The physiological signals of human are very important for the diagnosis of diseases. There are two different applications of physiological signals in this study. One is using oxyhemoglobin saturation to diagnose the obstructive sleep apnea hypopnea syndrome (OSAS); the other is to determine the association between dermatoglyphics and schizophrenia by using fingerprint asymmetry measures. The objective of the first part is to comprehensively evaluate the capablity and reliability of the previously proposed oxyhemoglobin indices derived automatically for predicting the severity of OSAS. Patients with a diagnosis of OSAS by standard polysomnography were recruited from China Medical University Hospital Sleep Center. The result revealed that when AHI cutoff value was set to 30/h, ODI achieves 87.8% sensitivity and 96.6% specificity. Another important finding is that, for both apnea and hypopnea, probability of oxyhemoglobin desaturation increases with increases of body mass index (BMI) and neck circumference (NC). Early detection and intervention strategies for schizophrenia are receiving increasingly more attention. Dermatoglyphic patterns have been hypothesized to be indirect measures for early abnormal developmental processes that can lead to later psychiatric disorders such as schizophrenia. However, previous results have been inconsistent in trying to establish the association between dermatoglyphics and schizophrenia. The goal of second part of this work is to try to resolve this problem by borrowing well developed techniques from the field of fingerprint matching. Fingerprint images were acquired digitally from 40 schizophrenic patients and 51 normal individuals. Based on these images, the sample means of the proposed measures consistently identified the patient group as having a higher degree of asymmetry than the control group.

There is evidence that non-surgical treatment of OSA improves blood pressure (BP) in patients with obstructive sleep apnea (OSA). The objective of this study is to determine the effect of maxillomandibular advancement (MMA) surgery for OSA on BP. 15 patients undergoing MMA surgery for treatment of OSA were enrolled. Ambulatory BP, and BMI were recorded pre- and post-operatively. The average age of the patients was 48.9 years and they had mean preoperative AHI of 40.8 and a mean baseline BMI of 30.8 kg/m2. There were no statistically significant reductions in mean systolic or diastolic BP postoperatively. The BMI was found to decrease on average from 30.8 kg/m2 to 29.3 kg/m2 at follow up (p = 0.01). There were no identifiable relationships between OSA severity and BP. Given the prevalence of OSA and it’s adverse medical consequences, more studies to determine the effect of MMA on BP are warranted.

