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Biomedical subjects

D Léger

Publications and source records attributed to D Léger.

At least 19 recordsLinked to original sources
PubMed2005

[Attitude toward insomnia: survey of 6043 French general practitioners].

AIM: To describe the attitudes of French general practitioners (GPs) about insomnia and its effect on patients' physical health and work. METHOD: A questionnaire about patients with insomnia and its diagnosis, treatment, and consequences was distributed to a representative sample of 8000 GPs. RESULTS: 6,043 GPs completed and returned the questionnaires. They estimated the prevalence of insomnia in their patients at 18.1%. They identified the principal causes of insomnia as anxiety (58.8%) and work issues (54%). Nearly 45% reported that they always raise the subject of sleep with their patients. For 62.4% sleep problems reflect another disorder rather than being a primary syndrome. Nearly two-thirds (60.2%) do not prescribe medication at the first complaint. When prescribing hypnotics, 81.3% also recommended sleep hygiene measures. Most (68.5%) agreed that insomnia affects concentration, memory, and attention. Almost all employed patients with insomnia complained of work-related effects, such as loss of productivity and absenteeism. CONCLUSION: Insomnia and its management are topics of strong interest for GPs.

Attitude of Health Personnel↗
PubMed2005

Epidemiology of restless legs syndrome in French adults: a nationwide survey: the INSTANT Study.

OBJECTIVE: To evaluate the prevalence, characteristics, and treatment of restless legs syndrome (RLS) in France. METHODS: In this population-based survey, face-to-face home interviews were conducted among a random sample of 10,263 French adults. A French translation of the four features defined by the International RLS Study Group in 1995 was used to assess the prevalence of symptoms consistent with a diagnosis of RLS. Data on severity of symptoms and their management were also collected. RESULTS: The 12-month prevalence of RLS symptoms in the French adult population was estimated to be 8.5% (95% CI 8.0%, 9.0%), with a higher prevalence (p < 0.001) observed in women (10.8%) than in men (5.8%). Prevalence increases with age until 64 years and decreases thereafter in both sexes. Half of the identified subjects reported symptoms once a week at least. Symptoms were more severe in subjects reporting symptoms once a week at least compared to subjects with less frequent symptoms. In this group, half of the subjects reported a family history, the age at onset was earlier, and severity of symptoms higher. RLS had been previously diagnosed in only 5.3% of the subjects who reported previous medical diagnosis, and recommended RLS drug treatment was received by 3.4% of the 28.7% currently treated subjects. CONCLUSIONS: Restless legs syndrome (RLS) occurred in 10% of women and 5% of men. RLS prevalence decreases after the age of 64. RLS is often underdiagnosed and few subjects receive recommended RLS drug treatment.

Adolescent↗
PubMed2005

Characteristics of intermittent and persistent allergic rhinitis: DREAMS study group.

BACKGROUND: In the Allergic Rhinitis and its Impact on Asthma (ARIA) classification, intermittent and persistent rhinitis were proposed to replace seasonal and perennial allergic rhinitis (AR). AIM: To better understand the ARIA classification of rhinitis. METHODS: A cross-sectional study was carried out in 591 patients consulting ENT or allergy specialists for AR and 502 control subjects. The diagnosis of AR was based on a score for allergic rhinitis (SFAR) > or =7. Patients were classified according to the four ARIA classes (mild intermittent, mild persistent, moderate/severe intermittent and moderate/severe persistent). Allergen sensitization (skin prick tests (SPTs) or specific IgE) and co-morbidities were examined according to the ARIA classes. RESULTS: Ten percent of patients had mild intermittent rhinitis, 14% mild persistent rhinitis, 17% moderate/severe intermittent rhinitis and 59% moderate/severe persistent rhinitis. Most patients with intermittent rhinitis had a pollen sensitivity, but 5% had a single house dust mite (HDM) sensitization. Over 50% of patients with persistent rhinitis were allergic to pollens or HDM. Asthma was present in 24% of rhinitis patients and in only 2% of the control population (P<0.0001). Patients with moderate/severe persistent rhinitis had the highest asthma prevalence (33%). DISCUSSION: Intermittent and persistent rhinitis are not synonymous of seasonal and perennial rhinitis. Most patients consulting specialists have severe rhinitis. Asthma prevalence increases with duration and severity of rhinitis supporting the ARIA major recommendation that patients with persistent rhinitis should be evaluated for asthma.

Adolescent↗
PubMed2002

Work and rest sleep schedules of 227 European truck drivers.

