Intérêt des différentes huiles alimentaires végétales dans le processus de l'atherosclerose

LIMOGES-BU Médecine pharmacie (870852108) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

Validation of an apnea and hypopnea detection algorithm implemented in implantable cardioverter defibrillators. The AIRLESS study

International audienceDiagnosis of sleep apnea (SA) using simple tools has the potential to improve the efficacy of cardiac implants in the prevention of cardiac arrhythmias. The aim of the present study was to validate a transthoracic impedance sensor for SA diagnosis in patients with cardiac implants. We compared the apnea-hypopnea index (AHI) obtained from polysomnography (AHIPSG) with the AHI obtained from autoscoring algorithms of the ApneaScan implantable impedance respiration sensor (AHIAS) three months after implantation of cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) devices. Twenty-five patients with indications for implantation of ICD or CRT-D (INCEPTA; Boston Scientific) (24 men, 59.9 ± 14.4 years; LVEF 30.3 ± 6.4%; body mass index 25.9 ± 4.2 kg/m²) were included. Mean AHI-PSG was 21.9 ± 19.1 events/hr. A significant correlation was found between AHIPSG and AHIAS especially for the most severe SA (Spearman correlation: 0.71, p < 0.001). Intraclass Correlation Coefficient (was in the expected range: 0.67, 95% CI: 0.39–0.84. The mean bias was 5.4 events per hour (mean AHI: 23.3 ± 14.6 versus 29.7 ± 13.7 for AHI-PSG and AHI-AS, respectively). An optimal cutoff value for the AHIAS at 30 events/h was obtained from the Receiver Operator Characteristic (ROC) curve analysis, which yielded a sensitivity of 100%, a specificity of 80%, PPV = 67%, NPV = 100%. Using an advanced algorithm for autoscoring of transthoracic impedance included in ICDs is reliable to identify SA and has the potential to improve the management of patients with cardiac implants

Validation of an apnea and hypopnea detection algorithm implemented in implantable cardioverter defibrillators. The AIRLESS study

International audienceDiagnosis of sleep apnea (SA) using simple tools has the potential to improve the efficacy of cardiac implants in the prevention of cardiac arrhythmias. The aim of the present study was to validate a transthoracic impedance sensor for SA diagnosis in patients with cardiac implants. We compared the apnea-hypopnea index (AHI) obtained from polysomnography (AHIPSG) with the AHI obtained from autoscoring algorithms of the ApneaScan implantable impedance respiration sensor (AHIAS) three months after implantation of cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) devices. Twenty-five patients with indications for implantation of ICD or CRT-D (INCEPTA; Boston Scientific) (24 men, 59.9 ± 14.4 years; LVEF 30.3 ± 6.4%; body mass index 25.9 ± 4.2 kg/m²) were included. Mean AHI-PSG was 21.9 ± 19.1 events/hr. A significant correlation was found between AHIPSG and AHIAS especially for the most severe SA (Spearman correlation: 0.71, p < 0.001). Intraclass Correlation Coefficient (was in the expected range: 0.67, 95% CI: 0.39–0.84. The mean bias was 5.4 events per hour (mean AHI: 23.3 ± 14.6 versus 29.7 ± 13.7 for AHI-PSG and AHI-AS, respectively). An optimal cutoff value for the AHIAS at 30 events/h was obtained from the Receiver Operator Characteristic (ROC) curve analysis, which yielded a sensitivity of 100%, a specificity of 80%, PPV = 67%, NPV = 100%. Using an advanced algorithm for autoscoring of transthoracic impedance included in ICDs is reliable to identify SA and has the potential to improve the management of patients with cardiac implants

Validation of an apnea and hypopnea detection algorithm implemented in implantable cardioverter defibrillators. The AIRLESS study

International audienceDiagnosis of sleep apnea (SA) using simple tools has the potential to improve the efficacy of cardiac implants in the prevention of cardiac arrhythmias. The aim of the present study was to validate a transthoracic impedance sensor for SA diagnosis in patients with cardiac implants. We compared the apnea-hypopnea index (AHI) obtained from polysomnography (AHIPSG) with the AHI obtained from autoscoring algorithms of the ApneaScan implantable impedance respiration sensor (AHIAS) three months after implantation of cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) devices. Twenty-five patients with indications for implantation of ICD or CRT-D (INCEPTA; Boston Scientific) (24 men, 59.9 ± 14.4 years; LVEF 30.3 ± 6.4%; body mass index 25.9 ± 4.2 kg/m²) were included. Mean AHI-PSG was 21.9 ± 19.1 events/hr. A significant correlation was found between AHIPSG and AHIAS especially for the most severe SA (Spearman correlation: 0.71, p < 0.001). Intraclass Correlation Coefficient (was in the expected range: 0.67, 95% CI: 0.39–0.84. The mean bias was 5.4 events per hour (mean AHI: 23.3 ± 14.6 versus 29.7 ± 13.7 for AHI-PSG and AHI-AS, respectively). An optimal cutoff value for the AHIAS at 30 events/h was obtained from the Receiver Operator Characteristic (ROC) curve analysis, which yielded a sensitivity of 100%, a specificity of 80%, PPV = 67%, NPV = 100%. Using an advanced algorithm for autoscoring of transthoracic impedance included in ICDs is reliable to identify SA and has the potential to improve the management of patients with cardiac implants

Waist, neck circumferences, waist-to-hip ratio: Which is the best cardiometabolic risk marker in women with severe obesity? The SOON cohort.

