated with SHC. Mood played a mediating role in each of these relationships with the exception of objective sleep quality. The tested model on the association among PC, sleep and SHC and the mediating role of mood received partial support, highlighting the importance of sleep and mood in the emergence of SHC among university music students

Genioglossal muscle response to CO2 stimulation during NREM sleep

STUDY OBJECTIVES: The objective was to evaluate the responsiveness of upper airway muscles to hypercapnia with and without intrapharyngeal negative pressure during non-rapid eye movement (NREM) sleep and wakefulness. DESIGN: We assessed the genioglossal muscle response to CO2 off and on continuous positive airway pressure (CPAP) (to attenuate negative pressure) during stable NREM sleep and wakefulness in the supine position. SETTING: Laboratory of the Sleep Medicine Division, Brigham and Women's Hospital. PATIENTS OR PARTICIPANTS: Eleven normal healthy subjects. INTERVENTIONS: During wakefulness and NREM sleep, we measured genioglossal electromyography (EMG) on and off CPAP at the normal eupneic level and at levels 5 and 10 mm Hg above the awake eupneic level. MEASUREMENTS AND RESULTS: We observed that CO2 could increase upper-airway muscle activity during NREM sleep and wakefulness in the supine position with and without intrapharyngeal negative pressure. The application of nasal CPAP significantly decreased genioglossal EMG at all 3 levels of PETCO2 during NREM sleep (13.0 +/- 4.9% vs. 4.6 +/- 1.6% of maximal EMG, 14.6 +/- 5.6% vs. 7.1 +/- 2.3% of maximal EMG, and 17.3 +/- 6.3% vs. 10.2 +/- 3.1% of maximal EMG, respectively). However, the absence of negative pressure in the upper airway did not significantly affect the slope of the pharyngeal airway dilator muscle response to hypercapnia during NREM sleep (0.72 +/- 0.30% vs. 0.79 +/- 0.27% of maximal EMG per mm Hg PCO2, respectively, off and on CPAP). CONCLUSIONS: We conclude that both chemoreceptive and negative pressure reflex inputs to this upper airway dilator muscle are still active during stable NREM sleep

Physical activity is associated with higher sleep efficiency in the general population: the CoLaus study.

To evaluate the association of objective physical activity (PA) and sedentary behavior (SB) with sleep duration and quality. Cross-sectional study including 2649 adults (53.5% women, 45-86 years) from the general population. Proportions of time spent in PA and SB were measured using 14 day accelerometry. Low PA and high SB statuses were defined as the lowest and highest tertile of each behavior. "Inactive," "Weekend warrior," and "Regularly active" weekly patterns were also defined. Sleep parameters were derived from the accelerometer and validated questionnaires. High PA, relative to low PA, was associated with higher sleep efficiency (76.6 vs. 73.8%, p < 0.01) and lower likelihood of evening chronotype [relative-risk ratio (RR) and 95% CI: 0.71 (0.52; 0.97)]. Similar associations were found for low SB relative to high SB. "Weekend warriors" relative to "Inactives," had higher sleep efficiency [76.4 vs. 73.9%, p < 0.01] and lower likelihood of evening chronotype [RR: 0.63 (0.43; 0.93)]. "Regularly actives," relative to "Inactives," had higher sleep efficiency [76.7 vs. 73.9%, p < 0.01] and tended to have less frequently an evening chronotype [RR: 0.75 (0.54; 1.04), p = 0.09]. No associations were found for PA and SB with sleep duration, daytime sleepiness, insomnia, and risk of sleep apnea (after adjustment for body mass index). High PA and low SB individuals, even if they do not sleep longer, have higher sleep efficiency and have less frequently an evening chronotype

