Introdução. Apneia obstrutiva do sono (AOS) provoca alterações autonômicas, tais como, hipersensibilidade quimiorreflexa e diminuição da sensibilidade barorreflexa e metaborreflexa muscular que contribuem para a hiperativação simpática em indivíduos que sofrem desse distúrbio. O objetivo desse estudo foi avaliar o efeito do treinamento físico no controle metaborreflexo da atividade nervosa simpática muscular (ANSM) em indivíduos com apneia obstrutiva do sono. Métodos. Todos os indivíduos triados para este estudo foram submetidos à polissonografia noturna convencional e avaliação da capacidade cardiorrespiratória em esforço. Quarenta e um adultos sedentários com AOS moderada e severa foram aleatoriamente divididos em grupo não-treinado (AOSNT, n=21) e treinado (AOST, n=20). A ANSM foi avaliada pela técnica microneurografia, o fluxo sanguíneo muscular (FSM) por pletismografia de oclusão venosa, a frequência cardíaca (FC) pelo eletrocardiograma e a pressão arterial (PA) método oscilométrico automático. Todas as variáveis fisiológicas foram avaliadas simultaneamente durante quatro minutos de repouso, seguido de três minutos de exercício isométrico de preensão manual a 30% da contração voluntária máxima, seguido por dois minutos de oclusão circulatória pós-exercício (OCPE) do segmento corporal previamente exercitado. A ativação seletiva do controle metaborrelfexo foi calculada pela diferença da ANSM do primeiro e segundo minutos da OCPE e a média da ANSM no repouso. Resultados. Os grupos foram semelhantes em gênero, idade, parâmetros antropométricos, parâmetros neurovasculares, parâmetros hemodinâmicos e parâmetros do sono. O treinamento físico reduziu a ANSM e aumentou o FSM no repouso. O treinamento físico diminuiu significativamente os níveis de ANSM e aumentou a resposta de FSM durante o exercício isométrico de preensão manual. O treinamento físico não alterou as respostas de frequência cardíaca e de PA durante o exercício isométrico. Em relação à sensibilidade metaborreflexa, o treinamento físico aumentou significativamente as respostas da ANSM no 1º minuto de OCPE. Não foram observadas diferenças significativas no FSM, FC e PA após o treinamento físico. Conclusões. O treinamento físico aumenta a sensibilidade metaborreflexa muscular em indivíduos com AOS, o que pode contribuir, pelo menos em parte, para a melhora no controle neurovascular durante o exercício nesses pacientes / Introduction. Obstructive sleep apnea (OSA) causes autonomic dysfunction, such as, chemoreflex hypersensitivity and baroreflex impairment and muscle metaboreflex decrease, which contribute to sympathetic overactivity in subjects who suffer from this disturbance. The purpose of this study was evaluated the effect of exercise training on muscle metaboreflex control of muscle sympathetic nerve activity (MSNA) in subjects with OSA. Methods. All individuals selected for this study underwent overnight polysomnography and cardiopulmonary exercise testing. Forty-one untrained adults with moderate to severe OSA were randomly divided into non-trained (AOSNT, n=21) and trained (AOST, n=20) groups. MSNA was assessed by microneurography technique, muscle blood flow (FBF) by venous occlusion plethysmography, heart rate (HR) by electrocardiography and blood pressure (BP) by noninvasively automated oscillometric device. All physiological variables were simultaneously assessed for 4 minutes at rest, followed by three minutes of isometric handgrip exercise at 30% of maximal voluntary contraction, followed by two minutes of postexercise regional circulatory arrest (PECA). Muscle metaboreflex sensitivity was calculated as the difference in MSNA at first and second minute of PECA and MSNA at rest period. Results. AOSNT and AOST groups were similarly in gender, age, anthropometric, neurovascular, hemodynamic and sleep parameters. Exercise training reduced MSNA and increased FBF. Exercise training significantly reduced MSNA levels and increased FBF responses during isometric handgrip exercise. Regarding the metaboreflex sensitivity, exercise training significantly increased MSNA response at 1st minute of PECA. There were no significantly difference in FBF, HR and BP after exercise training. Conclusions. Exercise training increases muscle metaboreflex sensitivity in patients with OSA, which seems to contribute, at least in part, to the improvement in neurovascular control during exercise in these patients

Introdução: A pericardiectomia é o tratamento de escolha para pacientes com pericardite constritiva crônica sintomática, entretanto, o impacto do procedimento na capacidade cardiopulmonar e fisiologia cardiorrespiratória durante a vigília e sono é pouco estudado. Objetivo: Avaliar o impacto da cirurgia de pericardiectomia sobre a capacidade funcional de pacientes com pericardite constritiva crônica sintomática. Métodos: Trata-se de estudo observacional prospectivo com 25 pacientes consecutivos com diagnóstico de pericardite constritiva crônica submetidos à pericardiectomia. Foram realizados os seguintes procedimentos uma semana antes e seis meses após a pericardiectomia: avaliação clínica e antropométrica, avaliação da qualidade de vida e do sono, dosagem dos níveis séricos de BNP, ecocardiograma transtorácico, teste cardiopulmonar de esforço, polissonografia noturna completa. Resultados: A