Gisèle Maury

Skeletal Muscle Force and Functional Exercise Tolerance Before and After Lung Transplantation: A Cohort Study

We investigated the impact of lung transplantation and outpatient pulmonary rehabilitation after lung transplantation on skeletal muscle function and exercise tolerance. Skeletal muscle force (Quadriceps force, QF), exercise tolerance (six minute walking distance, 6MWD) and lung function were assessed in 36 patients before and after lung transplantation. Seventeen male and 19 female patients (age 57 ± 4) showed skeletal muscle weakness before the transplantation. A further 32 ± 21% reduction was seen 1.2 (interquartile range 0.9 to 2.0) months after LTX. The number of days on the intensive care unit was significantly related to the observed deterioration in muscle force after LTX. At this time point 6MWD was comparable to pre‐LTX.

Influence of radiological emphysema on lung function test in idiopathic pulmonary fibrosis

INTRODUCTIONnIdiopathic pulmonary fibrosis (IPF) is one of the most frequent interstitial lung disease. Emphysema can be associated with IPF as described in the «Combined pulmonary fibrosis and emphysema» syndrome.nnnAIMnThe primary endpoint of this retrospective cohort study was to evaluate the impact of the association of IPF and emphysema on lung function tests parameters (FVC, TLC, FEV1, FEV1/FVC and DLCO). The secondary endpoint was to assess the impact of the associated radiological emphysema on lung function parameters used in the du Bois prognostic score recently developed by Ron du Bois etxa0al.nnnMETHODnWe retrospectively reviewed the medical files of 98 patients with lung fibrosis who were followed in our University Hospital with access to pharmacological studies and lung transplantation from 1981 to 2011. Fifty six patients were considered for analysis. The collected data included gender, age, smoking history and respiratory hospitalizations. We also analysed their pulmonary functional parameters along with radiological characteristics, in particular the presence of emphysema which was assessed on thoracic high resolution CT scan. The du Bois score was retrospectively calculated from these data.nnnRESULTSnTLC and FVC at diagnosis were significantly higher in the IPF-E group compared to the IPF group (respectively 86.6xa0±xa017.2% pv versus 72.0xa0±xa015.0% pv; p: 0.004 and 86.8xa0±xa018.4% pv versus 72.6xa0±xa020.6% pv; p: 0.020). The [Formula: see text] used in the calculation of the du Bois prognostic score was significantly higher in the IPF-E group. By cons, [Formula: see text] was not statistically different between the two groups.nnnCONCLUSIONnRadiological emphysema associated with IPF had an impact on pulmonary function tests. Despite this difference, the du Bois score was not statistically different between these two groups. Nevertheless, after one year of follow up, the patients with emphysema were in a subclass with a lower mortality rate than those without emphysema.

The sleep/wake state scoring from mandible movement signal.

PurposeEstimating the total sleep time in home recording devices is necessary to avoid underestimation of the indices reflecting sleep apnea and hypopnea syndrome severity, e.g., the apnea–hypopnea index (AHI). A new method to distinguish sleep from wake using jaw movement signal processing is assessed.MethodsIn this prospective study, jaw movement signal was recorded using the Somnolter (SMN) portable monitoring device synchronously with polysomnography (PSG) in consecutive patients complaining about a lack of recovery sleep. The automated sleep/wake scoring method is based on frequency and complexity analysis of the jaw movement signal. This computed scoring was compared with the PSG hypnogram, the two total sleep times (TSTPSG and TSTSMN) as well.ResultsThe mean and standard deviation (in minutes) of TSTPSG on the whole dataset (nu2009=u2009124) were 407u2009±u200995.6, while these statistics were 394.2u2009±u200999.3 for TSTSMN. The Bland and Altman analysis of the difference between the two TST was 12.8u2009±u200957.3xa0min. The sensitivity and specificity (in percent) were 85.3 and 65.5 globally. The efficiency decreased slightly when AHI lies between 15 and 30, but remained similar for lower or greater AHI. In the 24 patients with insomnia/depression diagnosis, a mean difference in TST of −3.3xa0min, a standard deviation of 58.2xa0min, a sensitivity of 86.3%, and a specificity of 66.2% were found.ConclusionsMandible movement recording and its dedicated signal processing for sleep/wake recognition improve sleep disorder index accuracy by assessing the total sleep time. Such a feature is welcome in home screening methods.

