Early phase assesment of therapeutic devices and of a new treatment for patients with severe obstructive sleep apnea

The works reported in this thesis have explored different aspects of the non-pharmacologic treatment of obstructive sleep apnea. We believe to have adequately justified the idea that external medical devices devoted to improve the treatment of patients with obstructive sleep apnea based on positive pressure application should be required to go through a rigorous assessment before being commercialized. This applies to both machines and mask interfaces. We believe to have also shown how a rigorous premarketing assessment of a new type of therapy combining a surgical implantation and a physiologic titration during sleep may contribute to the development of a treatment able to serve those patients unable or unwilling to use the standard therapy for the disease, CPAP.(MED - Sciences médicales) -- UCL, 201

Quelles sont les données physiopathologiques expliquant la forte prévalence du syndrome d’apnées obstructives du sommeil chez le sujet âgé ?

La prévalence du syndrome d’apnées hypopnées du sommeil augmente avec l’âge, sans qu’on ait une explication claire du pourquoi de cette évolution. Ce chapitre passe en revue les modifications liées à l’âge survenant dans l’anatomie et la physiologie des voies aériennes supérieures, ainsi que dans la physiologie du sommeil, la fonction de l’appareil musculaire ou l’exposition à des médicaments hypnotiques ou antalgiques qui peuvent rendre compte de la plus forte prévalence de ce syndrome chez le sujet âgé.[What are the physiopathological features possibly accounting for the high frequency of the obstructive sleep apnea sydrome in the elderly?] The prevalence of the sleep apnea-hypopnea syndrome increases with age, without a clear explanation as why this happens. This chapter recalls the age-related changes in upper airway anatomy and physiology, as well as in sleep physiology, the functioning of the muscles or the exposure to hypnotic or pain suppressor medications that can account for the increased prevalence of sleep apnea in older age

CPAP Added to Oxygen Administration Avoid Intubation in Acute Respiratory Distress in COVID-19 Pneumonia. Case Report

It was recently described that COVID-19 pneumonia patients had an atypical form of the ARDS syndrome and required gentle ventilation. We report here on benefits of CPAP treatment in a patient with COVID-19 pneumonia. A 63-year-old patient of African origin presented to the emergency room with COVID-19 pneumonia. Fever had started 5 days before her admission. On day 4, rapid clinical deterioration associated to a high respiratory rate and increased oxygen requirements was noted. The patient was working in an intensive care unit and refused to be intubated. Oxygen was administered at a rate of 15 litres per minute via a Boussignac valve, which initially restored normal oxygen saturation, but this treatment was poorly tolerated and the patient withdrew it after 2 h. A CPAP set at a pressure of 8 cm of water (Goodknight®) was then introduced with better tolerance, allowing the patient to wear it almost continuously for more than 38 h. The patient also benefited from the administration of methypredinsolone 40 mg. Concerning tolerance, a substantial advantage was noted for CPAP machine compared to the Boussignac valve with in addition, a clear decrease in respiratory rate. We would like to encourage the use of CPAP, better tolerated for extended hours with lower oxygen flows, in patients with COVID-19 pneumonia, where acute respiratory distress all too often leads to patient intubation and the genesis of deleterious lung lesion