idade média foi 45 anos, com predomínio do sexo masculino (76%). A etiologia foi principalmente idiopática (76%), seguida por tuberculose (12%). O ecocardiograma revelou fração de ejeção do ventrículo esquerdo preservada e dilatação de veia cava inferior (92%) na maioria dos pacientes. Todos os pacientes foram submetidos à pericardiectomia de frênico a frênico via esternotomia mediana, sem circulação extracorpórea. Após a pericardiectomia, houve redução da: classe funcional III/IV (56% vs. 8%, p < 0,001), ascite (72% vs. 12%, p < 0,001) e edema de membros inferiores (88% vs. 24%, p < 0,001) em relação ao pré-operatório. O teste cardiopulmonar revelou melhora do VO2 pico (18,7 ± 5,6 vs. 25,2 ± 6,3 mL/kg/min, p < 0,001), limiar anaeróbico (13,1 ± 3 vs. 17,7 ± 5,5 mL/kg/min, p < 0,001) e velocidade na esteira rolante de 2,5 (2-2,5) para 3 (2,5-3,3) mph, p=0,001. Na análise multivariada, a idade foi o único preditor independente da variação de VO2 (r=-0,658, p=0,003). Os níveis séricos de BNP apresentaram redução significativa de 143 (83,5-209,5) pg/mL para 76 (40-117,5) pg/mL, p=0,011. A polissonografia noturna completa no pré-operatório demonstrou a presença de apneia do sono moderada/ grave (IAH >= 15 eventos/hora) em 13 pacientes, com predomínio de hipopneias. Não houve mudança significativa do índice de apneia-hipopneia após a pericardiectomia: IAH pré 15,6 (8,3-31,7) vs. IAH pós 14,6 (5,75-29,9), p=0,253; entretanto, houve melhora da qualidade do sono (Pittsburgh pré 7,8 ± 4,10 vs. Pittsburgh pós 4,7 ± 3,7, p < 0,001). O IAH apresentou correlação positiva com os níveis de BNP (r=0,418, p=0,037) e EuroSCORE (r=0,480, p=0,015) no pré-operatório. Conclusão: Pacientes com pericardite constritiva crônica sintomática apresentaram, seis meses após a cirurgia de pericardiectomia, melhora da capacidade cardiopulmonar, da classe funcional e da qualidade de vida. A apneia do sono se mostrou frequente e apresentou correlação com níveis séricos de BNP e EuroSCORE no pré-operatório. O índice de apneia-hipopneia não apresentou mudanças significativas após a pericardiectomia. A despeito disso, houve melhora da qualidade do sono / Introduction: Pericardiectomy is the treatment of choice for patients with symptomatic chronic constrictive pericarditis; however, the impact of the procedure on cardiopulmonary capacity and cardiorespiratory physiology during wakefulness and sleep has been poorly studied so far. Objective: To evaluate the impact of pericardiectomy surgery on functional capacity of patients with symptomatic chronic constrictive pericarditis. Methods: This is a prospective observational study with 25 consecutive patients diagnosed with chronic constrictive pericarditis submitted to pericardiectomy. The following procedures were performed one week before and six months after pericardiectomy: clinical and anthropometric evaluation, quality of life and sleep evaluation, serum BNP levels, transthoracic echocardiography, cardiopulmonary exercise test, complete nocturnal polysomnography. Results: The mean age was 45, with a predominance of males (76%). The etiology was mainly idiopathic (76%), followed by tuberculosis (12%). The echocardiogram revealed preserved left ventricular ejection fraction and inferior vena cava dilatation (92%) in most patients. All patients underwent phrenic to phrenic pericardiectomy via median sternotomy, without extracorporeal circulation. After pericardiectomy there was a reduction in: functional class III / IV (56% vs. 8%, p < 0.001), ascites (72% vs. 12%, p < 0.001) and lower limb edema (88% vs. 24%, p < 0.001) as compared to the preoperative period. The cardiopulmonary test revealed improvement in VO2 peak (18.7 ± 5.6 vs. 25.2 ± 6.3 mL/kg/min, p < 0.001), anaerobic threshold (13.1 ± 3 vs. 17.7 ± 5.5 mL/kg/min, p < 0.001) and velocity on the treadmill from 2.5 (2-2.5) to 3 (2.5-3.3) mph, p=0.001. In multivariate analysis, age was the only independent predictor of VO2 variation (r = -0.658, p = 0.003). Serum BNP levels showed a significant reduction from 143 (83.5-209.5) pg/mL to 76 (40-117.5) pg/mL, p=0.011. The complete nocturnal polysomnography in the preoperative period showed moderate / severe sleep apnea (AHI >= 15 events / hour) in 13 patients, predominantly hypopnea. There was no significant change in apnea-hypopnea index after pericardiectomy: AHI pre 15.6 (8.3-31.7) vs. AHI post 14.6 (5.75-29.9), p= 0.253; however, there was improvement in sleep quality (Pittsburgh pre 7.8 ± 4.10 vs. Pittsburgh post 4.7 ± 3.7, p < 0.001). AHI presented a positive correlation with BNP levels (r=0.418, p=0.037) and EuroSCORE (r=0.480; p=0.015) in the preoperative period. Conclusion: Patients with symptomatic chronic constrictive pericarditis showed improvement in cardiopulmonary capacity, functional class and quality of life six months after pericardiectomy. Sleep apnea was frequent and correlated with serum levels of BNP and EuroSCORE in the preoperative period. The apnea-hypopnea index did not show significant changes after pericardiectomy. Nevertheless, there was an improvement in sleep quality