Added value of a mandible movement automated analysis in the screening of obstructive sleep apnea

In‐laboratory polysomnography is the ‘gold standard’ for diagnosing obstructive sleep apnea syndrome, but is time consuming and costly, with long waiting lists in many sleep laboratories. Therefore, the search for alternative methods to detect respiratory events is growing. In this prospective study, we compared attended polysomnography with two other methods, with or without mandible movement automated analysis provided by a distance‐meter and added to airflow and oxygen saturation analysis for the detection of respiratory events. The mandible movement automated analysis allows for the detection of salient mandible movement, which is a surrogate for arousal. All parameters were recorded simultaneously in 570 consecutive patients (M/F: 381/189; age: 50u2003±u200314u2003years; body mass index: 29u2003±u20037u2003kgu2003m−2) visiting a sleep laboratory. The most frequent main diagnoses were: obstructive sleep apnea (344; 60%); insomnia/anxiety/depression (75; 13%); and upper airway resistance syndrome (25; 4%). The correlation between polysomnography and the method with mandible movement automated analysis was excellent (r: 0.95; Pu2003<u20030.001). Accuracy characteristics of the methods showed a statistical improvement in sensitivity and negative predictive value with the addition of mandible movement automated analysis. This was true for different diagnostic thresholds of obstructive sleep severity, with an excellent efficiency for moderate to severe index (apnea–hypopnea index ≥15u2003h−1). A Bland & Altman plot corroborated the analysis. The addition of mandible movement automated analysis significantly improves the respiratory index calculation accuracy compared with an airflow and oxygen saturation analysis. This is an attractive method for the screening of obstructive sleep apnea syndrome, increasing the ability to detect hypopnea thanks to the salient mandible movement as a marker of arousals.

Mandible Behavior in Obstructive Sleep Apnea Patients Under CPAP Treatment

Aim: To investigate whether obstructive sleep apnea (OSA) patients present different behaviors of mandible movements before and under CPAP therapy. Materials and Methodology: In this retrospective study, patients were selected according to inclusion criteria: both the di- agnostic polysomnography recording showing an OSA with an apnea-hypopnea index (AHI) greater than 25 (n/h) and the related CPAP therapy control recordings were available, presence of mandible movement and mask pressure signals in the recordings, and tolerance to the applied positive pressure. Statistical analysis on four parameters, namely the apnea- hypopnea index (AHI), the arousal index (ArI), the average of the mandible lowering during sleep (aLOW), and the aver- age amplitude of the oscillations of the mandible movement signal (aAMPL), was performed on two sets of recordings: OSA and CPAP therapy. Results: Thirty-four patients satisfied the inclusion criteria, thus both OSA and CPAP groups included thirty-four record- ings each. Significant difference (p < 0.001) was found in the OSA group compared with the CPAP group when consider- ing either the four parameters or only the two ones related to mandible movements. Conclusions: When an efficient CPAP pressure is applied, the mouth is less open and presents fewer broad sharp closure movements, and oscillating mandible movements are absent or very small.

Mandible behaviour interpretation during wakefulness, sleep and sleep-disordered breathing.

The mandible movement (MM) signal provides information on mandible activity. It can be read visually to assess sleep–wake state and respiratory events. This study aimed to assess (1) the training of independent scorers to recognize the signal specificities; (2) intrascorer reproducibility and (3) interscorer variability. MM was collected in the mid‐sagittal plane of the face of 40 patients. The typical MM was extracted and classified into seven distinct pattern classes: active wakefulness (AW), quiet wakefulness or quiet sleep (QW/S), sleep snoring (SS), sleep obstructive events (OAH), sleep mixed apnea (MA), respiratory related arousal (RERA) and sleep central events (CAH). Four scorers were trained; their diagnostic capacities were assessed on two reading sessions. The intra‐ and interscorer agreements were assessed using Cohens κ. Intrascorer reproducibility for the two sessions ranged from 0.68 [95% confidence interval (CI): 0.59–0.77] to 0.88 (95% CI: 0.82–0.94), while the between‐scorer agreement amounted to 0.68 (95% CI: 0.65–0.71) and 0.74 (95% CI: 0.72–0.77), respectively. The overall accuracy of the scorers was 75.2% (range: 72.4–80.7%). CAH MMs were the most difficult to discern (overall accuracy 65.6%). For the two sessions, the recognition rate of abnormal respiratory events (OAH, CAH, MA and RERA) was excellent: the interscorer mean agreement was 90.7% (Cohens κ: 0.83; 95% CI: 0.79–0.88). The discrimination of OAH, CAH, MA characteristics was good, with an interscorer agreement of 80.8% (Cohens κ: 0.65; 95% CI: 0.62–0.68). Visual analysis of isolated MMs can successfully diagnose sleep–wake state, normal and abnormal respiration and recognize the presence of respiratory effort.

