[Excessive daytime sleepiness. An epidemiological study based on a "sleep/breathing" questionnaire]. / Somnolence diurne excessive. Étude épidémiologique basée sur un questionnaire « sommeil/respiration ¼

BACKGROUND: A field survey used a "sleep-breathing" questionnaire to estimate the prevalence of the excessive daytime sleepiness in a sample of middle-aged males. METHODS: Eight hundred and fifty men aged 22 to 66 years agreed to answer a questionnaire and have anthropometric measurements. To the question on excessive daytime sleepiness, 90 subjects (10.8%) responded "often" or "almost always"; 740 gave a negative answer. RESULTS: The sleepy subjects were older and had a higher "central" weight. All the sleep-disturbed breathing symptoms and those suggesting sleep disturbances were more frequent in sleepy subjects. Sleepiness was significantly associated with sleep apnea and chronic bronchitis. Logistic regression identified six items independently associated with daytime sleepiness; there were three indirect indicators of sleepiness, age, a history of chronic bronchitis and disruptive movements during sleep. CONCLUSIONS: This epidemiologic study in a sample of active middle-aged males confirms the association of daytime sleepiness with a series of respiratory and non-respiratory sleep disturbances. The original findings are the role of a "central" obesity, the association with nightmares, and the role of chronic bronchitis as a determinant of daytime sleepiness.

[Is a sedentary lifestyle a risk factor for sleep-related respiratory disturbance?]. / La sédentarité est-elle un facteur de risque de troubles respiratoires pendant le sommeil?

INTRODUCTION: This questionnaire-based epidemiological study was aimed at identifying possible sleep disturbance in a sample of active French males. METHODS: Eight hundred and fifty male subjects, aged 22 to 66 years, completed a structured sleep questionnaire supplemented by information about their life habits and medical history. The study compared the prevalence of positive responses between an "at risk" group of sedentary people (with no declared leisure exercise) and a control group of "exercising" subjects (with more than 5 hours of planned exercise weekly). RESULTS: Among the symptoms suggesting sleep-disordered breathing, only the question "Have you ever been told that you snore?" significantly separated the two groups. In addition, the sedentary group declared a history of treated hypertension significantly more often. CONCLUSIONS: The present survey identified only one item that differed significantly between a sedentary of men and an exercising group - a history of treated hypertension. The result may be explained by the limitations of a questionnaire survey and by the limited contrast in exercise practice: the "sedentary" subjects had an occupational labour demand (not quantified), and the control group had a relatively modest leisure physical activity.

Social disparities in musculoskeletal disorders and associated mental malaise: findings from a population-based survey in France.

AIMS: Various types of musculoskeletal disorders (MSDs) have comorbid mental disorders, which may in turn have a negative influence on disease course and role impairment, but the contribution of social factors to this type of comorbidity is a much under-researched area. This study investigates whether there is a socially patterned association of MSDs with different dimensions of mental malaise. METHODS: The sample included 3,368 economically active participants aged 18-64 years, randomly selected from the Lorraine region in north-eastern France. Information was provided through a post-mailed questionnaire on fatigue, sadness/depression (Duke questionnaire) and cognitive disability during the last eight days. RESULTS: MSDs were significantly more prevalent in manual workers, clerks and other occupations than in upper and intermediate professionals, and similar occupational disparities were found for cognitive disability, fatigue and sadness/ depression. Stratifying the sample, we found the occupational disparities in cognitive disability to be much stronger among participants suffering from MSDs than among participants not suffering from MSDs, and the occupational disparities in fatigue and sadness/depression to be limited to the subsample of subjects suffering from MSDs. CONCLUSIONS: The findings demonstrate that the association of MSDs with mental malaise is much stronger in the lower occupational groups than in the higher groups. Given that psychological factors are implicated in disease prognosis and in the development of disabilities, awareness of the social dimension of the association and treatment of the comorbid mental disorders could open a promising avenue for reducing social inequalities in disability related to MSDs.

Determinants of school injury proneness in adolescents: a prospective study.

