Should flow-volume loop be monitored in sleep apnea patients treated with continuous positive airway pressure?

AbstractNasal continuous positive airway pressure (nCPAP) has been widely established in the treatment of obstructive sleep apnea syndrome (OSAS). However, only few studies have evaluated long-term effects of this treatment on lung function. This study assesses the effect of nCPAP on lung function parameters and response to bronchodilators in 50 OSAS patients. Spirometry and arterial blood gas measurements were performed before starting nCPAP and after 16.8±8 months of treatment. Of the 50 study patients (55±12 years, with an apnea/hypopnea index of 47±34h−1), 15 had asthma, 13 had chronic obstructive pulmonary disease (COPD) and 22 had no obstructive airway disease (NOAD). In the entire population, significant decreases in FEF50 (from 69±38% to 61±30%, P<0.005), FEF25 (from 53±34% to 46±28%, P<0.05) and FEF25−75 (from 65±33% to 57±27%, P<0.005) were observed after treatment. No impairment of lung function was found in COPD and asthmatic patients. In contrast, lung function was changed in the NOAD group where FEF50, FEF25 and FEF25−75 as well as FEV1 and FEV1/VC ratio were significantly reduced. Moreover, bronchial hyperresponsiveness occurred in five of 22 patients of this group. These results suggest that tolerance of nCPAP should be handled by long-term follow-up of flow-volume loops

La recherche-action au service de l’examen périodique de santé senior

The increase of life expectancy is a major issue to face in the decades to come. A consequence of this increasing life expectancy is the emergence of chronic diseases. It is now acknowledged that individual ageing is strongly influence by biological, psychological, environmental and social variables. Prevention begins at birth and continues throughout life. It is for this reason, that a prevention consultation at certain key moments in life, such as at retirement, is strongly advised. Our doctorate work consisted of documenting the setup of periodic health examinations dedicated to seniors. This was supported by scientific proof provided by carrying out many action researches in the Health Examination centres of French Health Insurance, an approach similar to ‘Evidence Based Medicine’. The action researches were directed towards three main public health issues amongst the elderly which include falling, memory cognitive impairment and macular degeneration related to age. Each action research contributed to the establishment of this health examination for seniors. Indeed, now there is a better recognition of characteristics amongst seniors who have suffered falls thanks to the development of a tool which gives a predictive score a falling, and in turn action strategies. In addition, there is a tool to spot and identify mild cognitive impairment and screening for macular degeneration related to age through the use of telemedicine. Other health topics will need to be explored but French Health Examination Centres already position themselves as responsible decisive actors for the ageing populationLa longévité est un enjeu majeur des prochaines décennies. La conséquence de cette longévité est l’émergence des maladies chroniques. Il est aujourd’hui admis que le vieillissement individuel est fortement influencé par des variables biologiques, psychologiques, environnementales et sociales. La prévention commence à la naissance pour se poursuivre tout au long de la vie. C’est pourquoi, une consultation de prévention à des moments clés du parcours de vie notamment au moment de la retraite est largement conseillée. Notre travail de doctorat a consisté, grâce à la mise en place de plusieurs recherches-actions dans les Centres d’examens de santé de l’Assurance maladie, à documenter par la preuve scientifique, démarche qui rejoint celle de l’Evidence-Based Medecine, la construction d’un examen périodique de santé dédié aux séniors. Les recherches-actions ont concerné trois problématiques de santé publique des personnes âgées que sont la chute, les troubles cognitifs et la dégénérescence maculaire liée à l’âge. Chaque recherche-action a apporté sa contribution à la construction de cet examen de santé senior : une meilleure connaissance des caractéristiques des chuteurs avec élaboration d’un score prédictif de chute et de stratégies de prise en charge de ce risque, des outils simples de repérage des troubles cognitifs légers, un dépistage de la dégénérescence maculaire liée à l’âge via la télémédecine. D’autres thématiques de santé seront à explorer mais les Centres d’examens de santé se positionnent d’ores et déjà, comme des acteurs déterminants de la prise en charge des populations vieillissante

Flow-mediated-paradoxical vasoconstriction is independently associated with asymptomatic myocardial ischemia and coronary artery disease in type 2 diabetic patients.

