Corticomotor control of the genioglossus in awake OSAS patients: a transcranial magnetic stimulation study

<p>Abstract</p> <p>Background</p> <p>Upper airway collapse does not occur during wake in obstructive sleep apnea patients. This points to wake-related compensatory mechanisms, and possibly to a modified corticomotor control of upper airway dilator muscles. The objectives of the study were to characterize the responsiveness of the genioglossus to transcranial magnetic stimulation during respiratory and non-respiratory facilitatory maneuvers in obstructive sleep apnea patients, and to compare it to the responsiveness of the diaphragm, with reference to normal controls.</p> <p>Methods</p> <p>Motor evoked potentials of the genioglossus and of the diaphragm, with the corresponding motor thresholds, were recorded in response to transcranial magnetic stimulation applied during expiration, inspiration and during maximal tongue protraction in 13 sleep apnea patients and 8 normal controls.</p> <p>Main Results</p> <p>In the sleep apnea patients: 1) combined genioglossus and diaphragm responses occurred more frequently than in controls (<it>P </it>< 0.0001); 2) the amplitude of the genioglossus response increased during inspiratory maneuvers (not observed in controls); 3) the latency of the genioglossus response decreased during tongue protraction (not observed in controls). A significant negative correlation was found between the latency of the genioglossus response and the apnea-hypopnea index; 4) the difference in diaphragm and genioglossus cortico-motor responses during tongue protraction and inspiratory loading differed between sleep apnea and controls.</p> <p>Conclusion</p> <p>Sleep apnea patients and control subjects differ in the response pattern of the genioglossus and of the diaphragm to facilitatory maneuvers, some of the differences being related to the frequency of sleep-related events.</p

Favoriser la participation en assemblée générale en répondant aux besoins des membres

Traditionnellement dans les organismes communautaires au Québec, l'assemblée générale prend une signification qui dépasse son mandat de redditions de comptes pour également prétendre à être un lieu où les membres peuvent exercer une participation active. Dans la réalité, on observe toutefois que les membres sont difficiles à mobiliser et que, lorsqu'ils sont présents, ils participent peu aux délibérations et aux prises de décision. Cette faible participation est souvent associée au désintérêt du citoyen pour les décisions collectives sans que l'on questionne l'efficacité des structures et des pratiques des organismes à stimuler une réelle vitalité démocratique dans leurs instances. Notre intérêt porte donc sur les pratiques favorisant la participation active des membres en assemblée générale, c'est-à-dire leur donnant la possibilité de prendre la parole et de participer aux décisions. Cette démarche vise beaucoup plus que de dresser une liste des meilleures pratiques. Son objectif est d'identifier des éléments qui sous-tendent ces pratiques afin de favoriser la compréhension de concepts plus abstraits permettant de définir les pratiques appropriées à chaque contexte particulier. La question est étudiée sous l'angle des besoins psychosociaux des participants. Quatre besoins sont identifiés à partir de la classification de Glasser (1983) : le plaisir, l'appartenance, la liberté et le pouvoir. Nous explorons l'importance de ces besoins pour les participants en assemblée générale ainsi que les pratiques qui contribuent à satisfaire ces besoins. Finalement, nous cherchons à identifier comment les pratiques ciblées peuvent favoriser une participation active des membres. La collecte de données a été réalisée dans un organisme d'alphabétisation populaire. La méthodologie qualitative utilisée met l'accent sur le sens de l'expérience vécue par les participants. L'approche retenue se rapproche de la recherche participative. En effet l'élaboration et la réalisation de la collecte de données ont été effectuées avec la participation des animatrices du secteur alpha de l'organisme étudié. Cette collaboration a permis de bénéficier de l'influence positive du milieu de la pratique sur le processus de collecte de données et de produire des outils adaptés au milieu étudié. Nos résultats font ressortir l'interdépendance existant entre la satisfaction de l'ensemble des besoins, ce qui illustre l'importance de maintenir un équilibre dans les mesures favorisant la réponse à ces différents besoins. Cinq éléments sont finalement mis en relief pour soutenir la participation en assemblée générale : l'établissement d'un climat convivial, le soutien à la compréhension du contenu, le soutien à la prise de parole, la création d'espaces de prise de décision et la collaboration avec les différents acteurs concernés dans la mise en place de pratiques visant la participation active.\ud ______________________________________________________________________________ \ud MOTS-CLÉS DE L’AUTEUR : participation, assemblée générale, besoins des membres, instances démocratique