Techniques ambulatoires de diagnostic et de monitoring des troubles respiratoires liés au sommeil.Le syndrome d’apnées obstructives du sommeil (SAOS) est un trouble du sommeil très fréquent, fortement lié à l’obésité, ce qui explique sa prévalence en pleine expansion. En parallèle, la demande d’examens polysomnographiques (PSG) en laboratoire du sommeil, méthode diagnostique de référence, est en croissance. Comme l’accès à cette technique est peu aisé, de nombreux appareils simplifiés d’enregistrement de sommeil ont été récemment développés, mais restent imparfaits (mauvaise évaluation du temps de sommeil, sous-estimation de la sévérité du SAOS, faux négatifs, taux d’échec élevé) et sont d’un apport limité pour le diagnostic du SAOS. La PSG au domicile (PSG-d) est une alternative bien plus informative, permettant d’éviter nombre des désavantages rencontrés par l’usage d’appareils simplifiés. Nous l’avons dès lors étudiée pour le diagnostic du SAOS, au travers d’une étude randomisée comparant la PSG-d vs la PSG hospitalière. En termes d’efficacité diagnostique, les résultats sont excellents, avec un faible taux d’échec d’examens à domicile (4.7 vs 1.5%). Les patients préfèrent être enregistrés dans leur propre environnement où la qualité de leur sommeil est d’ailleurs meilleure. Nous avons ensuite voulu faire le point sur la littérature récente au travers d’un article de revue, en analysant les études prospectives randomisées comparant la PSG-d et au labo du sommeil. Les résultats de ces études concordent pour démontrer que la PSG-d constitue une excellente alternative aux tests réalisés à l’hôpital. Outre le SAOS, l’outil permet le diagnostic d’autres troubles du sommeil, comme les mouvements périodiques des jambes durant le sommeil, les troubles du rythme circadien, Une question restée jusqu’ici sans réponse était l’influence de la localisation du branchement des PSG-d, à l’hôpital ou à domicile. Une étude prospective randomisée nous a permis d’établir que la localisation du branchement des PSG-d n’influençait pas la qualité globale de l’examen, ce qui simplifiera l’utilisation de cet outil à l’avenir. Enfin, nous avons utilisé des techniques de télé monitoring (TM) pour contrôler, en temps réel, la qualité des PSG-d. Dans une première étude pilote, la faisabilité a été confirmée, malgré quelques difficultés techniques. Nous avons voulu appliquer la technique à une population de patients souffrant d’un syndrome coronarien aigu, incapables d’être enregistrés au labo du sommeil. Nous avons étudié la qualité du screening du SAOS par PSG vs polygraphie (PG). Les résultats se sont révélés surprenants :82% de cette population présentait des troubles respiratoires liés au sommeil, principalement centraux. La PSG était nettement plus sensible que la PG, et le TM améliorait la qualité des PSG. Chez les patients traités pour SAOS, nous avons ensuite utilisé un outil de monitoring, l’actigraphie (Act), afin d’observer, dans la vie de tous les jours, les changements de schémas de sommeil et d’activité physique engendrés par la pression positive continue (PPC). Dans un premier travail, rétrospectif, nous avons observé ces paramètres chez des SAOS avant traitement, puis au travers d’une étude prospective multicentrique, nous avons suivi 150 patients avant et après PPC, et observé chez eux une augmentation de temps de sommeil, mais pas de l’activité physique. En conclusion, nous avons démontré dans cette thèse l’intérêt clinique de deux excellents outils ambulatoires, la PSG-d et l’Act, pour la prise en charge du SAOS. Les implications potentielles sont une meilleure accessibilité diagnostique pour le SAOS, une initiation thérapeutique plus précoce et un suivi plus précis des SAOS traités, dans des conditions ambulatoires, plus confortables et plus adéquates pour les patients. / Ambulatory diagnostic and monitoring techniques for sleep disordered breathingSleep disordered breathing (SDB), including obstructive sleep apnea syndrome (OSAS), is directly related to obesity. Significant morbi-mortality is associated with OSAS, explaining the increasing demand for in-hospital polysomnography (PSG), the reference diagnostic method. As this technique is complex and time-consuming, many simplified portable monitoring (PM) devices for home sleep testing have been developed. However, the ability of PM devices to detect OSA remains limited: sleep time is not correctly assessed, OSA severity is underestimated, false negative results occur and the failure rate of the tests is high, up to 30%. Home-PSG (H-PSG) is an interesting alternative, avoiding many of these drawbacks. In the first part of this work, we studied the tool in an original study comparing H-PSG and in-lab PSG. Diagnostic efficacy was good and the failure rate low (4.7 vs 1.5%). Patients slept in their own environment and thus sleep quality was better. We were then interested by reviewing recent literature data regarding prospective randomised trials comparing H-PSG and in-lab PSG. We concluded that H-PSG is an excellent alternative for in-lab PSG, allowing not only OSA detection but also diagnosis of a large panel of other sleep disorders (periodic leg movements during sleep, circadian disorders,). As the best place to perform set-up for H-PSG remained unknown, we studied, in another prospective randomised study, the recording’s quality obtained in both settings. As no difference was observed, lab set up was found to be the simpler option for performing H-PSG. We then tested, in a prospective pilot study, real-time telemonitoring (TM) of H-PSG in order to enhance recording quality. Results were encouraging but we faced some technical problems. In a second study, we applied TM coupled with PSG to detect SDB in acute coronary syndrome, in patients too unstable to come in the sleep lab. We compared also PSG results to polygraphy (PG). Surprisingly, 82% of patients suffered from SDB. PSG was much more sensitive than PG to screen SDB in this population and TM improves recording quality. In the second part of this work, we have used actigraphy (Act) to assess sleep and physical activity in OSA patients in real-life conditions. Firstly, in a retrospective study, we documented these parameters before treatment. In a second multicentre study, we evaluated the changes in sleep schemes and physical activity under continuous positive airway pressure (CPAP) in 150 OSA patients. We observed that sleep time was increased under CPAP, but physical activity was not improved, contrarily to sleepiness and quality of life. In conclusion, we have shown through these works the clinical interest of two excellent ambulatory tools, H-PSG and Act, for OSA management. Potential clinical implications include enhanced healthcare accessibility, earlier treatment initiation and a closer follow-up of treated patients, through ambulatory tools, in a comfortable environment for the patients. / Doctorat en Sciences médicales (Médecine) / info:eu-repo/semantics/nonPublished

Background-Previous studies have documented a high prevalence of atrial fibrillation (AF) in individuals with obstructive sleep apnea (OSA). Central sleep apnea (CSA) has been associated with AF in patients with heart failure. However, data from prospective cohorts are sparse and few studies have distinguished the associations of obstructive sleep apnea from CSA with AF in population studies. Methods and Results-We assessed the association of obstructive sleep apnea and CSA with incident AF among 2912 individuals without a history of AF in the SHHS (Sleep Heart Health Study), a prospective, community-based study of existing ("parent") cohort studies designed to evaluate the cardiovascular consequences of sleep disordered breathing. Incident AF was documented by 12-lead ECG or assessed by the parent cohort. obstructive sleep apnea was defined by the obstructive apnea-hypopnea index (OAHI). CSA was defined by a central apnea index >= 5 or the presence of Cheyne Stokes Respiration. Logistic regression was used to assess the association between sleep disordered breathing and incident AF. Over a mean of 5.3 years of follow-up, 338 cases of incident AF were observed. CSA was a predictor of incident AF in all adjusted models and was associated with 2-to 3-fold increased odds of developing AF (central apnea index >= 5 odds ratio [OR], 3.00, 1.40-6.44; Cheyne-Stokes respiration OR, 1.83, 0.95-3.54; CSA or Cheyne-Stokes respiration OR, 2.00, 1.16-3.44). In contrast, OAHI was not associated with incident AF (OAHI per 5 unit increase OR, 0.97, 0.91-1.03; OAHI 5 to <15 OR, 0.84, 0.59-1.17; OAHI 15 to <30 OR, 0.93, 0.60-1.45; OAHI >= 30 OR, 0.76, 0.42-1.36). Conclusions-In a prospective, community-based cohort, CSA was associated with incident AF, even after adjustment for cardiovascular risk factors.

