📇 Rhumatologue · LE MANS · (72) · Libéral

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Rhumatologue

📍 LE MANS (72)LibéralRPPS 10100203032

📊 Reconnaissance scientifique : 11/100📝 52 articles publiés🇫🇷 Publications académiques françaises (8)

✨ Génération du profil synthétique IA en cours…

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Sleep Apnea-Specific Hypoxic Burden, Symptom Subtypes, and Risk of Cardiovascular Events and All-Cause Mortality

American journal of respiratory and critical care medicine · 2022

📚 231 citations🎯 RCR 28.46Top 0% NIH

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Abstract Rationale Data from population-based cohorts suggest that symptom subtypes and obstructive sleep apnea (OSA)–specific hypoxic burden (HB) could help to better identify patients with OSA at high cardiovascular (CV) risk. Objectives We aimed to evaluate whether those new markers are associated with the risk of major adverse CV events (MACE) in clinical setting. Methods Data from the Pays de la Loire cohort were linked to health administrative data to identify the occurrence of MACE (a composite outcome including all-cause mortality, acute myocardial infarction, stroke, and unplanned coronary revascularization) in patients with newly diagnosed OSA and no overt CV disease. Latent class analysis was used to identify subtypes based on eight clinically relevant variables. HB was defined as the total area under the respiratory event–related desaturation curve. Cox proportional hazards models were used to evaluate the association of symptom subtypes and HB with MACE. Measurements and Main Results Four symptom subtypes were identified (minimally symptomatic [22.0%], disturbed sleep [17.5%], excessively sleepy [49.8%], and moderately sleepy [10.6%]). After a median follow-up of 78 months (interquartile range, 52–109), 592 (11.05%) of 5,358 patients experienced MACE. In a fully adjusted model, HB and overall nocturnal hypoxemia assessed by sleep time with oxygen saturation &lt;90% were the only predictors of MACE (hazard ratio, 1.21; 95% confidence interval, 1.07–1.38; and hazard ratio, 1.34; 95% confidence interval, 1.16–1.55, respectively). The association appeared stronger toward younger patients and women. Conclusion In clinical setting, patients with OSA who demonstrate elevated OSA-specific HB are at higher risk of a CV event and all-cause mortality. Symptom subtypes were not associated with MACE after adjustment for confounders.

Relationship Between OSA Clinical Phenotypes and CPAP Treatment Outcomes

Chest · 2016

📚 107 citations🎯 RCR 5.46Top 7% NIH

Impact of Mandibular Advancement Therapy on Endothelial Function in Severe Obstructive Sleep Apnea

American journal of respiratory and critical care medicine · 2017

📚 51 citations🎯 RCR 2.87Top 17% NIH🩺 Clinique

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Abstract Rationale Endothelial dysfunction, a major predictor of late cardiovascular events, is linked to the severity of obstructive sleep apnea (OSA). Objectives To determine whether treatment with mandibular advancement device, the main alternative to continuous positive airway pressure, improves endothelial function in patients with severe OSA. Methods In this trial, we randomized patients with severe OSA and no overt cardiovascular disease to receive 2 months of treatment with either effective mandibular advancement device or a sham device. The primary outcome, change in reactive hyperemia index, a validated measurement of endothelial function, was assessed on an intention-to-treat basis. An embedded microsensor objectively measured treatment compliance. Measurements and Main Results A total of 150 patients (86% males; mean [SD] age, 54 [10] yr; median [interquartile range] apnea–hypopnea index, 41 [35–53]; mean [SD] Epworth sleepiness scale, 9.3 [4.2]) were randomized to effective mandibular advancement device (n = 75) or sham device (n = 75). On intention-to-treat analysis, effective mandibular advancement device therapy was not associated with improvement of endothelial function compared with the sham device. Office and ambulatory blood pressure outcomes did not differ between the two groups. Effective mandibular advancement device therapy was associated with significant improvements in apnea–hypopnea index (P &lt; 0.001); microarousal index (P = 0.008); and symptoms of snoring, fatigue, and sleepiness (P &lt; 0.001). Mean (SD) objective compliance was 6.6 (1.4) h/night with the effective mandibular advancement device versus 5.6 (2.3) h/night with the sham device (P = 0.006). Conclusions In moderately sleepy patients with severe OSA, mandibular advancement therapy reduced OSA severity and related symptoms but had no effect on endothelial function and blood pressure despite high treatment compliance. Clinical trial registered with www.clinicaltrials.gov (NCT 01426607).

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