Distension thoracique et BPCO, au-delà de la mécanique respiratoire et de la dyspnée

Introduction The interactions between thoracic hyperinflation and respiratory mechanics, as well as their importance in the development of dyspnoea, are now well understood. We discuss here other aspects of thoracic hyperinflation that are relevant in the context of COPD. BACKGROUND: Both clinical examination and imaging have a limited role in the detection of thoracic hyperinflation for which respiratory function tests remain the gold standard. Imaging, however, has led us to a better understanding of how the chest wall accommodates for hyperinflation, which mainly affects the diaphragm, particularly its vertical portion. More recently the adverse effects of hyperinflation on both pulmonary and systemic haemodynamics and life expectancy have been highlighted. Viewpoints and conclusions Thoracic hyperinflation affecting patients with COPD has important consequences that extend far beyond the framework of respiratory mechanics. In the future the importance of hyperinflation as a determinant of the prognosis should be confirmed and the most relevant parameter, in this context, defined. The potential links between thoracic hyperinflation and systemic inflammation should also be clarified.

Comportement de la mandibule chez les patients souffrant d’un syndrome d’apnées obstructives sévère et traités sous CPAP

Adresse e-mail : remy.hurdiel@orange.fr (R. Hurdiel) Le développement et la validation d’appareils facilement utilisable et de faible coût enregistrant les paramètres du sommeil, sont d’un intérêt important pour la recherche et pour l’éducation à la santé. Objectif.— L’objectif était de comparer l’enregistrement des principales variables du sommeil obtenues par agenda électronique, actimètre et agenda de sommeil manuscrit. Méthode.— On note que 48 adultes répartis en deux groupes (A et B) ont accepté d’enregistrer les données de leur sommeil pendant 6 à 7 jours consécutifs (soit 123 et 126 nuits respectivement). Tous ont porté un actimètre et ont utilisé l’application Scextan® (ULCO, Dunkerque, France) durant toute la période d’étude (intervalle d’une minute). Les 19 participants du groupe B ont en supplément fourni des données à partir d’un agenda de sommeil manuscrit (intervalle de 15 minutes). Les variables analysées ont été : le temps total de sommeil (TTS), les éveils après endormissement (WASO), le nombre d’éveils nocturnes (NbE), l’efficacité du sommeil (SE). Également, la latence d’endormissement (LE) a été déterminée par l’actimètre et par l’agenda de sommeil électronique (référence de l’heure de coucher). Résultats.— Les analyses (Pearson et Bland et Altman) montrent une forte corrélation de la LE (r = 0,94), du TTS (r = 0,96) et un fort agrément entre l’actimètre et l’agenda électronique (Biais LE = 3,3 ± 13 minutes ; biais TTS = 8,7 ± 11 minutes). La mesure du TTS est moins bonne entre l’actimètre et l’agenda de sommeil manuscrit (r = 0,78 ; Biais = —3,7 ± 56 minutes). Toutefois, quel que soit le type d’agenda, les corrélations et agréments avec l’actimètre sont faibles pour les éveils nocturnes (WASO, NbE, SE ; corrélation systématiquement inférieure à 0,22). Conclusion.— L’agenda de sommeil électronique, tel que Scextan®, est une méthode valable pour la mesure des temps de sommeil et du rythme circadien du sommeil. De plus, la mesure est plus précise qu’avec un agenda de sommeil manuscrit. Même si ces évaluations doivent être complétées par l’utilisation d’un accéléromètre pour détecter les éveils nocturnes, l’agenda électronique installé sur un appareil mobile offre plus de facilités éducatives que l’agenda de sommeil manuscrit.