OBJECTIVE: To investigate the sleep-wake behavior and performance of a random sample of European truck drivers. METHODS: The drivers completed a questionnaire concerning sleep-wake habits and disorders experienced during the previous 3 months. In addition, they were asked to complete a sleep and travel log that included their usual work and rest periods during the previous two days. They answered questions concerning working conditions and reported their caffeine and nicotine intake during their trips. RESULTS: A total of 227 drivers, mean age 37.7+/- 8.4 years (96.2% acceptance rate), participated in the study. The drivers were found to have a fairly consistent total nocturnal sleep time during their work week, but on the last night at home prior to the new work week there was an abrupt earlier wake-up time associated with a decrease in nocturnal sleep time. Of the drivers, 12.3% had slept less than 6 h in the 24 h previous to the interview and 17.1% had been awake more than 16 h. CONCLUSIONS: Shifting sleep schedules between work and rest periods can generate long episodes of wakefulness. This type of sleep deprivation is rarely investigated. Its is usually not taken into consideration when creating work schedules, but affects the performance of drivers. Unsuspected shifts occur at the onset of a new workweek. Sleep hygiene education for professional drivers is still far from perfect.

Journal Article↗
PubMed2001

[Diurnal consequence of insomnia: impact on quality of life].

Insomnia is not only a disease of sleep, it has also daily consequences: fatigue, irritability, impaired daytime functioning. These complaints are regent reported by the patients, however the objective tests assessing alertness in insomnia are usually not impaired when compared with good sleepers. We wanted to appreciate more accurately the daily consequences of insomnia, in terms of quality of life. 240 severe insomniacs (according to the DSM-IV criterias) and 391 good sleepers received a questionnaire on quality of life items. Depressed and anxious patients were excluded from this group. The questionnaire was built by a multidisciplinary group, based on insomniac's interviews. It was primarily tested in a small sample and then proposed in the entire group. Insomniac's quality of life appeared to be significantly impaired in comparison with good sleepers. They experienced more fatigue and more sleepiness during the daytime. They reported more attention disorders and memory complaints. They seemed to be more irritable and sensitive to the environment. At work they made more mistakes and had more sic leave. They also had poorer relationships with relatives and family than good sleepers.

Adult↗
PubMed2001

[Delayed wakefulness-sleep rhythm syndrome and melatonin. Synthesis of existing studies].

Delayed sleep phase syndrome involves undesirable late bed times and arising times with extreme difficulties in falling asleep and in awakening at a desired clock time. These patients present a delayed circadian system. Chronotherapy and phototherapy are designed to have a training effect on the circadian system. Response to these treatments varies widely and depends on the patient's motivation and associated psychological disorders. Other treatments have been proposed with less evident results. The few studies testing the effect of melatonin in delayed sleep phase syndrome concern a small number of patients and present methodological drawbacks. It can be concluded from these studies however that exogenous melatonin influences endogenous secretion more than other secretion rhythms. The effect on sleep time is significant but clinically moderate. More studies are needed to examine the effect of exogenous melatonin as a treatment strategy in delayed sleep phase syndrome.

Circadian Rhythm↗
PubMed2001

[Disorders of wakefulness and sleep in blind patients].

The goal of this paper was to summarize three studies focused on sleep/wake disorders in blind subjects. The first study was an epidemiology survey performed in 1073 blind subjects in comparison with non-blind controls. The blind had more episodes of insomnia and free running rhythms. They also took more sleeping pills and complained of more daytime somnolence. The seriousness of the sleep disorders was related to the seriousness of the blindness. In the second study, 78 blind children were compared with seeing children. They had more insomnia and more parasomnias but there was not any more free running. Finally, polysomnography was performed in 26 free running blind subjects in comparison with 26 controls. Total sleep time and sleep efficiency were lower in the blind. Sleep latency was increased and REM sleep was disturbed (longer latency and percentage decreases). There was no difference concerning slow wave sleep. Factorial analysis showed that factors such as being born blind, having ocular prosthesis, being single or having children had no influence on sleep. Working did however have an influence.

Adolescent↗
PubMed2000

Public health and insomnia: economic impact.