La validité convergente des instruments auto-rapportés de la psychopathie : recension systématique et revue critique

La mesure auto-rapportée de la psychopathie a été critiquée depuis sa création. Présentement, il n'existe toujours aucun consensus dans la littérature quant au questionnaire auto-rapporté qui serait le plus approprié pour évaluer la psychopathie. Ainsi, plusieurs questionnaires auto-rapportés sont utilisés dans la littérature, ce qui rend la comparaison des résultats difficile, voire impossible. Ce mémoire sera donc une revue critique qui aura pour objectif de répertorier et comparer les instruments auto-rapportés spécifiques à la psychopathie chez les adultes sur les plans de leur validité convergente avec la Psychopathy Checklist-Revised (PCL-R) ou sa version courte la Psychopathy Checklist-Screening Version (PCL-SV), et leurs populations d'utilisation. Tous les instruments auto-rapportés mesurant la psychopathie chez les adultes créés depuis la conceptualisation de la psychopathie de Cleckley en 1941 ont été répertoriés. Des corrélations pondérées moyennes entre les questionnaires auto-rapportés et la PCL-R/PCL-R ont été calculées. Dans des populations majoritairement composées de détenus, ce sont les facettes de la Self-Report Psychopathy scale – Short Form (SRP-SF) qui obtiennent les meilleurs indices de validité convergente avec leurs homologues de la PCL-R (r = .33, .43, .65 et .64) et c'est le Psychopathic Personality Inventory – Short Form (PPI-SF) total qui obtient la meilleure validité convergente avec la PCL-R total (r = .46). La psychopathie semble être une pathologie difficilement mesurable par questionnaire comparativement à plusieurs autres troubles de personnalité. Pour améliorer leur mesure, il est proposé que plusieurs items personnologiques des questionnaires soient reformulés et que le nombre d'items soit réduit

Impediment in upper airway stabilizing forces assessed by phrenic nerve stimulation in sleep apnea patients

BACKGROUND: The forces developed during inspiration play a key role in determining upper airway stability and the occurrence of nocturnal breathing disorders. Phrenic nerve stimulation applied during wakefulness is a unique tool to assess Upper airway dynamic properties and to measure the overall mechanical effects of the inspiratory process on UA stability. OBJECTIVES: To compare the flow/pressure responses to inspiratory and expiratory twitches between sleep apnea subjects and normal subjects. METHODS: Inspiratory and expiratory twitches using magnetic nerve stimulation completed in eleven untreated sleep apnea subjects and ten normal subjects. RESULTS: In both groups, higher flow and pressure were reached during inspiratory twitches. The two groups showed no differences in expiratory twitch parameters. During inspiration, the pressure at which flow-limitation occurred was more negative in normals than in apneic subjects, but not reaching significance (p = 0.07). The relationship between pharyngeal pressure and flow adequately fitted with a polynomial regression model providing a measurement of upper airway critical pressure during twitch. This pressure significantly decreased in normals from expiratory to inspiratory twitches (-11.1 ± 1.6 and -15.7 ± 1.0 cm H(2)O respectively, 95% CI 1.6–7.6, p < 0.01), with no significant difference between the two measurements in apneic subjects. The inspiratory/expiratory difference in critical pressure was significantly correlated with the frequency of nocturnal breathing disorders. CONCLUSION: Inspiratory-related upper airway dilating forces are impeded in sleep apnea patients

Multi-center, randomized, placebo-controlled trial of nocturnal oxygen therapy in chronic obstructive pulmonary disease: a study protocol for the INOX trial