INTRODUÇÃO: Pacientes com síndrome metabólica (SMet) apresentam aumento na atividade nervosa simpática muscular (ANSM) e diminuição no ganho do controle barorreflexo arterial (CBR). E, a apnéia obstrutiva do sono (AOS), uma comorbidade frequentemente encontrada em pacientes com SMet, exacerba essas disfunções autonômicas. Sabe-se que a incidência dos disparos e o padrão oscilatório da ANSM dependem do ganho (sensibilidade) e do tempo de retardo (latência) do CBR da ANSM (CBRANSM). Contudo, o padrão oscilatório da ANSM e o tempo de retardo do CBRANSM em pacientes com SMet associada ou não à AOS são desconhecidos. Além disso, estudos prévios demonstram que o treinamento físico associado à dieta hipocalórica (TF+D) diminui a incidência dos disparos da ANSM e aumenta o ganho do CBR em pacientes com SMet. No entanto, os efeitos de TF+D no padrão oscilatório da ANSM e no ganho e tempo de retardo do CBRANSM em pacientes com SMet associado ou não a AOS permanecem desconhecidos. MÉTODOS: Foram estudados quarenta e quatro pacientes com SMet (critérios do ATP III), sem uso de medicamentos, que foram divididos em dois grupos de acordo com a presença da AOS (SMet-AOS, n=23 e SMet+AOS, n=21). Um grupo controle saudável (n=12) foi, também, incluído no estudo. Para avaliar o efeito da intervenção, os pacientes foram divididos consecutivamente em quatro grupos: 1- Sedentário sem AOS (SMet-AOS Sed, n=10); 2- Sedentário com AOS (SMet+AOS Sed, n=10); 3- TF+D sem AOS (SMet-AOS TF+D, n=13) e; 4- TF+D com AOS (SMet+AOS TF+D, n=11). Os grupos TF+D foram submetidos ao treinamento físico aeróbio (40 min, 3 vezes por semana) associado à dieta hipocalórica (-500 kcal/dia) durante quatro meses e os grupos sedentários não realizaram a intervenção (TF+D) e somente receberam orientações clínicas. A AOS foi determinada através do índice de apneia e hipopneia (IAH) >15 eventos/hora (polissonografia). A ANSM (microneurografia), pressão arterial (batimento a batimento, método oscilométrico), padrão oscilatório da ANSM (relação dos componentes de baixa frequência-BF, e alta frequência-AF da ANSM, BFANSM/AFANSM, análise espectral autorregressivo monovariada) e o CBRANSM espontâneo (ganho e tempo de retardo, análise espectral autorregressivo bivariada) foram avaliados durante o repouso na posição deitada por 10 minutos. RESULTADOS: No período pré-intervenção, os pacientes com SMet-AOS e SMet+AOS apresentaram redução no BFANSM/AFANSM (P=0,01 e P<0,001, respectivamente) e no ganho do CBRANSM (P=0,01 e P<0,001, respectivamente), em comparação com o grupo Controle. E, os pacientes com SMet+AOS apresentaram menor BFANSM/AFANSM (P=0,02) e ganho do CBRANSM (P<0,001) em comparação com SMet-AOS. Ainda, o tempo de retardo do CBRANSM estava aumentado no grupo SMet+AOS em comparação com os grupos SMet-AOS e Controle (P=0,01 e P<0,001, respectivamente). Após a intervenção TF+D, ambos os grupos SMet-AOS e SMet+AOS apresentaram redução do peso corporal, circunferência abdominal e pressão arterial sistólica e aumento consumo de oxigênio no pico do exercício. Nos pacientes com SMet-AOS, o TF+D aumentou o BFANSM/AFANSM (P<0,05) e o ganho do CBRANSM (P<0,01). Nos pacientes com SMet+AOS, o TF+D aumentou o nível de saturação mínima de O2 (P=0,02) durante a polissonografia, o BFANSM/AFANSM (P=0,001) e o ganho do CBRANSM (P<0,01) e, diminuiu o IAH (P<0,01) durante a polissonografia e o tempo de retardo do CBRANSM (P=0,01). Nenhuma alteração foi observada em ambos os grupos sedentários. CONCLUSÕES: O TF+D aumenta o padrão oscilatório da ANSM e o ganho do CBRANSM em pacientes com SMet, independentemente da presença da AOS. No entanto, este efeito é mais pronunciado em pacientes com SMet+AOS, já que após a intervenção o tempo de retardo do CBRANSM foi também diminuído nestes pacientes / INTRODUCTION: Patients with metabolic syndrome (MetS) have increased muscle sympathetic nerve activity (MSNA) and decreased arterial baroreflex control (BRC). Obstructive sleep apnea (OSA), a comorbidity often found in patients with MetS, exacerbates these autonomic dysfunctions. It is known that burst incidence and the oscillatory pattern of MSNA depend on the gain (sensitivity) and the time delay (latency) of BRC of MSNA (BRCMSNA). However, the oscillatory pattern of MSNA and the time delay of BRCMSNA in patients with MetS either with or without OSA are unknown. Moreover, previous studies have shown that exercise training associated with hypocaloric diet (ET+D) decreases the burst incidence of MSNA and increases the gain of BRC in patients with MetS. However, the effects of ET+D on the oscillatory pattern of MSNA and on the gain and time delay of BRCMSNA in patients with MetS with or without OSA remain unknown. METHODS: Forty-four never-treated MetS patients (ATP III criteria) were allocated in two groups according to the presence of OSA (MetS-OSA, n=23 and MetS+OSA, n=21). A healthy control group (n=12) was also included in the study. To evaluate the effect of the intervention, patients were consecutively divided into four groups: 1- Sedentary without OSA (MetS-OSA Sed, n=10); 2- Sedentary with OSA (MetS+OSA Sed, n=10); 3- ET+D without OSA (MetS-OSA TF+D, n=13) and 4- ET+D with OSA (MetS+OSA ET+D, n=11). ET+D groups were submitted to aerobic exercise (40 min, 3 times per week) associated to hypocaloric diet (-500 kcal / day) for four months and sedentary groups did not perform the intervention (ET+D) and only received clinical orientations. OSA was determined by the apnea-hypopnea index (AHI) >15 events/hour (polysomnography). The MSNA (microneurography), blood