Syndrome respiratoire aigu après inhalation de sprays imperméabilisants

Au cours de l'hiver 2002-2003, le Centre suisse d'information toxicologique a enregistré une augmentation inhabituelle de troubles respiratoires après exposition à des sprays imperméabilisants utilisés pour l'imprégnation du cuir et des textiles. Plus de 150 cas ont ainsi été rapportés. De telles épidémies sont déjà survenues au cours des vingt dernières années dans divers pays. Sur le plan clinique, des symptômes de toux, dyspnée et fièvre apparaissent dans le minutes ou les heures qui suivent l'exposition. Certains patients présentent une détresse respiratoire aiguë nécessitant une hospitalisation en soins intensifs. L'évolution clinique est favorable en quelques jours dans la majorité des cas, mais une dyspnée ou une toux chroniques pourraient persister chez certains patients. Un récent changement de formulation chimique semble être la cause de l'épidémie survenue en Suisse. Les produits incriminés ont été retirés de la vente. De nouveaux cas pourraient toutefois survenir à l'avenir en lien avec l'utilisation accrue de sprays imperméabilisants durant l'hiver et la possible commercialisation de nouveaux produits. [¨Résumé des Auteurs] A la suite de l'épidémie survenue en Suisse, l'Office fédéral de la santé publique a fait classer tous les sprays imperméabilisants pour cuirs et textiles dans la classe de toxicité 5S. Leurs emballages comporteront donc davantage d'avertissements aux utilisateurs. Il est actuellement recommandé d'employer ces sprays à l'air libre, d'éviter de s'exposer au brouillard de vaporisation (ne pas employer le spray contre le vent), et de bien laisser sécher les articles imperméabilisés à l'extérieur. L'emploi à l'intérieur est à éviter. Il ne suffit pas d'ouvir une fenêtre. Les personnes atteintes de maladies respiratoires (par exemple, asthme) devraient éviter d'utiliser elles-mêmes ces produits et ne pas se tenir à proximité d'un endroit où ils sont employés. [Auteurs, p. 2177]]]> Aerosols ; Respiratory Tract Diseases ; Environmental Exposure fre oai:serval.unil.ch:BIB_28738 2022-05-07T01:13:32Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_28738 Substances végétales toxiques et allergisantes. Giroud, C info:eu-repo/semantics/bookPart incollection 2003 Plantes, Pollen &amp; Allergies, vol. 3, pp. 50-63 oai:serval.unil.ch:BIB_28738FE2CF5F 2022-05-07T01:13:32Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_28738FE2CF5F Comparative Studies of Fluoroquinolones in the Treatment of Urinary Tract Infections info:doi:10.1093/clinids/10.supplement_1.s153 info:eu-repo/semantics/altIdentifier/doi/10.1093/clinids/10.supplement_1.s153 Malinverni, R. Glauser, M. P. info:eu-repo/semantics/article article 1988 Clinical Infectious Diseases, vol. 10, no. Supplement_1, pp. S153-S163 info:eu-repo/semantics/altIdentifier/pissn/1537-6591 info:eu-repo/semantics/altIdentifier/pissn/1058-4838 eng oai:serval.unil.ch:BIB_28739 2022-05-07T01:13:32Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_28739 Grössenselektive personenbezogene Staubprobenahme : Verwendung offenporiger Schäume Möhlmann, C. Aitken, R. J. Kenny, L. C. Görner, P. Vu Duc, T. Zambelli, G. info:eu-repo/semantics/article article 2003 Gefahrstoffe - Reinhaltung der Luft, vol. 63, no. 10, pp. 413-416 info:eu-repo/semantics/altIdentifier/pissn/0949-8036 ger oai:serval.unil.ch:BIB_28740 2022-05-07T01:13:32Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_28740 Intellectuelle ou militante? le serpent de mer fait son numéro. Kraus, C Malbois, F Messant, F Pannatier, G Perrin, C info:eu-repo/semantics/article article 2003 Nouvelles Questions Féministes, vol. volume 22, n° 1, pp. 4-12 oai:serval.unil.ch:BIB_28742 2022-05-07T01:13:32Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_28742 Poétique et dramaturgie: les didascalies de personnage. Exemple du théâtre de Georges Ferydeau. Myszkorowska, M info:eu-repo/semantics/article article 2003 Pratiques, vol. 119-120, pp. 35-66 oai:serval.unil.ch:BIB_286DBB5FB136 2022-05-07T01:13:32Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_286DBB5FB136 Low-grade glioma: a challenge in therapeutic options: the role of radiotherapy. info:doi:10.1093/annonc/mdn434 info:eu-repo/semantics/altIdentifier/doi/10.1093/annonc/mdn434 info:eu-repo/semantics/altIdentifier/pmid/18790954 Baumert, B.G. Stupp, R. info:eu-repo/semantics/review article 2008 Annals of Oncology, vol. 19, no. Suppl 7, pp. vii217-vii222 info:eu-repo/semantics/altIdentifier/pissn/1569-8041 Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Chemotherapy, Adjuvant; Dacarbazine; Glioma; Humans; Lomustine; Neoplasm Recurrence, Local; Procarbazine; Prognosis; Radiotherapy; Radiotherapy Dosage; Vincristine eng https://serval.unil.ch/resource/serval:BIB_286DBB5FB136.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_286DBB5FB1362 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_286DBB5FB1362 info:eu-repo/semantics/publishedVersion info:eu-repo/semantics/openAccess Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_286DD50ABE29 2022-05-07T01:13:32Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_286DD50ABE29 Cycling to Work : An Analysis of the Practice of Utility Cycling info:doi:10.1007/978-3-030-62256-5 info:eu-repo/semantics/altIdentifier/doi/10.1007/978-3-030-62256-5 urn:isbn:9783030622558 info:eu-repo/semantics/altIdentifier/isbn/9783030622558 urn:isbn:9783030622565 info:eu-repo/semantics/altIdentifier/isbn/9783030622565 info:eu-repo/semantics/altIdentifier/pissn/2191-530X info:eu-repo/semantics/altIdentifier/pissn/2191-5318 Rérat, Patrick info:eu-repo/semantics/book book 2021 <![CDATA[This book presents a thorough discussion of utility cycling, cycling in the urban environment, and everyday mobility. It is based on large survey answered by 14,000 participants in the bike to work action in Switzerland, and quantifies the various dimensions of utility cycling. It proposes an innovative theoretical framework to analyse and understand the various dimensions of the uses of bikes and their diversity. It addresses the factors that motivate commuters to get on their bike, and highlights the barriers to this practice between deficient infrastructures and lack of legitimacy. This research makes a diagnosis and discusses the way to develop this sustainable mode of transportation. By combining quantitative results in the form of tables, figures, and maps, and including qualitative results in the form of quotations from survey participants, this book provides a thorough and enjoyable read. It will be of interest to researchers, policy makers, advanced students in the field of urban planning, social sciences, and transportation