Abstract\ud \ud Background\ud Long-term oxygen therapy (LTOT) is the only component of the management of chronic obstructive pulmonary disease (COPD) that improves survival in patients with severe daytime hypoxemia. LTOT is usually provided by a stationary oxygen concentrator and is recommended to be used for at least 15–18 h a day. Several studies have demonstrated a deterioration in arterial blood gas pressures and oxygen saturation during sleep in patients with COPD, even in those not qualifying for LTOT. The suggestion has been made that the natural progression of COPD to its end stages of chronic pulmonary hypertension, severe hypoxemia, right heart failure, and death is dependent upon the severity of desaturation occurring during sleep. The primary objective of the International Nocturnal Oxygen (INOX) trial is to determine, in patients with COPD not qualifying for LTOT but who present significant nocturnal arterial oxygen desaturation, whether nocturnal oxygen provided for a period of 3 years decreases mortality or delay the prescription of LTOT.\ud \ud \ud Methods\ud The INOX trial is a 3-year, multi-center, placebo-controlled, randomized trial of nocturnal oxygen therapy added to usual care. Eligible patients are those with a diagnosis of COPD supported by a history of past smoking and obstructive disease who fulfill our definition of significant nocturnal oxygen desaturation (i.e., ≥ 30% of the recording time with transcutaneous arterial oxygen saturation < 90% on either of two consecutive recordings). Patients allocated in the control group receive room air delivered by a concentrator modified to deliver 21% oxygen. The comparison is double blind. The primary outcome is a composite of mortality from all cause or requirement for LTOT. Secondary outcomes include quality of life and utility measures, costs from a societal perspective and compliance with oxygen therapy. The follow-up period is intended to last at least 3 years.\ud \ud \ud Discussion\ud The benefits of LTOT have been demonstrated whereas those of nocturnal oxygen therapy alone have not. The INOX trial will likely determine whether supplemental oxygen during sleep is effective in reducing mortality, delaying the need for LTOT and improving health-related quality of life in patients with COPD who desaturate overnight.\ud \ud \ud Trial registration\ud Current Controlled Trials \ud ISRCTN50085100\ud \ud ; ClinicalTrials.gov \ud NCT01044628\ud \ud (date of registration: January 6, 2010)

Une intervention de groupe brève pour favoriser le bien-être des femmes enceintes pendant la pandémie de COVID-19 et soutenir la résilience des familles

Contexte: La pandémie de COVID-19 a été associée à une augmentation de la détresse psychologique chez les femmes enceintes. Le présent article vise à évaluer l’acceptabilité du programme STEP-COVID (Soutenir la Transition et l’Engagement dans la Parentalité dans le contexte de la pandémie de COVID-19), une intervention prénatale de groupe en ligne, en mode synchrone, visant à soutenir le bien-être, la mentalisation et la résilience. Méthode: Vingt et une femmes enceintes québécoises ont participé au programme et ont complété des mesures des symptômes psychologiques et de la mentalisation avant et après l’intervention ainsi qu’une échelle évaluant leur perception de changements sur des domaines associés à la résilience. Après chaque rencontre, elles ont rempli un questionnaire évaluant leur appréciation du programme. Résultats: Les 18 participantes (86&nbsp;%) ayant complété le programme ont rapporté de hauts taux de satisfaction après chacune des rencontres et au terme de l’intervention. Une diminution des symptômes anxio-dépressifs et des symptômes de stress post-traumatiques et une amélioration des fonctions réflexives sont observées entre le début et la fin du programme. Les participantes ont également rapporté des changements positifs sur des sphères de fonctionnement associées à la résilience. Conclusion: Les résultats soutiennent l’acceptabilité du programme STEP-COVID et suggèrent que l’offre d’une intervention de groupe brève en ligne est appréciée par les participantes, semble favoriser une diminution de la détresse psychologique et une amélioration de la mentalisation et pourrait contribuer à la résilience dans le contexte de la pandémie de COVID-19

Evaluation of the acceptability of a prenatal program for women with histories of childhood trauma: The program STEP