Patients undergoing surgery with unrecognized obstructive sleep apnea (OSA) are at greater risk of complications. Ninety percent of those affected in the United States remain undiagnosed. To improve identification, screening tools such as the STOP-Bang questionnaire (Chung et al. 2008), provide anesthesia providers a method of detecting undiagnosed OSA. The purpose of this study is to assess anesthesia providers' practice of preoperative screening for OSA. An email survey was conducted at a Level-III trauma center in Phoenix, Arizona. The survey consisted of a 13 question, 5-point Likert scale questionnaire. It was sent to 29 Certified Registered Nurse Anesthetists (CRNA). A total of 8 CRNA's responded. Respondents were either neutral or disagreed that current methods of OSA screening works well and generally agree that the STOP-Bang tool would provide an advantage over the current methods, accurately detect OSA, and inform their anesthetic plan over current methods. Respondents leaned towards strong agreement that improving the recognition of undiagnosed OSA is needed. However, they were generally neutral on agreement that the STOP-Bang is necessary at their facility. Respondents agreed that the STOP-Bang tool is easy to use and interpret. However, most agreed that integrating the tool would add complexity to the preanesthesia evaluation but they remained neutral on whether it would add significant time to this process. Respondents were neutral on their observations that the STOP-Bang tool would improve early detection of OSA or reduce perianesthesia complications. Just 25% of respondents reported being aware of the existence of the STOP-Bang tool and none reported having used it. In conclusion, this project demonstrates that some providers have not used the STOP-Bang screening tool to detect undiagnosed OSA, but agree this tool is preferred over their current method. Results from the survey brought insight to a potential quality improvement strategy related to improving the perianesthesia care of patients with undiagnosed OSA. Improving knowledge through dissemination of evidence illustrates the value of the STOP-Bang prior to piloting the tool. The rates of perioperative complications justify the implementation of perioperative strategies such as the STOP-Bang as a tool for anesthesia providers.

Background: Obstructive sleep apnea (OSA) consists of repeated, involuntary breathing suspension during sleep. These events induce rapid depletion/repletion of blood/tissue oxygen content, a phenomenon known as intermittent hypoxia. Aside from causing daytime sleepiness, the most important health consequence of OSA is a 2-fold increase in cardiovascular (CVD) risk. Animal studies provide evidence that intermittent hypoxia, a simulating model of OSA, causes important rise in plasma TG, especially in the postprandial state. However, the underpinning mechanisms linking intermittent hypoxia to altered postprandial TG levels remain unknown. As such, the objective of this study was to characterize the effects of acute intermittent hypoxia on postprandial TG levels in 2 distinct lipoprotein subtypes in humans: chylomicrons which are secreted by the intestine and carry dietary lipids, and denser TG carriers (mainly VLDL) which are secreted by the liver and carry endogenous lipids. Methods: The research consisted of a randomized crossover design. In collaboration with the Sleep laboratory at Montfort Hospital, 7 individuals diagnosed with moderate sleep apnea were recruited through phone calls as well as 8 healthy individuals without OSA from the University of Ottawa. While lying on a bed, participants were given a meal after which they were exposed for 6 hours to normoxia or intermittent hypoxia corresponding to moderate OSA, e.g. 15 hypoxic events per hour. Blood lipid levels were measured hourly.  Results: Plasma TG levels increased over time in both experimental conditions and tended to be greater under 6-h exposure to intermittent hypoxia (p=0.093, effect size ηp2= 0.383.). This trend toward higher total plasma TG under intermittent hypoxia was attributable to increased levels in denser TG carrying lipoproteins such as VLDL and CM remnants (p= 0.009, ηp2 = 0.173).  Conclusion: Acute intermittent hypoxia, a simulating model of obstructive sleep apnea, tends to negatively affect postprandial TG levels, which is attributable to an increase in denser TG carrying lipoprotein levels such as VLDL and CM remnants. These results lend support to the increase in blood lipid levels in animal studies observing the effect of acute hypoxia in mice.  Contribution to advancement of knowledge: This proposed research will allow a better understanding of the mechanisms by which obstructive sleep apnea may alter blood lipid profile. This information will be beneficial to the treatment of obstructive sleep apnea related dyslipidemia and contribute to reduce CVD risk in the large proportion of obstructive sleep apnea patients who are reluctant to current treatment avenues.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23097号 / 医博第4724号 / 新制||医||1050(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 近藤 尚己, 教授 稲垣 暢也, 教授 石見 拓 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18166号 / 医博第3886号 / 新制||医||1003(附属図書館) / 31024 / 京都大学大学院医学研究科医学専攻 / (主査)教授 髙橋 良輔, 教授 三森 経世, 教授 佐藤 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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