METHODS:Data from women (n = 305, aged 43 [34; 53] years-old, BMI 44.2 [40.8; 48.2] kg/m2) included in the Severe Obesity Outcome Network (SOON) cohort were analyzed (i) to evaluate collinearity between the different anthropometric markers, (ii) to compare the association of markers with hypertension, type 2 diabetes, obstructive sleep apnea syndrome (OSAS) and other cardiometabolic risks. RESULTS:Hip, waist and neck circumferences correlated with BMI with respectively less collinearity (r = 0.70, r = 0.59 and r = 0.37, respectively, p<0.001) whereas waist-to-hip ratio was not correlated (r = 0.11, p = 0.072). Waist and neck circumferences were significantly associated with hypertension, type 2 diabetes and OSAS in univariate logistic regressions, waist-to-hip ratio with hypertension and type 2 diabetes. Hip circumference was inversely correlated with type 2 diabetes (OR 0.970 (95CI: 0.948; 0.991) p = 0.006). BMI was only linked to OSAS (OR 1.092 (95CI: 1.043; 1.143) p<0.001). Neck circumference was the only marker significantly associated with all cardiometabolic risk markers (HOMA-IR, apnea-hypopnea index, Log Triglycerides/HDL-c, alanin-aminotransferase, aspartate-aminotransferase, gammaglutamyl transpeptidase). CONCLUSIONS:Neck circumference appears the most appropriate anthropometric marker to identify the fat distribution associated with high cardiometabolic risk in women with severe obesity

Computed Tomography Registration-Derived Regional Ventilation Indices Compared to Global Lung Function Parameters in Patients With COPD

International audienceCT registration-derived indices provide data on regional lung functional changes in COPD. However, because unlike spirometry which involves dynamic maximal breathing maneuvers, CT-based functional parameters are assessed between two static breathholds, it is not clear how regional and global lung function parameters relate to each other. We assessed the relationship between CT-density change (dHU), specific volume change (dsV), and regional lung tissue deformation (J) with global spirometric and plethysmographic parameters, gas exchange, exercise capacity, dyspnoea, and disease stage in a prospective cohort study in 102 COPD patients. There were positive correlations of dHU, dsV, and J with spirometric variables, DLCO and gas exchange, 6-min walking distance, and negative correlations with plethysmographic lung volumes and indices of trapping and lung distension as well as GOLD stage. Stepwise regression identified FEV1/FVC (standardized β = 0.429, p < 0.0001), RV/ TLC (β = −0.37, p < 0.0001), and BMI (β = 0.27, p=<0.001) as the strongest predictors of CT intensity-based metrics dHU, with similar findings for dsV, while FEV1/FVC (β = 0.32, p=<0.001) and RV/TLC (β = −0.48, p=<0.0001) were identified as those for J. These data suggest that regional lung function is related to two major pathophysiological processes involved in global lung function deterioration in COPD: chronic airflow obstruction and gas trapping, with an additional contribution of nutritional status, which in turn determines respiratory muscle strength. Our data confirm previous findings in the literature, suggesting the potential of CT image-based regional lung function metrics as the biomarkers of disease severity and provide mechanistic insight into the interpretation of regional lung function indices in patients with COPD

Contribution of obstructive sleep apnoea to arterial stiffness: a meta-analysis using individual patient data