pressure (beat-to-beat basis, oscillometry method), oscillatory pattern of MSNA (relationship of the components of low frequency - LF, and high frequency - HF of MSNA, LFMSNA/HFMSNA, monovariate autoregressive spectral analysis) and spontaneous BRCMSNA (gain and time delay, bivariate autoregressive spectral analysis) were evaluated during rest at lying position for 10 min. RESULTS: In the pre-intervention period, patients with MetS-OSA and MetS+OSA showed reduced LFMSNA/HFMSNA (P=0.01 and P<0.001, respectively) and gain of BRCMSNA (P=0.01 and P<0.001, respectively) compared to Control group. And, the patients with MetS+OSA had lower LFMSNA/HFMSNA (P=0.02) and gain of BRCMSNA (P<0.001) compared to MetS- OSA. The time delay of BRCMSNA was higher in MetS+OSA group compared to MetS-OSA and Control groups (P=0.01 and P<0.001, respectively). After ET+D, both groups MetS-OSA and MetS+OSA decreased body weight, waist circumference and systolic blood pressure and increased peak oxygen uptake during exercise. In patients with MetS-OSA, the ET+D increased LFMSNA/HFMSNA (P<0.05) and the gain of BRCMSNA (P<0.01). In patients with MetS+OSA, ET+D increased minimum oxygen saturation level (P=0.02) during polysomnography, the LFMSNA/HFMSNA (P=0.001) and the gain of BRCMSNA (P<0.01) and decresed AHI (P<0.01) during polysomnography and the time delay of BRCMSNA (P=0.01). No alterations were observed in both sedentary groups. CONCLUSION: ET+D increase the oscillatory pattern of MSNA and the gain of BRCMSNA in patients with MetS, regardless of the presence of OSA. However, this effect is more pronounced in patients with MetS+OSA, since after intervention the time delay of BRCMSNA was also diminished in these patients

Introdução: A prevalência da apneia obstrutiva do sono (AOS) entre pessoas com mais de 70 anos atinge até 95%. As opções de tratamento incluem o uso de pressão positiva nas via aérea, dispositivos intraorais e mudança de estilo de vida. Programa de exercícios aeróbicos ou combinados mostrou reduzir o índice de apneia-hipopneia (IAH) em adultos de meia-idade. No entanto, o efeito do treinamento resistido sobre a gravidade da AOS de pessoas idosas é controverso. O objetivo do presente estudo é avaliar o impacto do treinamento resistido no IAH e identificar possíveis mediadores do efeito do exercício. Métodos: Estudo randomizado, mascarado, controlado, em grupo paralelo. Indivíduos entre 65 e 80 anos, com IAH entre 20 e 50 eventos/hora na poligrafia respiratória foram atribuídos aleatoriamente para 12 semanas de treinamento de força ou grupo controle. IAH foi o principal desfecho. Índice de massa corporal (IMC) e teor de água corporal foram testados como mediadores. Espessura do músculo, força máxima e função física também foram avaliadas. Resultados: A amostra incluiu 23 indivíduos, 57% homens, com média de idade de 71±5 anos, alocados para treinamento (n=12) e grupo controle (n=11). O IAH basal nos grupos de treinamento e controle foi, respectivamente, 30±7/h e 29±9/h. No seguimento, o IAH mostrou significativa interação tempo × grupo. Não foi observada correlação entre Delta IAH e Delta IMC ou Delta teor de água corporal. A interação tempo × grupo permanece significativa após ajustar o modelo GEE para esses possíveis mediadores. Conclusão: Treinamento resistido a curto prazo em pessoas idosas é viável e muda de forma favorável a severidade da AOS e desfechos funcionais. As alterações no IMC e no teor de água corporal não parecem mediar a redução da IAH. Estudos futuros em amostras maiores de pessoas idosas são necessários. / Introduction: Obstructive sleep apnea (OSA) prevalence among persons older than 70 years reaches up to 95%. The treatment options include use of positive airway pressure, intraoral devices, and lifestyle changes. Aerobic or combined exercise program has been shown to reduce the apnea-hypopnea index (AHI) in middle-aged adults. However, the effect of resisted training on OSA severity of older persons is controversial. The aim of the present study is to evaluate the impact of resisted training on the AHI and to identify possible mediators of the effect of exercise. Methods: This was a randomized, masked, controlled, parallel group trial. Subjects between 65 and 80 years, with AHI between 20 and 50 events/hour in the respiratory polygraphy were assigned randomly to 12 weeks of strength training or control groups. AHI was the main outcome. Body mass index (BMI) and bodily water content were tested as mediators. Muscle thickness, maximum strength, and physical function were assessed also. Results: The sample included 23 subjects, 57% men, aged 71±5 years, randomized to training (n=12) and control groups (n=11). The baseline AHI in the training and control groups were, respectively, 30±7/h and 29±9/h. At follow-up, the AHI showed significant time × group interaction. No correlation was observed between Delta AHI and delta BMI or delta bodily water content. The time × group interaction remains significant after adjusting the GEE model for these possible mediators. Conclusion: Short-term resisted training in older persons is feasible and changes favorably OSA severity and functional outcomes. Changes in BMI and in bodily water content do not seem to mediate the reduction in AHI. Future studies in larger samples of older persons are necessary.

