TRS et pression positive

Troubles respiratoires du sommeil et pression positive

Le SAOS non traité a été associé à plusieurs types de complications cardiovasculaires compreant l'hypertension, les maladies coronaires, l'insuffisance cardiaque congestive, les arythmies cardiaques, l'AVC et même le décès.1 En plus de la morbidité et de la mortalité cardiovasculaire, le SAOS non traité est associé à de nombreux seffets délétères, comprenant  la somnolence diurne excessive, une  fonction cognitive diminuée (p. ex. attention, fonctions motrices et mémoire à court terme) et une mauvaise qualité de vie.2

Le principe de la PPC a été décrit pour la première fois par le professeur Colin Sullivan en 1981. Le professeur Sullivan traita cinq patients souffrant d'un SAOS sévère avec une PPC appliquée aux patients  par l'intermédiaire d'un circuit et d'un masque. La PPC agit comme une attelle pneumatique qui prévient le colapsus  des voies aériennes supérieures pendant le sommeil. La PPC est considérée comme étant un traitement sûr, non invasif et efficace du SAOS.3

La pression positive continue (PPC) est désormais utilisée couramment et est considérée comme étant le traitement de référence du SAOS. Elle a démontré sa capacité à réduire le risque cardiovasculaire et à réduire le taux de mortalité des patients traités comparé au patient SAOS non traité4-6. Par ailleurs, il a été montré chez les patients observants, que le traitement par PPC améliore significativement les symptômes associés au SAOS, comme la somnolence diurne excessive, la fonction cognitive et la qualité de vie.7,8

Références

  1. Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. American journal of respiratory and critical care medicine 2001;163:19-25.
  2. Engleman HM, Douglas NJ. Sleep. 4: Sleepiness, cognitive function, and quality of life in obstructive sleep apnoea/hypopnoea syndrome. Thorax 2004;59:618-22.
  3. Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. The Lancet 1981;1:862-5
  4. Buchner NJ, Sanner BM, Borgel J, Rump LC (2007) Continuous positive airway pressure treatment of mild to moderate obstructive sleep apnea reduces cardiovascular risk. Am J Respir Crit Care Med 176(12):1274-1280.
  5. Campos-Rodriguez F, Pena-Grinan N, Reyes-Nunez N, De la Cruz-Moron I, Perez-Ronchel J, De la Vega-Gallardo F, Fernandez-Palacin A (2005) Mortality in obstructive sleep ap- nea-hypopnea patients treated with positive airway pressure. Chest 128(2):624-633.
  6. Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long- term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous pos- itive airway pressure: an observational study. Lancet 365 (9464):1046-1053.
  7. Avlonitou E, Kapsimalis F, Varouchakis G, Vardavas CI, Behrakis P (2011) Adherence to CPAP therapy improves quality of life and reduces symptoms among obstructive sleep apnea syndrome patients. Sleep Breath.
  8. Giles TL, Lasserson TJ, Smith BH, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. The Cochrane database of systematic reviews 2006:Cd001106.

Lectures supplémentaires

  1. Punjabi NM. Improvement of metabolic function in sleep apnea: the power of positive pressure. Am J Respir Crit Care Med 2004; 169(2):139-40:
  2. Harsch IA, Schahin SP, Radespiel-Troger M, Weintz O, Jahreiss H, Fuchs FS, Wiest GH, Hahn EG, Lohmann T, Konturek PC, Ficker JH. Continuous positive airway pressure treatment rapidly improves insulin sensitivity in patients with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2004; 169(2):156-62:
  3. Victor LD. Treatment of obstructive sleep apnea in primary care. Am Fam Physician 2004;69(3):561-8.
  4. Rappai M, Collop N, Kemp S, deShazo R. The nose and sleep-disordered breathing: what we know and what we do not know. Chest 2003; 124(6):2309-23:
  5. Davis PG, Henderson-Smart DJ. Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database Syst Rev 2003;(2):CD000143.
  6. Roux FJ, Hilbert J. Continuous positive airway pressure: new generations. Clin Chest Med 2003;24(2):315-42.
  7. Ferini-Strambi L, Zucconi M, Castronovo V, Garancini P, Oldani A, Smirne S. Snoring & sleep apnea: a population study in Italian women. Sleep 1999;22(7):859-64.:
  8. Ronald J, Delaive K, Roos L, Manfreda J, Bahammam A, Kryger MH. Health care utilization in the 10 years prior to diagnosis in obstructive sleep apnea syndrome patients. Sleep 1999;22(2):225-229.:
  9. Kapur V, Blough DK, Sandblom RE, Hert R, de Maine JB, Sullivan SD, Psaty BM. The medical cost of undiagnosed sleep apnea. Sleep 1999;22(6):749-755.:
  10. Bahammam A, Delaive K, Ronald J, Manfreda J, Roos L, Kryger MH. Health care utilization in males with obstructive sleep apnea syndrome two years after diagnosis and treatment. Sleep 1999;22(6):740-747.:
  11. Bassetti C, Aldrich MS. Sleep apnea in acute cerebrovascular diseases: final report on 128 patients. Sleep 1999;22(2):217-223.:
  12. Ballester E, Badia JR, Hernandez L, Carrasco E, de Pablo J, Fornas C, Rodriguez-Roisin R, Montserrat JM. Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 1999; 159(2):495-501:
  13. Loube DI, Gay PC, Strohl KP, Pack AI, White DP, Collop NA. Indications for positive airway pressure treatment of adult obstructive sleep apnea patients. Chest 1999; 115(3):863-866:
  14. Engleman HM, Martin SE, Kingshott RN, Mackay TW, Deary IJ, Douglas NJ. Randomized placebo controlled trial of daytime function after continuous positive airway pressure (CPAP) therapy for the sleep apnoea/hypopnoea syndrome. Thorax 1998;53:341-45.
  15. Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med 1998; 157(1):144-8:
  16. Bassetti C, Aldrich MS, Chervin RD, Quint D. Sleep Apnea in Patients with Transient Ischemic Attack and Stroke: A Prospective Study of 59 Patients. NEUROLOGY 1996;47:1167-1173.
  17. Montserrat JM, Ballester E, Olivi H, Reolid A, Lloberes P, Morello A, Rodriguez Rolsin R. Time-course of Stepwise CPAP Titration. Behaviour of Respiratory and Neurological Variables. Am J Respir Crit Care Med 1995;152(6 Pt 1):1854-9.
  18. Bearpark H, Elliott L, Grunstein R, Cullen S, Schneider H, Althaus W, Sullivan C. Snoring and sleep apnea. A population study in Australian men. Am J Respir Crit Care Med 1995; 151(5):1459-65:
  19. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328(17):1230-5.