International audienceBackground Arterial stiffness, measured by pulse wave velocity (PWV), is a strong independent predictor of late cardiovascular events and mortality. It is recognised that obstructive sleep apnoea (OSA) is associated with cardiovascular comorbidities and mortality. Although previous meta-analyses concluded that PWV is elevated in OSA, we feel that an individual patient data analysis from nine relatively homogeneous studies could help answer: to what extent does OSA drive arterial stiffness?Methods Individual data from well-characterised patients referred for suspicion of OSA, included in nine studies in which carotid–femoral PWV was measured using a Complior device, were merged for an individual patient data meta-analysis.Results 893 subjects were included (age: 56±11 (mean±SD), 72% men, 84% with confirmed OSA). Body Mass Index varied from 15 to 81 kg/m 2 (30±7 kg/m 2 ). PWV ranged from 5.3 to 20.5 m/s (10.4±2.3 m/s). In univariate analysis, log(PWV) was strongly related to age, gender, systolic blood pressure, presence of type 2 diabetes (all p<0.01) as well as to dyslipidaemia (p=0.03) and an Epworth Sleepiness Scale score ≥9 (p=0.04), whereas it was not related to obesity (p=0.54), a severe Apnoea–Hypopnoea Index (p=0.14), mean nocturnal saturation (p=0.33) or sleep time with oxygen saturation below 90% (p=0.47). In multivariable analysis, PWV was independently associated with age, systolic blood pressure and diabetes (all p<0.01), whereas severe OSA was not significantly associated with PWV.Conclusion Our individual patient meta-analysis showed that elevated arterial stiffness in patients with OSA is driven by conventional cardiovascular risk factors rather than apnoea parameters

Bariatric surgery short-term outcomes in patients with obstructive sleep apnoea: the Severe Obesity Outcome Network prospective cohort

International audienceBackground/objectives: Although the benefits of bariatric surgery have been clearly established, it is not known whether they are as important in patients with obstructive sleep apnoea (OSA). Primary aim: to evaluate whether patients with moderate-to-severe OSA (apnoea-hypopnea index (AHI) ≥ 15 events/h) treated by continuous positive airway pressure/non-invasive ventilation (median [IQR] adherence 6.5 h/night [5; 7.9] at baseline) lose the same amount of body weight 1 year after bariatric surgery as patients with no or mild OSA. Secondary objectives: to compare the evolution of type 2 diabetes and hypertension after bariatric surgery, and surgical complication rates between groups.Methods/subjects: Analyses were performed in 371 patients included in a prospective cohort of bariatric surgery, the Severe Obesity Outcome Network cohort. Subjects having moderate-to-severe OSA (n = 210) at baseline were compared with other subjects (n = 161).Results: Excess weight loss (%EWL) at 1 year was lower in patients with moderate-to-severe OSA than in patients without (64.9%EWL [46.9; 79.5] vs. 73.8%EWL [56.6; 89.3], p < 0.01). Multivariable analysis showed that age, initial body mass index and type of surgery, but not OSA status, were associated with 1-year %EWL. Diabetes remitted in 25 (41%) patients with moderate-to-severe OSA and 16 (48%) patients with no or mild OSA (p = 0.48). Hypertension remitted in 28 (32.9%) patients with moderate-to-severe OSA and 9 (40.9%) with no or mild (p = 0.48). Complication rates were 28 (13.3%) in patients with moderate-to-severe OSA and 12 (7.5%) in patients with no or mild OSA (p = 0.07).Conclusions: Patients with OSA lose less body weight after bariatric surgery. This was related to older age and a higher baseline body mass index. However, the improvements of diabetes and hypertension were similar to that of patients without OSA, and the risk of surgical complications was not higher

Heat-moulded versus custom-made mandibular advancement devices for obstructive sleep apnoea: a randomised non-inferiority trial

International audienceRationale Custom-made mandibular advancement devices (MADs) are reported as providing higher efficacy rates compared with thermoplastic heat-moulded MADs but at the price of higher costs and treatment delays.Objective To determine whether a thermoplastic heat-moulded titratable MAD (ONIRIS; ONIRIS SAS, Rueil Malmaison, France) is non-inferior to a custom-made acrylic titratable MAD (TALI; ONIRIS SAS, Rueil Malmaison, France) for obstructive sleep apnoea (OSA).Methods We conducted a multicentre, open, randomised controlled trial of patients with OSA refusing or not tolerating continuous positive airway pressure (CPAP). Participants were randomly assigned to a thermoplastic heat-moulded titratable device or a custom-made acrylic device for 2 months with stratification by centre and OSA severity. The non-inferiority primary outcome was a ≥50% reduction in apnoea–hypopnoea index (AHI) or achieving AHI <10 events/hour at 2 months. The non-inferiority margin was preset as a difference between groups of 20% for the primary outcome in the per-protocol analysis.Main results Of 198 patients (mean age 51 [SD, 12] years; 138 [72.6%] men; mean body mass index 26 [SD, 2.7] kg/m2; mean AHI 26.6/hour [SD, 10.4]), 100 received TALI and 98 ONIRIS. In per-protocol analysis, the response rate was 51.7% in the TALI group versus 53.6% in the ONIRIS group (absolute difference 1.9%; 90% CI: 11% to 15%, within the non-inferiority margin). Effectiveness was the same for severity, symptoms, quality of life and blood pressure reduction. Patients in ONIRIS group reported more side effects and adherence was slightly better with TALI.Conclusion In patients with OSA refusing or not tolerating CPAP, the thermoplastic heat-moulded titratable MAD was non-inferior in the short-term to the custom-made acrylic MAD