OBJECTIVE: Injury proneness is common in adolescents, but the role of individual factors has received little attention. This study assessed the relationships of a number of individual characteristics with frequency of school injuries. METHODS: This prospective study was conducted on 2396 students from middle schools and high schools in an urban area in France over one school year. A questionnaire was completed by each student at the beginning of the school year, and an injury questionnaire was completed for all injuries that occurred at school during the year. Data were analysed using the chi2 independence test and logistic models. RESULTS: Over the study year, 10.6% of the students had a single injury. Frequent injuries (two or more) were common (2.3%) and were strongly related to younger age [adjusted odds ratio (aOR) 1.52, 95% confidence interval (95%CI) 1.28-1.79], frequent use of psychotropic drugs (aOR 2.03, 95%CI 1.06-3.86) and a poorer average school mark (<10/20, aOR 2.58, 95%CI 1.30-5.12). The occurrence of a single injury was less strongly related to younger age (aOR 1.20, 95%CI 1.11-1.30) and frequent use of psychotropic drugs (aOR 1.43, 95%CI 1.04-1.96), and was also associated with parental absence (aOR 1.33, 95%CI 1.00-1.77), not being calm (aOR 1.41, 95%CI 1.03-1.89) and not being easily irritated (aOR 1.56, 95%CI 1.14-2.13). CONCLUSIONS: This study identified a number of factors associated with injury frequency. This information could be useful for injury prevention. Physicians could help students, parents, teachers and school staff to be more aware of the risks and to find remedial measures.

[Occupational exposure to low concentrations of carbon monoxide and sleep disordered breathing. A negative result]. / Exposition à des faibles concentrations d'oxyde de carbone et troubles respiratoires pendant le sommeil. Un résultat négatif.

INTRODUCTION: This study explored the possibility that occupational exposure to low concentrations of carbon monoxide (CO) could influence the synchronisation of upper airway and lower respiratory muscles and thus induce sleep disordered breathing. METHODS: Two hundred and thirty subjects exposed to between 1 and 5 ppm (peaks up to 25 ppm) at work and one hundred and sixteen unexposed controls were studied with a protocol comprising anthropomorphic measurements and a self-completed French translation of the Wisconsin Sleep Questionnaire. RESULTS: The two groups had similar anthropomorphic and lifestyle data with the exception that the exposed group were slightly younger (2.5 years). No differences were found in personal or family history, sleep related breathing disorder (snoring, breathing pauses etc) and disturbed sleep. CONCLUSIONS: Occupational exposure to low concentrations of CO do not seem to affect ventilatory drive and the synchronisation of upper airway and respiratory muscles during sleep. It should be recognised that these results were obtained by a relatively insensitive technique (questionnaire); a protocol including polysomnography applied to subjects exposed to higher concentrations of CO could lead to other conclusions.

[Habitual snoring. Prevalence and risk factors in a sample of the French male population]. / Le ronflement habituel. Prévalence et facteurs de risque dans un échantillon de la population masculine française.

INTRODUCTION: As there are important differences in the prevalence of snoring in the literature we have studied this prevalence and the risk factors in a sample of the active male population of Lorraine. METHODS: 850 men, aged 22 to 66 tears, volunteered for the study and completed a questionnaire on the frequency of snoring, their lifestyle and their personal and family histories. The usual anthropomorphic measurements were made together with a non-invasive examination of the upper airways. RESULTS: The prevalence of habitual snoring was 34.6%, increasing with age, weight and the derived indices. We identified, by logistic regression, the factors independently associated with habitual snoring in univariate analysis. These were age, weight, nocturnal nasal obstruction, a medical diagnosis of obstructive sleep apnoea, and hypertrophy of the soft palate and uvula. There was evidence that height had a protective effect but exercise activity did not appear to be significant. CONCLUSION: The 35% prevalence of habitual snoring in our sample of middle aged men is similar to other studies in the literature using the same methods. The present study confirmed that age, weight, girth, nasal obstruction and nasopharyngeal abnormalities are risk factors. The protective effect of height was a new finding not identified in previous studies.

Does the inclusion of wheeze detection as an outcome measure affect the interpretation of methacholine challenge tests? A study in workers at risk of occupational asthma.