Objectif: Les troubles respiratoires du sommeil (TRS) sont courants pendant la grossesse et sont associés à des conséquences néfastes pour la santé de la mère et du fœtus. Ceux-ci peuvent être causés par des changements dans l'équilibre sympathovagal (ESV), qui peuvent être estimés par des analyses de la variabilité de la fréquence cardiaque (VFC). Le but de l'étude est d'évaluer la VFC chez les femmes enceintes souffrant d'apnée obstructive du sommeil (AOS) à l’aide d’enregistrements polysomnographiques (PSG) à trois moments. Matériel et méthode: Dix-sept femmes enceintes diagnostiquées avec une AOS légère à modérée ont effectué des PSGs: au 2e trimestre (PSG1), au 3e trimestre, traitées avec une orthèse d’avancement mandibulaire (OAM) titrée (PSG2) et 3-6 mois post-partum (PSG3). Les données ont été analysées par conditions en intervalles cumulés de 5 minutes d’état de base (Baseline) et en intervalles cumulés de 3 minutes avant le début des événements d'AOS (Event) pour chaque stade du sommeil (NREM2, NREM3, REM) au cours de la nuit. Résultats: Le ESV (rapport de puissance spectrale basses fréquences / hautes fréquences) était statistiquement significatif pour toutes les PSGs cumulatifs par conditions (stades de sommeil Baseline p <0,01 et stades de sommeil Event p <0,01; REM> NREM2> NREM3). Une diminution significative de l'indice d'apnée-hypopnée (IAH) a été observée à PSG2 (PSG1 vs PSG2; p < 0,01). À l'analyse post hoc, à PSG2 uniquement, l'activité parasympathique (puissance spectrale des hautes fréquences normalisées (% HF normalisé)) en condition Event diminue significativement dans les stades de sommeil NREM2 (p = 0,01) et NREM3 (p <0,01) par rapport au % HF normalisé en condition Baseline pour les mêmes stades de sommeil. Conclusions: Bien que l’IAH soit réduit avec le traitement de l’OAM pendant la grossesse, l’influence du système nerveux autonome sur les évènements respiratoires semble modérée. / Purpose: Sleep breathing disorders are common during pregnancy and are associated with adverse consequences for the health of the mother and the fetus. These can be caused by changes in sympatho-vagal balance (SVB), which can be estimated through heart rate variability (HRV) analyses. The aim of the study is to assess the HRV in pregnant women with obstructive sleep apnea (OSA) at three time points. Methods: Seventeen pregnant women diagnosed with mild to moderate OSA performed 3 polysomnographic recordings (PSG): in the second trimester (PSG1), in the third trimester treated with a titrated oral appliance (OA) (PSG2) and 3-6 months post-partum. Data were analyzed in cumulative 5 minutes baseline interval samples (Baseline) and in cumulative 3 minutes interval samples before the onset of the OSA events (Event) for each sleep stages (NREM2, NREM3, REM) over the course of the night. Results: SVB (Low-/High-Frequency power ratio) was statistically significant for all cumulative PSGs per samples (Baseline sleep stages p < 0.01 and Event sleep stages p < 0.01 ; REM > NREM2 > NREM3). Significant diminution of apnea-hypopnea index (AHI) was observed at PSG2 (PSG1 vs PSG2; p < 0,01). In post hoc analysis, at PSG2 only, Event parasympathetic activity (Normalized High-Frequency % (Normalized HF %)) decreases significantly in NREM2 (p = 0.01) and NREM3 (p < 0.01) when compared to respective Baseline Normalized HF %. Conclusions: Results suggest normal shifts in SVB across sleep stages. Although AHI is reduced with the treatment of OA during pregnancy, the influence of the autonomic nervous system on respiratory events seems to remain mild.

Cognitive and psychosocial sequelae following hypoxic brain injury Abstract in English Hypoxic brain injury leads to neuronal necrosis and to other cerebral changes which may affect psychosocial functioning. Although the pathophysiology of cerebral hypoxia is multifactorial, and it is not possible to reliably describe the unified clinical picture of hypoxia patients, the most commonly described psychosocial consequences of cerebral hypoxia are cognitive impairment, increased anxiety and depressive symptoms. The aim of the present study is to characterize cognitive functioning and psychosocial changes of the patients exposing mild intermittent cerebral hypoxia (=chronic form of hypoxia, model of obstructive sleep apnea diagnosed by neurologist) and patients after severe one-time cerebral hypoxia (=acute form of hypoxia, model of cardiac arrest diagnosed by cardiologist). Regardless of the different etiology of particular hypoxia forms described in the theoretical part of the thesis, both forms may lead to neuronal death. In the experimental part we test a hypothesis comparing healthy individuals to patients with acute or chronic form of hypoxia in cognitive performance or anxiety and depressive symptoms. We document a decreased cognitive performance and higher level of state anxiety in a group of patients...