International audienceBACKGROUND: To investigate whether flow-mediated dilation (FMD) impairment, which precedes overt atherosclerosis, is associated with silent myocardial ischemia (SMI) and asymptomatic coronary artery disease (CAD) in type 2 diabetes. METHODS: Forearm FMD was measured by ultrasonography in 25 healthy control, 30 non-diabetic overweight or obese patients and 118 asymptomatic type 2 diabetic patients with a high cardiovascular risk profile. SMI (abnormal stress myocardial scintiscan and/or stress dobutamine echocardiogram) and CAD (coronary angiography in the patients with SMI) were assessed in the diabetic cohort. RESULTS: FMD was lower in diabetic patients (median 0.61% (upper limits of first and third quartiles -1.22;3.2)) than in healthy controls (3.95% (1.43;5.25), p < 0.01) and overweight/obese patients (4.25% (1.74;5.56), p < 0.01). SMI was present in 60 diabetic patients, including 21 subjects with CAD. FMD was lower in patients with SMI than in those without (0.12% (-2.3;1.58) vs 1.64% (0;3.69), p < 0.01), with a higher prevalence of paradoxical vasoconstriction (50.0% vs 29.3%, p < 0.05). FMD was also lower in patients with than without CAD (-1.22% (-2.5;1) vs 1.13% (-0.4;3.28), p < 0.01; paradoxical vasoconstriction 61.9% vs 34.4%, p < 0.05). Logistic regression analyses considering the parameters predicting SMI or CAD in univariate analyses with a p value <0.10 showed that paradoxical vasoconstriction (odds ratio 2.7 [95% confidence interval 1.2-5.9], p < 0.05) and nephropathy (OR 2.6 [1.2-5.7], p < 0.05) were independently associated with SMI; and only paradoxical vasoconstriction (OR 3.1 [1.2-8.2], p < 0.05) with CAD. The negative predictive value of paradoxical vasoconstriction to detect CAD was 88.7%. CONCLUSIONS: In diabetic patients, FMD was independently associated with SMI and asymptomatic CAD.Trial registration: Trial registration number NCT00685984

Heat and moisture exchanger vs heated humidifier during long-term mechanical ventilation. A prospective randomized study.

peer reviewedAdequate humidification of inspired gases with HMEs during long-term MV remains controversial. In this study, a comparison is made between tracheal secretions during long-term MV either with HME or conventional HH. Both the HME and HH groups were similar with respect to age, sex, diagnosis, duration of MV, SAPS and mortality. Temperature of gases in the tracheal tube was lower and the amount of tracheal instillations was greater in the HME group than in the HH group. Tracheal secretions became thicker between day 1 (control) and day 5, in the HME group than in the HH group. Four and two tube occlusions occurred in HME and HH groups, respectively. Tracheal bacterial colonization was similar in the two groups. Given the advantages of HME (reduced nurses' work and financial cost), HME could be routinely used under cautious surveillance and replaced by HH if difficulty in suctioning occurs

Serum Lipid Changes after Short Term SIPC Therapy for Lower Limb Lymphedema

Lymphedema is a ubiquitous chronic disease with various suggested treatment options, but no definite treatment. Using (Sequential) Intermittent Pneumatic Compression (SIPC) is one of the most appropriate non-surgical treatments without any noticeable complications. In this study, we evaluated the serum lipids changes following SIPC. Participants included 40 lower limb lymphedema patients who underwent High Pressure SIPC for a period of 48 hrs. Pre and Post SIPC serum lipids changes were evaluated. Though, there was some increase in the serum level of cholesterol and triglyceride, none of the patients had the values above the normal range. We concluded that, the fluid entering the serum during SIPC, contain large molecules such as lipids, which increases serum lipid levels. However this phenomenon does not have any significant complication for the patients

Changes of Coronary Blood Flow in Vasospastic Angina under Cold Stimulation by Transthoracic Doppler Echocardiography

This study was done to evaluate changes of microvascular function under cold stimulation by measuring coronary flow velocities (CFVs) in vasospastic angina (VA) patients using transthoracic Doppler echocardiography (TTDE). 14 patients with VA and 15 healthy controls were included. CFVs were measured at the distal left anterior descending coronary artery by TTDE at baseline and under cold stimulation. Hyperemia was induced by intravenous adenosine infusion (140 µg/kg/min). At baseline, CFVs and coronary flow reserve (CFR) were not different between controls and VA patients. Under cold stimulation, the degree of increment of CFV with adenosine was lower in VA patients than in controls. Comparing baseline with cold stimulation, coronary flow reserve (CFR) increased (3.1±0.7 to 3.8±1.0, p=0.06) in controls. In contrast, in VA patients, CFR was decreased (2.8±0.9 to 2.6±0.7, p=0.05) and coronary vascular resistance index markedly increased (0.35 to 0.43, p=0.01). Throughout the study, no patient experienced chest pain or ECG changes. In VA patients, CFR was preserved at baseline, but coronary blood flow increase in response to cold stimulation was blunted and CFR was decreased. These findings suggest that endothelial dependent vasodilation is impaired at the coronary microvascular and the epicardial artery level in VA under cold stimulation