REM-associated sleep apnoea: prevalence and clinical significance in the HypnoLaus cohort

This study determined the prevalence of rapid eye movement (REM) related sleep-disordered breathing (REM-SDB) in the general population and investigated the associations of REM-SDB with hypertension, metabolic syndrome, diabetes and depression.Home polysomnography (PSG) recordings (n=2074) from the population-based HypnoLaus Sleep Cohort (48.3% men, 57±11 years old) were analysed. The apnoea-hypopnoea index was measured during REM and non-REM sleep (as REM-AHI and NREM-AHI, respectively). Regression models were used to explore the associations between REM-SDB and hypertension, diabetes, metabolic syndrome and depression in the entire cohort and in subgroups with NREM-AHI &lt;10 events·h &lt;sup&gt;-1&lt;/sup&gt; and total AHI &lt;10 events·h &lt;sup&gt;-1&lt;/sup&gt; The prevalence of REM-AHI ≥20 events·h &lt;sup&gt;-1&lt;/sup&gt; was 40.8% in the entire cohort. An association between increasing REM-AHI and metabolic syndrome was found in the entire cohort and in both the NREM-AHI and AHI subgroups (p-trend=0.014, &lt;0.0001 and 0.015, respectively). An association was also found between REM-AHI ≥20 events·h &lt;sup&gt;-1&lt;/sup&gt; and diabetes in both the NREM-AHI &lt;10 events·h &lt;sup&gt;-1&lt;/sup&gt; (odds ratio (OR) 3.12 (95% CI 1.35-7.20)) and AHI &lt;10 events·h &lt;sup&gt;-1&lt;/sup&gt; (OR 2.92 (95% CI 1.12-7.63)) subgroups. Systolic and diastolic blood pressure were positively associated with REM-AHI ≥20 events·h &lt;sup&gt;-1&lt;/sup&gt; REM-SDB is highly prevalent in our middle-to-older age sample and is independently associated with metabolic syndrome and diabetes. These findings suggest that an increase in REM-AHI could be clinically relevant