Une mauvaise qualité de sommeil est souvent observée chez les personnes âgées. Diverses méthodes sont alors utilisées afin d’en évaluer les caractéristiques, notamment les questionnaires auto-recensés et la polysomnographie (PSG). Cependant, l’utilisation de la PSG étant dispendieuse et chronophage, le recours aux analyses par questionnaires auto-recensés en milieu clinique pourrait être privilégié et faciliterait grandement l’évaluation de la qualité du sommeil. Cette étude vise à valider la méthode par questionnaires auto-recensés lors de l’évaluation de la qualité de sommeil chez les personnes âgées et à comparer ces différents questionnaires aux mesures obtenues par une PSG. Le devis de l'étude est une une sous-analyse d’une étude d’essais cliniques randomisés. L’étude a été menée auprès de patients édentés de 65 ans et plus, recrutés entre décembre 2013 et août 2018. Les données ont été collectées à domicile avec une PSG et jumelées à divers questionnaires sur le sommeil : le questionnaire de Berlin (QB, plage de scores comprise entre 0 et 3), l’échelle de somnolence Karolinska (ESK, plage de scores 1-9), l’indice de qualité du sommeil de Pittsburgh (IQSP, plage de scores de 0 à 21), l’échelle de somnolence d’Epworth (ESE, plage de scores de 0 à 24). Les données obtenues par la PSG incluent : l'indice d'apnée-hypopnée (IAH), l'indice de désaturation en oxygène (IDO) et le pourcentage d'efficacité du sommeil. L’analyse des données a été effectuée par statistiques descriptives et tests statistiques bivariés. Chez les 130 patients ayant participé à l’acquisition de données de base (51 hommes et 79 femmes, âge moyen 75 ± 6 ans), il n'y a pas de forte corrélation entre les scores totaux de qualité du sommeil mesurés par les questionnaires et le pourcentage d'IAH, d'ODI et d'efficacité du sommeil obtenus par la PSG. Seuls deux des questionnaires utilisés ont eu une sensibilité distinctive, comportant toutefois des valeurs de seuil différentes de la norme utilisée chez les adultes : le QB et l’ESK. Nos résultats démontrent que les questionnaires auto-recensés disponibles s’avèrent limités pour le dépistage clinique chez les personnes âgées. Afin de développer un nouvel instrument de mesure fiable permettant le diagnostic d’AOS et l’évaluation de la qualité de sommeil chez cette population, il est nécessaire d’effectuer des études sur un plus grand échantillon et de créer un questionnaire spécifique destiné à la population âgée. / Poor sleep quality is often seen in the elderly. Various methods are then used to evaluate their characteristics, including self-reported questionnaires and polysomnography (PSG). However, since the use of PSG is expensive and time-consuming, the use of self-reported questionnaires in a clinical setting could be preferred and would greatly facilitate the assessment of sleep quality. This study aims to validate the self-reported questionnaire method used in the evaluation of sleep quality in the elderly and compare these different questionnaires to the measures obtained by a PSG. The study design is a sub-analysis of a randomized clinical trial study. The study was conducted in edentulous patients aged 65 years and older, recruited between December 2013 and August 2018. The data were collected at home with a PSG and combined with various sleep questionnaires: the Berlin questionnaire (BQ, range of scores from 0 to 3), the Karolinska sleepiness scale (KSS, range of scores from 1-9), the Pittsburgh Sleep Quality Index (PSQI, range of scores from 0 to 21), the Epworth sleepiness scale (ESS, range of scores from 0 to 24). Data obtained by PSG include: apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and sleep efficiency percentage. Data analysis was performed by descriptive statistics and bivariate statistical tests. Of the 130 patients who participated in baseline data acquisition (51 males and 79 females, mean age 75 ± 6 years), there was no strong correlation between the total sleep quality scores measured by the questionnaires and the IAH, ODI and sleep efficiency percentage achieved by PSG. Only two of the questionnaires used had a distinctive sensitivity, but with threshold values different from the norm used in adults: QB and ESK. Our results demonstrate that self-reported questionnaires available are limited for clinical screening for the elderly. In order to develop a new reliable measuring instrument for the diagnosis of obstructive sleep apnea (OSA) and the evaluation of sleep quality in this population, it is necessary to carry out studies on a larger sample and to create a specific questionnaire intended for the elderly population.

The focus of this study is the problem of declining trend in obstructive sleep apnea (OSA) patient compliance. Studies reported improved compliance in patients with chronic diseases due to technology-based interventions. However, researchers have not investigated the advantages of technology to improve the compliance of OSA patients in detail. The specific problem was the lack of engagement between patients and healthcare managers, resulting in low compliance within OSA patients. The purpose of this qualitative study was to evaluate how technology-based interventions can improve OSA patient engagement with the healthcare managers resulting in improved compliance with treatment procedures. In this study, the technology acceptance model was used as the instrument in evaluating the information collected through interviews with 20 healthcare managers about their attitudes toward usage, perceived usefulness, and perceived ease of use. The transcribed interviews were open-coded using the RQDA library in R Studio. In general, results from this study indicated that the healthcare managers showed a positive attitude towards the use of technology for patient engagement and expressed that the technology is useful for patient engagement and is easier to use. However, they identified technology-related and patient-related challenges in implementing technology for patient engagement. Further, the respondents identified process-related and patient-related opportunities in using technology for patient engagement. Results from this study have practice and policy implications by enabling healthcare managers to devise better compliance plans for OSA patient management. The findings could have a social benefit by helping healthcare managers to implement technology-based interventions to better achieve a higher compliance resulting in better patient health at lower costs.