Background: Childhood trauma would negatively affect pregnant women's mental health and would have intergenerational repercussions. However, there is a paucity of prenatal interventions specifically designed for women exposed to childhood trauma. The study aims to evaluate the acceptability of STEP, a manualized group intervention designed for pregnant women having experienced early life adversity. Methods: The acceptability of STEP was assessed in four phases. In Phase 1, six experts evaluated whether the program activities were pertinent and trauma sensitive. In Phase 2, three parents read the intervention manuals and evaluated whether they considered each session relevant, interesting, and clear. In Phase 3, the program was briefly presented by phone to 309 pregnant women from the community. Women were inquired about their interest in the program, and the reasons for their lack of interest were assessed. In Phase 4, 30 pregnant women exposed to childhood trauma participated in the program and completed anonymous satisfaction questionnaires after each session. Psychological distress was also measured before and after the program. Results: All activities were rated by independent experts as highly pertinent, adequate, and sufficiently safe to be offered to pregnant women. Parents who read through the intervention manuals also considered that the sessions were relevant, clear, and interesting. About half of the pregnant women from the community showed interest in the program. Participants reported very high levels of satisfaction and a significant decrease in psychological distress during the program. Conclusions: Our findings show a high level of convergence among various indicators of program acceptability

Reliability of home CPAP titration with different automatic CPAP devices

<p>Abstract</p> <p>Background</p> <p>CPAP titration may be completed by automatic apparatus. However, differences in pressure behaviour could interfere with the reliability of pressure recommendations. Our objective was to compare pressure behaviour and effective pressure recommendations between three Automatic CPAP machines (Autoset Spirit, Remstar Auto, GK 420).</p> <p>Methods</p> <p>Sixteen untreated obstructive sleep apnea patients were randomly allocated to one of the 3 tested machines for a one-week home titration trial in a crossover design with a 10 days washout period between trials.</p> <p>Results</p> <p>The median pressure value was significantly lower with machine GK 420 (5.9 +/- 1.8 cm H₂O) than with the other devices both after one night and one week of CPAP titration (7.4 +/- 1.3 and 6.6 +/- 1.9 cm H₂O). The maximal pressure obtained over the one-week titration was significantly higher with Remstar Auto (12.6 +/- 2.4 cm H₂O, Mean +/- SD) than with the two other ones (10.9 +/- 1.0 and 11.0 +/- 2.4 cm H₂O). The variance in pressure recommendation significantly differed between the three machines after one night and between Autoset Spirit and the two other machines after 1 week.</p> <p>Conclusion</p> <p>Pressure behaviour and pressure recommendation significantly differ between Auto CPAP machines both after one night and one week of home titration.</p

Obstructive sleep apnea and its malajemente in patients with atrial fibrillation: An International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT) global survey of practicing cardiologists

Background: Among international cardiologists it is unclear whether equipoise exists regarding the benefit of diagnosing and managing obstructive sleep apnea (OSA) to improve atrial fibrillation (AF) outcomes and whether clinical practice and equipoise are linked. Methods: Between January 2019 and June 2020 we distributed a web-based 12-question survey regarding OSA and AF management to practicing cardiologists in 16 countries. Results: The United States, Japan, Sweden, and Turkey accounted for two-thirds of responses. 863 cardiologists responded; half were general cardiologists, a quarter electrophysiologists. Responses regarding treating OSA with CPAP to improve AF endpoints were mixed. 33% of respondents referred AF patients for OSA screening. OSA was diagnosed in 48% of referred patients and continuous positive airway pressure (CPAP) was prescribed for 59% of them. Nearly 70% of respondents believed randomized controlled trials (RCTs) of OSA treatment in AF patients were necessary and indicated willingness to contribute to such trials. Conclusions: There was no clinical equipoise among surveyed cardiologists; a majority expressed certainty that combined OSA and AF treatment is superior to AF treatment alone for improving AF outcomes. However, a minority of surveyed cardiologists referred AF patients for OSA testing, and while half of screened AF patients had OSA, CPAP was prescribed in little more than half of them, reflecting the view that better clinical trial evidence is needed to support this practice. Our results underscore the need for larger, multi-national prospective studies of OSA treatment and AF outcomes to inform more uniform society guideline recommendations