Methacholine challenge testing (MCT) is widely used to assess airway hyperresponsiveness (AHR). Traditionally, a 20% or greater decline in forced expiratory volume in 1 (FEV(1)) is the primary outcome measure. We examined whether the inclusion of wheeze detection as outcome measure influenced the categorical interpretation of MCT in workers at risk of occupational asthma (OA). We examined 28 occupationally exposed smokers with asthma-like symptoms (SympAsth), 22 asymptomatic, occupationally exposed smokers (Symp0), and 30 nonexposed, asymptomatic controls (Ctrl). MCT was done using an abbreviated technique. Spirometry and tracheal wheezes were recorded using a computerized system. MCT was considered either positive or negative using three outcome measures separately: (1) > or = 20% fall in FEV(1) (MCT("FEV1")); (2) wheeze appearance (MCT("Wheeze")); and (3) whichever among the two was present (MCT("FEV1Wheeze")). The proportion of reactors in each group were, by outcome measure, as follows: MCT("FEV1"): Ctrl = 2 (6.7%), Symp0 = 6 (27.3%), SympAsth = l2 (42.8%) (chi(2) = 10.2; p = 0.006); MCT("Wheeze"): Ctrl = 1 (3.3%), Symp0 = 4 (18.2%), SympAsth = 13 (46.4%) (chi(2) = l5.7; p = 0.001); MCT("FEV1Wheeze") Ctrl = 2 (6.7%), Symp0 = 7 (31.8%), SympAsth = 18 (64.3%) (chi(2) = 21.5; p = 0.001). Overall, including wheeze detection increased the proportion of "reactors" detected by spirometry by 30% (27 reactors vs. 20). This increase reached 50% (18 vs. 12) among workers with asthma like symptoms. In summary, the inclusion of wheeze detection as outcome measure for MCT allowed the recognition as reactors of subjects that otherwise would be "missed" by spirometry. The resulting increase in the number of true positives improved the sensitivity of MCT to detect AHR in occupationally exposed workers at risk of occupational asthma.

[Tobacco, alcohol and psychotropic drugs in Lorraine, epidemiological survey of the general population]. / Tabac, alcool et médicaments psychotropes en Lorraine, enquête épidémiologique en population générale.

The aim of this study is to determine the prevalence of the use of tobacco, alcohol and psychotropic drugs by the people of Lorraine and characterise the consumption behaviours of that population. The sample consisted of 6571 people from the ages of 18 to 74 who were randomly selected from the telephone directory and were interviewed through the use of a self-questionnaire sent out by mail. The behaviours vary according to sex and gender. Tobacco is the product with the highest prevalence rate of consumption. This rate decreases with age and is most frequent in sectors of the population who are less educated, holding low or poorly skilled jobs or unemployed. Excessive alcohol consumption is observed in 13.8% of men and 3.8% of women. Regular consumption of psychotropic drugs is two times higher in women than in men, and it increases with age. Women who are single, divorced or widowed are at the most risk, as are those who are not engaged in any professional activity. The prevalence of the consumption of psycho-active licit toxic substances in the Lorraine population differs little from the national French average as far as men are concerned, yet appears to be higher for women. These results are very useful for regional prevention activities such as those within the Regional Health Programmes framework.

Witnessed breathing pauses during sleep: a study in middle-aged French males.

The aim of the study was to evaluate the prevalence, the covariates and determinants of respiratory pauses during sleep in a sample of French middle-aged males. Study subjects were 850 active males, aged 22-66 years; 88.4% of them answered the question on breathing pauses during sleep from a structured, validated sleep questionnaire. Forty-one (=5.4%) subjects reported breathing pauses at least once a week; these "positive responders" were older, heavier and had larger neck- and waist girths as compared to subjects with negative answers. Loud habitual snoring, various sleep disturbances, excessive daytime sleepiness, a doctor diagnosis of sleep apnoea, history of stroke and hypertension were significantly more frequent among subjects with breathing pauses during sleep. The prevalence found in this survey was close to that reported from the UK (5.2%). However, by logistic regression, we identified novel determinants of breathing pauses i.e. habitual snoring, loud snoring, and excessive sleepiness, factors well known in clinical setting, but never previously reported in epidemiologic studies.

Marital status and sleep-disordered breathing in a sample of middle-aged French men.

The aim of the present study was to test the hypothesis that unmarried (single) men have more sleep-disordered breathing symptoms due to a higher prevalence of obesity and a less healthy lifestyle than men living with a partner. Men (499) aged 23-66 years completed a structured questionnaire, had standard anthropometric measurements and a simple, noninvasive nose-throat examination. Of the 499,496 subjects answered the question concerning their marital status; 86% of them were married or lived with a partner (reference group) and the other 14% had never been married, divorced, or widowed ("single" group, considered at risk). Single subjects were younger, included slightly more smokers (30 vs. 23%) and more subjects with a history of chronic bronchitis, and less frequently had a large soft palate. The prevalence of sleep-disordered symptoms was not significantly different between the two groups. However, a study involving a larger number of subjects with information regarding alcoholic consumption may be needed to further evaluate this question.

Occupational status and sleep-disordered breathing in a sample of French males.