Le syndrome d’apnées obstructives du sommeil (SAOS) est une pathologie caractérisée par des épisodes d’hypoxie intermittente (HI) nocturnes et est un problème de santé publique par sa prévalence dans la population générale (5-20%) et ses nombreuses complications métaboliques et cardiovasculaires. La répétition des épisodes d’HI est considérée comme le facteur principal responsable de cette morbidité cardiovasculaire dont l’athérosclérose fait partie. Le traitement de référence du SAOS par la pression positive continue présente dans certains cas une efficacité limitée, en particulier sur les conséquences cardiovasculaires qui nécessitent d’autres thérapeutiques plus spécifiques. Les mécanismes reliant SAOS et athérosclérose ne sont pas encore totalement connus. Cependant, des perturbations du métabolisme des acides gras (AG) en lien avec le processus athéromateux ont déjà été rapportées au cours du SAOS. Elles concernent en particulier le métabolisme de l’acide arachidonique (AG n-6) avec une augmentation d’eicosanoïdes pro-inflammatoires. Par ailleurs, les AG n-3 peuvent avoir une influence sur le développement et la progression des maladies cardiovasculaires, notamment grâce à une modification de la balance AG n-6 / AG n-3. Ainsi l’objectif de ce travail a donc été dans un premier temps de caractériser expérimentalement l’effet d’une supplémentation en AG n-3 sur le développement de l’athérosclérose dans le contexte d’HIC, et d’évaluer cliniquement la distribution AG n-6 / AG n-3 au niveau érythrocytaire chez des patients atteints d’un SAOS. Nous avons démontré que la supplémentation en AG n-3 permet de prévenir l’accélération de l’athérosclérose dans le contexte de l’HIC et est associée à une modulation de l’expression de certains médiateurs inflammatoires. Ces résultats prometteurs incitent à envisager une étude interventionnelle chez les patients SAOS. Dans un second temps, nous nous sommes intéressés au métabolisme des AG, via la β-oxydation mitochondriale, et aux métabolites intermédiaires produits, les acylcarnitines (ACs). Ces métabolites sont de plus en plus étudiés dans le contexte des pathologies cardiovasculaires. Nous avons étudié l’impact du SAOS sur la β-oxydation et ses conséquences sur la fonction vasculaire. L’étude de ces métabolites semble prometteuse et permettra peut-être l’émergence de marqueurs biologiques en relation avec l’état cardiovasculaire des patients. / Obstructive sleep apnea (OSA) syndrome is a disease characterized by recurrent episodes of nocturnal intermittent hypoxia (IH). OSA is a major public health problem due to its frequency in general population (5 to 20%) and its numerous metabolic and cardiovascular complications. Repetitive apneas lead to IH which is responsible of early atherosclerosis and cardiovascular complications. Gold standard treatment of OSA, that is to say continuous positive airway pressure, has poor effects on OSA cardiovascular consequences in some patients, underlining the need of alternative therapeutic strategies. Underlying mechanisms linking OSA to atherosclerosis are still poorly understood. Nevertheless, a link between polyunsaturated fatty acids (PUFAs) metabolism changes and atheromatous process has already been report during OSA syndrome. Arachidonic acid (n-6 PUFA) metabolism leads to increased biosynthesis of pro-inflammatory eicosanoids during OSA. Moreover, n-3 PUFAs influence cardiovascular complications progression especially by modifying n-6 FA / n-3 FA balance. The aim of this work was first to evaluate the influence of n-3 PUFAs supplementation on a CIH induced atherosclerosis progression model, and to clinically evaluate erythrocyte n-6 PUFA / n-3 PUFA distribution in OSA patients. We have shown that n-3 PUFAs supplementation prevents atherosclerosis acceleration in CIH exposed mice and is associated with a modulation of inflammatory mediators. These promising results encourage us to consider an interventional clinical study in OSA patients. In a second time, we have studied FA mitochondrial β-oxidation metabolism via acylcarnitines (ACs) metabolites. These ACs are increasingly studied especially in cardiovascular diseases context. OSA impact on β-oxidation metabolism and its vascular function consequences have been evaluated. ACs study is promising and will perhaps allow biological markers emergence in relation to cardiovascular pattern.

Le syndrome d'apnée obstructive du sommeil (SAOS), est une maladie chronique qui se caractérise par des interruptions répétées de la respiration durant le sommeil en raison de la fermeture temporaire des voies aériennes supérieures. L'hypoxie intermittente chronique (HI) résultante de cette fermeture transitoire des voies aériennes supérieures, constitue l’une des conséquences majeures du SAOS, et elle est la responsable de la plupart des complications liées à cette pathologie, dont nous citons: l’hypertension artérielle, l’infarctus de myocarde et plus généralement le remodelage cardiovasculaire.D’autre part, l’entrainement physique intensif(EI)est bien connu d’avoir des bénéfices sur le système cardiovasculaire, d’où nous avons poser l’hypothèse que l’EI peut inverser les effets délétères de l’HI sur la réactivité et le remodelage vasculaire ainsi que sur la signalisation calcique intracellulaire dans les cellules musculaires.Pour répondre à cette question, nous avons choisi le rat comme modèle animal, pour étudier l’effet potentiel de l'EI dans la prévention et l’inversion des effets délétères de (HI) en termes de réactivité et signalisation calcique dans les tissues musculaires.Des rats ont été exposés durant 21 jours à l’hypoxie intermittente dans des cages spécialement équipées pour maintenir un flux d’air alternant entre 21% et 5% de PO2 dans les cages contenant les rats hypoxique et a 21% de PO2 dans les cages contenant les rats contrôles. Durant les deux dernières semaines d’exposition à l’HI, un groupe des rats