Juliette Chambe

Floppy eyelid syndrome is associated with obstructive sleep apnoea: a prospective study on 127 patients

A few investigations have raised the question of a possible relationship between obstructive sleep apnoea syndrome (OSAS) and floppy eyelid syndrome (FES). FES is an easily inverted floppy eyelid with papillary conjunctivis, and is a subset of the general pathology, lax eyelid syndrome. The aim of the current study is to determine whether OSAS severity is associated with FES. One hundred and 27 consecutive subjects (aged 25–75 years) referred to the Strasbourg University Sleep Clinic with suspicion of OSAS were included. All patients underwent overnight ambulatory respiratory polygraphy, comprehensive ophthalmological examination and completed standard sleep questionnaires. OSAS severity was defined based on the patient’s obstructive apnoea–hypopnoea index (AHI). As expected, age, body mass index (BMI) and the proportion of males increased with OSAS severity. FES was observed in 15.8% of the subjects without OSAS, 25.8% of the total OSAS population and the frequency was significantly increased (40%) in patients with severe OSAS (AHI > 30 h−1). A significant correlation between OSAS severity and FES was found after adjustment for age, sex and BMI, using a principal component analysis (PCA). The multivariate analysis included clinical, polygraphic and comorbidity data and was followed by logistic regressions for the main components extracted from the PCA. In summary, our findings show an association between OSAS severity and FES and suggest that severe OSAS might be an independent risk factor for FES. These two disorders may share common biological determinants, such as tissue elasticity. Finally, clinicians should be aware of this association so that underlying OSAS or FES can be detected.

Brainstem stroke-related restless legs syndrome: frequency and anatomical considerations.

Background: Given the discordant results of studies that have reported cases of RLS associated with brainstem stroke and the absence of RLS in large series describing the clinical spectrum of brainstem infarctions, we decided to assess RLS in all patients admitted for brainstem stroke. Methods: All patients who were consecutively referred to the Strasbourg stroke unit for brainstem infarction were prospectively evaluated for RLS. The different parameters analyzed were the topography of the ischemic lesions (magnetic resonance imaging), the different symptoms (sensory, motor, cerebellar, cranial nerves and dysarthria) and the NIH stroke scale. Statistical analyses used the Bayesian paradigm. Results: Thirty patients have been included, and RLS was observed in three patients (10%). Two patients suffered from an exacerbation of symptoms anterior to the stroke, and the other patient a de novo, but transient, RLS. Patients with stroke-induced sensory symptoms have a higher risk to develop brainstem stroke-related RLS as compared to patients without sensory symptoms. Conclusion: The results suggest that RLS should be systematically screened in patients affected with brainstem stroke, especially in the case of stroke-induced sensory symptoms. Clinicians should be aware of this association, especially as efficient treatments are available and allow improving the management of patients affected with stroke. i 2014 S. Karger AG, Basel

How do general practice residents use social networking sites in asynchronous distance learning

BackgroundBlended learning environments - involving both face-to-face and remote interactions - make it easier to adapt learning programs to constraints such as residents’ location and low teacher-student ratio. Social networking sites (SNS) such as Facebook®, while not originally intended to be used as learning environments, may be adapted for the distance-learning part of training programs. The purpose of our study was to explore the use of SNS for asynchronous distance learning in a blended learning environment as well as its influence on learners’ face-to-face interactions.MethodsWe conducted a qualitative study and carried out semi-structured interviews. We performed purposeful sampling for maximal variation to include eight general practice residents in 2nd and 3rd year training. A thematic analysis was performed.ResultsThe social integration of SNS facilitates the engagement of users in their learning tasks. This may also stimulate students’ interactions and group cohesion when members meet up in person.ConclusionsMost of the general practice residents who work in the blended learning environment we studied had a positive appraisal on their use of SNS. In particular, we report a positive impact on their engagement in learning and their participation in discussions during face-to-face instruction. Further studies are needed in order to evaluate the effectiveness of SNS in blended learning environments and the appropriation of SNS by teachers.