Sleep-disordered breathing (SDB) and lower socio-professional status have in common a series of risk factors for ill health such as sedentary lifestyle, weight excess, heavy alcohol and tobacco consumption. We hypothesised that SDB will be more prevalent in lower socio-professional groups. A total of 496 male middle aged subjects (23-66 years) were tested with a protocol including a self-completed structured sleep questionnaire (translation of the Madison sleep cohort study form), anthropometry (including neck, waist and hip girth) and a simple, non-invasive nose-throat examination by a specialist physician. The subjects were classified according to the 10 major groups of the ISCO-88 classification (International Labour Office). Our sampling base did not contain subjects in the major groups 1 (senior officials, legislators), 6 (fishery and agricultural workers), and zero (armed forces), thus these groups were not represented in the analysis. To improve the power of the statistical analysis, groups 3 and 4, 5 and 7, 8 and 9 were merged, the analysis thus including four categories. The differences in demographic data were negligible; as expected, smoking was more prevalent in low socio-occupational groups (difference non-significant). A history of chronic bronchitis was more frequent in low socio-occupational groups, while a low physical job labour was more frequent in higher occupational groups. We did not find any differences in the prevalence of sleep-related respiratory disturbances (snoring, sleep apnoeas). This first study of the possible association between socio-occupational factors and sleep disordered breathing was negative, but we believe further studies, on larger samples, with a more homogeneous distribution of social groups are warranted.

Prevalence of habitual snoring in a sample of French males. Role of "minor" nose-throat abnormalities.

BACKGROUND: No data on snoring prevalence obtained with a standard questionnaire exist for France. Major nose-throat abnormalities have been demonstrated in cases with obstructive sleep apnea; evidence of "minor" abnormalities in community studies is scarce. OBJECTIVES: The first objective of our study was to estimate the prevalence of habitual snoring in a sample of middle-aged active males in France. The second objective was to test the hypothesis that "minor" nose-throat abnormalities could be associated with habitual snoring in a field survey. METHODS: Three hundred thirty-four male employees of a local university volunteered for the study (93.6% of those contacted by mail); 300 returned a sleep questionnaire. The protocol also included anthropometry and a noninvasive nose-throat examination. RESULTS: Complete data were obtained in 299 subjects aged 23-63 years. When "habitual snorers" (= 32%) were compared with never-snorers, significant differences were found for all anthropometric variables, except height. In univariate analysis, habitual snoring was associated with a large number of variables, including a large soft palate, a large uvula, and altered nose patency. A logistic regression model retained 8 factors independently associated with snoring: age, neck circumference, tobacco consumption, breathing pauses during sleep, not feeling rested during the day, need for coffee to stay awake, blocked or running nose at night and a large soft palate. CONCLUSIONS: The prevalence of habitual snoring in this sample of middle-aged French males was 32%. We confirmed the significant association of habitual snoring with age, weight excess, and tobacco smoking, and identified two further factors: blocked nose at night and a large soft palate.

Breathing pauses during sleep: can a non-invasive ENT examination help identify subjects at risk in epidemiological settings?

In patients with obstructive sleep apnoea (OSA) anatomic and functional upper airway abnormalities are frequent and severe. Invasive methods are used to identify and quantitate the obstruction, to precisely locate its site, etc. as part of pre-treatment or of preoperative evaluations.These methods (lateral skull radiographs, computerized tomography, MRI, fibroscopies, etc) are too expensive and too invasive to be utilized in field surveys. To the classical sleep questionnaires and anthropometric measurements, some simple nose-throat examinations, easily accepted by the volunteers in a population study, could add useful information for the identification of the subjects at risk for sleep-disordered breathing. The present paper is a review of these examinations and of their utility.

[An epidemiologic study of sleep-disordered breathing in the male population of Lorraine: preliminary results]. / Etude épidémiologique des troubles respiratoires du sommeil dans une population masculine lorraine: résultats préliminaires.