hypoxiques et un des rats normoxiques ont subi des sessions d'EI en courant sur un tapis roulant avec une vitesse allant de 16m/min jusqu'à 30 m/min.Les paramètres physiologiques ont été mesurés (Pression artérielle, fréquence cardiaque, hématocrites), l’aorte a été prélevé pour étudier la réactivité vasculaire, les cellules musculaires lisses de l’aorte ont été ensuite prélevés et cultivées pour étudier la signalisation calcique par microscopie à EPIfluorescence. Finalement les gènes codant pour les médiateurs de la signalisation calcique : RyR1, RyR2 RyR3, (ryanodine receptors), TRPV4 (transient receptor potential channel), SERCA1, SERCA2 (Sarco/Endoplasmic Reticulum Ca2+ -ATPase) et IP3R1 (Inositol 1,4,5-Trisphosphate Receptor) dans différentes tissues vasculaires et squelettiques ont été étudiés au niveau moléculaire par Q-PCR et Western Blot.Nos résultats montrent que l'HI induit une augmentation significative de pression artérielle et de l’hématocrite et une diminution dans la relaxation de l'aorte induite par l'acétylcholine pré contractée par la phénylnephrine. Ceci est conforme à notre observation selon laquelle HI augmente le niveau de calcium intracellulaire dans le muscle lisse aortique cultivé. D'autre part, l'EI induit une diminution significative de l’hématocrite et de la vasoconstriction aortique induite par la phénylnephrine et l'endothélie-1, conformément à l'observation que l'EI réduit la différence HI-N dans la réponse calcique. A l’échelle moléculaire, HI induit une augmentation significative de l'expression de RyR1, RyR2, RyR3, SERCA1, SERCA2, TRPV4 et IP3R1 au niveau de l'ARNm dans les tissus de tous les groupes, avec une plus grande quantité de RyR1,RyR2,et RyR3 dans les tissus HI des muscles lisses (principalement dans l'aorte thoracique et abdominale) et le SERCA1 (9 fois plus haut dans les tissus IH) et le SERCA2 (10 fois plus élevé dans les tissus HI) dans les muscles squelette (Gastrocnemius, plantaris et soléus). De plus, HI induit une augmentation significative de RYR1, RYR2 et TRPV4 au niveau protéique dans l'aorte thoracique et abdominale; et l'EI réduit la différence d'expression entre les animaux N et IH.Nos résultats suggèrent que l'EI représente un traitement prometteur non pharmacologique ou complémentaire pour limiter les complications cardio-vasculaires induites par l’HI et le remodelage musculaire chez les patients atteints de SAOS. / Obstructive sleep apnea syndrome (OSAS) is a chronic disease characterized by repeated interruptions of breathing during sleep due to the temporary closure of the upper airway. Its prevalence increases with the increasing in prevalence of obesity, especially in developed countries.Chronic intermittent hypoxia (IH) resulting from this transient closure of the upper airway is one of the major consequences of OSAS and is responsible of most of the complications related to this pathology, including hypertension, myocardial infarction, atherosclerosis and more generally cardiovascular remodeling.On the other hand, intensive physical training(IT) is well known to have benefits on cardiovascular system, thus we hypothesize that physical training can reverse the deleterious effects of IH on reactivity and vascular remodeling as well as intracellular calcium signaling in muscle cells.To answer this question, we chose the rat as an animal model to study the potential effect of IT in the prevention and reversal of deleterious (IH) effects in terms of reactivity and calcium signaling in muscle tissue.Rats were exposed for 21 days to intermittent hypoxia and housed in cages specially equipped to maintain an airflow alternating between 21% and 5% PO2 in cages containing hypoxic rats and 21% PO2 in cages containing the control rats. During the last two weeks of exposure to IH, a group of hypoxic rats and one of the normoxic rats underwent IT sessions on a treadmill at a speed of 16m / min to 30m / min.Physiological parameters were measured (blood pressure, heart rate, hematocrit), the aorta was removed to study the vascular reactivity, then vascular smooth muscle cells were removed and cultured to study calcium signaling by EPIfluorescence microscopy. Finally, the genes coding for the key mediators of the calcium signaling: RyR1, RyR2 RyR3, (ryanodine receptors), TRPV4 (transient receptor potential channel), SERCA1, SERCA2 (Sarco / Endoplasmic Reticulum Ca2 + -ATPase) and IP3R1 , 5-Trisphosphate Receptor) in various vascular and skeletal tissues were studied at the molecular level as mRNA by Q-PCR or as protein by Western Blot.Our results show that IH induces a significant increase in blood pressure and hematocrit and a decrease in acetylcholine-induced aortic relaxation pre-contracted with phenylnephrine. This was consistent with our observation that HI increases the level of intracellular calcium in cultured aortic smooth muscle. On the other hand, IT induced a significant decrease in hematocrit and aortic vasoconstriction induced by phenylnephrine and endothelial-1, consistant with the observation that IT reduces the IH-N difference in the calcium response. On the molecular scale, IH induces a significant increase in the expression of RyR1, RyR2, RyR3, SERCA1, SERCA2, TRPV4 and IP3R1 at the mRNA level in the tissues of all groups with a greater amount of RyR1,RyR2,& RyR3 higher in IH tissue of smooth muscles (mainly in the thoracic and abdominal aorta) and SERCA1 (9-fold higher in IH tissues) and SERCA2 (10-fold higher in IH tissues) in the skeletal muscles (Gastrocnemius, plantaris and soléus). In addition, IH induces a significant increase in RYR1, RYR2 and TRPV4 at the protein level in the thoracic and abdominal aorta; And IT reduces the difference in expression between animals N and IH.Our results suggest that IT is a promising, non-pharmacological or complementary treatment for limiting cardiovascular complications induced by IH and muscle remodeling in patients with OSAS.