Evaluating the validity of the French version of the Four-Dimensional Symptom Questionnaire with differential item functioning analysis

BACKGROUND GPs are daily confronted with mental disorders and psychosomatic problems. The Four-Dimensional Symptom Questionnaire (4DSQ), measuring distress, depression, anxiety and somatization, was purposively developed for primary care. It has been translated into 12 languages and is commonly used in several countries. It was translated into French in 2008, by forward and backward translation, but it has not been validated for a primary care population. AIM This study aimed to establish whether the French 4DSQ measured the same constructs in the same way as the original Dutch 4DSQ. METHOD Two samples of French general practice patients were recruited during routine care to obtain as much variability as possible. One sample included consecutive patients, from the waiting room of rural GPs, over a period of 2 weeks and the other sample included patients with suspected psychological problems or unexplained symptoms. This population was compared to a matched Dutch sample using confirmatory factor analysis (CFA) and differential item functioning (DIF) analysis. RESULTS A total of 231 patients, from 15 French GPs, completed the questionnaire (Dutch reference group: 231). Mean age was 42.9 years (Dutch: 42.1); females numbered 71% in both samples. The multigroup CFA assessed configural invariance of one-factor models per 4DSQ scale. Thirteen of the total of 50 items in the 4DSQ, in three scales, were detected with DIF. However, DIF did not impact on the scale scores. CONCLUSION French 4DSQ scales have the same latent structures and measure the same traits as the original Dutch 4DSQ.

Intravenous Immunoglobulin Therapy Administered Early after Narcolepsy Type 1 Onset in Three Patients Evaluated by Clinical and Polysomnographic Follow-Up

Narcolepsy type 1 is a rare disabling sleep disorder mainly characterized by excessive daytime sleepiness and cataplexy, an emotion-triggered sudden loss of muscle tone. Patients have a selective degeneration of hypocretin-producing neurons in the dorsolateral posterior hypothalamus with growing evidence supporting the hypothesis of an autoimmune mechanism. Few case studies that reported intravenous immunoglobulin therapy (IVIg) suggest the efficacy of IVIg when administered early after disease onset, but the results are controversial. In these retrospective case observations, IVIg cycles were initiated within one to four months after cataplexy onset in a twenty-seven-year-old man, a ten-year-old girl, and a seven-year-old boy, all three with early onset typical narcolepsy type 1. Efficacy of treatment (three IVIg cycles of 1 g/kg administered at four-week intervals) was evaluated based on clinical, polysomnographic, and multiple sleep latency test (mean latency and SOREM) follow-up. Two patients reported decreased cataplexy frequency and ameliorated daytime sleepiness, but no significant amelioration of polysomnographic parameters was observed. Given the possibility of spontaneous improvement of cataplexy frequency with self-behavioral adjustments, these observations would need to be confirmed by larger controlled studies. Based on the present study and current literature, proof of concept is still missing thus prohibiting the consideration of IVIg as an efficient treatment option.

Association Between Alcohol Consumption and Nocturnal Leg Cramps in Patients Over 60 Years Old: A Case-Control Study

PURPOSE Nocturnal leg cramps are a specific kind of cramps affecting almost one-half of patients aged 60 years and older. They reduce patients’ quality of sleep and have a negative impact on their quality of life. The aim of this study was to evaluate the association between nocturnal leg cramps and the consumption of alcoholic beverages in patients aged 60 years and older attending general practices. METHODS Case-control study with a Bayesian approach for sensitivity analysis. Participants were voluntary ambulatory patients aged 60 years and older consulting their family doctor. They were recruited in 67 general practices across the Alsace region. Cases (patients having cramps), were matched with controls (patients free from cramps) for age, sex, medical history, and medications known to trigger cramps. Alcohol consumption was assessed through a standardized food frequency questionnaire. RESULTS We found an association between the global consumption of alcoholic beverages and nocturnal leg cramps (OR = 6.5, 95% credibility interval, 1.68-38.05; posterior probability 99.82%). CONCLUSION We identified an association between alcohol consumption and nocturnal leg cramps among patients aged 60 years and older attending general practices. These findings have implications for the prevention of cramps.