The prevalence of sleep-disordered breathing (SDB) was evaluated in a male population sample of Lorraine (university staff), with a protocol including a self-completed standardized questionnaire, anthropometry (including neck, waist and hip circumferences) and non-invasive ear, nose, and throat examination. Among 357 subjects present in the institution at the moment of the survey, 334 (93.6%) accepted to participate, and 300 (84%) returned the questionnaires. The anthropometric results corresponded to the French normative values according to gender and age. We chose a value of 32 as limit of the body mass index (BMI) between weight excess and obesity; this limit was exceeded by 7.2% of the subjects. The mean age of the sample was 44.8 (SD 10.1) years; the waist-to-hip ratio was of 0.907 +/- 0.053. The ENT examination found a high prevalence of nasal septum deviations (52.6%), of soft palate (25.2%), and uvula (42%) abnormalities; 32.1% of the subjects had experienced amygdalectomy. The non-responses to the questionnaire were infrequent (less than 2%), except for the questions regarding a history of hypertension (2.6%), weight fluctuations the last 5 years (7.6%), and the number of years in school (12%). The questionnaire included, for each question, the optional answer "don't know"; this answer was chosen for the questions concerning the duration of snoring (37.1%), stopping breathing during sleep (12.7%) and the parental history of narcolepsy (18.7 and 20.7%) and sleep apnoea (33.7 and 36.4%). 5.7% of the subjects declared sleep apnoeas at least once per week: 16.1% had unrefreshing sleep; 10.6% admitted to excessive daytime sleepiness; 41.9% were habitual snorers. These results indicate a prevalence of SDB in our sample which is comparable to the figures obtained in other European studies. Further analysis of our data will indicate if, besides weight excess and its troncular distribution, cigarette smoking and respiratory symptoms, the "minor" ENT abnormalities play a role in the pathogenesis of SDB.

Study of parameters involved in specific immunoadsorption of apolipoprotein B.

A therapeutic immunoadsorption system on immobilized and anti-apolipoprotein B as a plasma cholesterol lowering procedure was optimized. Several antibodies were compared and highest adsorption capacity was obtained with goat polyclonal antibodies. Optimum quantities of antibodies to be immobilized on the gel and quantities of apo-B to be applied to columns were determined. The amount of antibodies released from immunoadsorbents can be minimized by treatment with a 0.005% glutaraldehyde solution with an acceptable reduction rate of adsorption capacity. Each phase, adsorption and desorption respectively, were well-defined and synchronized so two columns could be used in parallel in an automated procedure. In these conditions, the immunoadsorption system can efficiently, specifically and safely remove cholesterol and has to be subjected to clinical trials.

[Development of a technique of immunoadsorption of LDL-cholesterol]. / Mise au point d'une technique d'immuno-adsorption du LDL-cholestérol.

An immunoadsorption system for lowering plasma cholesterol was optimized. Several polyclonal and monoclonal antibodies were compared and the best results were obtained with goat polyclonal antibodies. The optimum quantity of antibodies to be immobilized on the gel was 5 mg/ml. Taking into account two variables, i.e., 1) that the regeneration must be as complete as possible and, 2) that immunoadsorbents must be used several times without a loss of adsorption capacity, desorption was achieved with 0.3 M glycine adjusted to pH 2.8. Antibody release from the immunoadsorbent was determined and can be minimized by glutaraldehyde treatment of the immunoadsorbent. Each phase, adsorption and desorption, respectively, was well-defined and synchronized, so that two columns could be used in parallel in an automated procedure. The kinetics of plasma protein removal demonstrated the efficiency and the specificity of the procedure.

[Immunosorption of apolipoproteins B. Optimization of the method in an in vitro bench test]. / Immunoépuration des apolipoprotéines B. Optimisation de la méthode sur banc d'essai in vitro.

The aim of the present study was to determine optimum conditions for preparation and use of immunoadsorbents for removal of apolipoprotein B from plasma. An in vitro study was carried out to optimize different chromatography parameters: linear flow rate, apo B quantity loaded, gel regeneration conditions. Specificity of removal of apo B, stability of antibody covalent linkage and possible multiple use of immunoadsorbents were assessed. No significant loss of adsorption capacity was observed after sterilization and storage of immunoadsorbents.

[A microprocessing system for respiratory epidemiological studies (author's transl)]. / Système micro-informatisé pour enqueêtes épidémiologiques respiratoires.

A microprocessing system designed to collect and analyse data from respiratory epidemiological studies is described. It has several independent modules. The first module presents the questions from the European Coal and Steel Community questionnaire in a logical sequence and analyses and stores the responses. The second module is associated with a device that measures CO diffusion and determines gas exchange; it calculates, displays and stores the results. The last module collects and integrates digitally the flow measured at the mouth by a pneumotachograph during forced expiration, then displays and calculates the principal indices when certain programmed criteria for selection of flow-volume curves are met. All modules are connected to a numerical magnetic tape-recorder which centralizes the information data. The system is easily transportable and satisfactory for epidemiological studies.