There seems to be a lack of understanding between practitioners and patients on the topic of insomnia. One adult out of four complains of insomnia; however only one insomniac out of four has ever complained about it to their practitioner during a visit made for another problem and only one out of twenty has come to discuss specifically the problem of his or her insomnia. Only a few patients with insomnia take a treatment for it. This gap between the patient's feeling and the practitioner's answer has to be better understood if we want to know why insomnia seems to be so prevalent and what impact it has on society. One aspect may be a question of definition. Insomnia may be considered an ordinary complaint (after one poor night) or as a chronic disease. Practitioners have poor knowledge about sleep disorders and may be embarrassed about coping with an impairment they never specifically learned to manage. The second aspect concerns the impact of insomnia on daytime alertness and performance. While patients usually complain of an impaired daytime functioning with a feeling of fatigue, sleepiness, and risk of mistakes, many studies of insomniacs do not reveal any increased sleepiness or decrease of performance (measured by objective tests) the day following a poor night. Practitioners may therefore find it difficult to understand the real impact of insomnia on daytime functioning. The third aspect is related to the large co-morbidity between insomnia and psychiatric diseases, especially depression and anxiety. It does make it harder for practitioners to define whether the sleep impairment suffered by their patient is the cause for other symptoms or the consequence of an underlying disease. Thus, it makes it all the more difficult for the practitioner to determine which treatment is the most appropriate. These aspects have to be clarified if one wants to estimate the real impact of insomnia on society. It could be useful to both practitioners and patients to have a better understanding on the relationship between poor sleep and daily lives.

Absenteeism↗
PubMed2000

[Value of Holter ECG in the diagnosis of sleep apnea syndrome in patients with massive obesity].

OBJECTIVE: Assess the diagnostic contribution of cyclic nocturnal variations in heart rate in sleep apnea syndrome. PATIENTS AND METHODS: Holter recordings performed in a population of 30 patients with massive obesity defined as a body mass index greater than 40 kg/m2 and sleep apnea syndrome defined by an apnea index greater than 5 apneas per hour were analyzed retrospectively. The control group was composed of 15 patients with massive obesity but without sleep apnea syndrome. High variability in nocturnal heart rate was assessed using a visual criterion defined as repeated episodes of progressive reduction in heart rate followed by a sudden acceleration reaching a difference of 30 bpm between the highest and lowest heart rate and occurring at least 5 times during one consecutive hour of recording. RESULTS: Increased nocturnal variability in heart rate was evidenced in all the patients with sleep apnea syndrome (30/30) but was not observed in any of the control subjects (0/15). CONCLUSION: These results suggest that Holter recordings can be a useful tool for the diagnosis of sleep apnea syndrome.

Adult↗
PubMed2000

Depression and sleep disorders: clinical relevance, economic burden and pharmacological treatment.

A wide range of studies have been published over the past two decades that involve the intersection of sleep EEG, insomnia, psychiatric illness (especially depressive disorders) and psychopharmacology. Much of value has been discovered, but there have also been false starts and contradictory results. There is in fact strong evidence that insomnia is associated with medical and psychiatric illness and that the sleepiness associated with insomnia is the cause of many accidents. Thus, the direct (visits to doctors, cost of sleeping medication, complications from use of these medications) and indirect (accidents, quality of life) costs of insomnia are enormous and constitute a major public health problem in the industrialized countries. Believing that it is now timely to assess the state of this important research area, a consensus conference was convened on June 26-28, 1998, in Porto Cervo (Italy) to attempt to clarify the important issues and findings on the clinical effect of the different classes of antidepressant drugs on sleep quality in depression. The participants' consensus on some of the main topics is presented with the hope that this discussion and analysis will contribute to productive research in this important field.

Antidepressive Agents↗
PubMed2000

[Comparative study of actigraphy and ambulatory polysomnography in the assessment of adaptation to night shift work in nurses].

Night shift work is common in hospitals to assure continuous care. This practice, however, induces difficulties due to changes in the sleep/awake cycle of hospital workers. The aims of the present study were to validate actigraphy in comparison with polysomnography for sleep evaluation and to assess nurses' adaptation to sleep/wake cycles when on a permanent night shift schedule. Actigraphy and ambulatory polysomnography were performed in fifteen night shift nurses employed in hospital on a full time basis, during their work and their rest periods. Our first findings showed that actigraphy gave reliable results compared with polysomnography in evaluation of total sleep time. In addition, it was found that seven of the nurses exhibited, during their work periods, an approximately five-hour delay in the acrophase of their rest/activity rhythm compared with their rest periods. In contrast, five other nurses whose acrophase did not change between work and rest periods, exhibited sleep episodes of more than 100 minutes duration at work. These results confirm data in the literature and show that some nurses cannot adjust the circadian rhythm of their inner biological clock to their nocturnal schedules. Actigraphy seems to be an efficient, low cost and easy method for measuring total sleep time as well as for assessing the inability of nurses to adapt to permanent night shift work.

Adaptation, Physiological↗
PubMed1998

Cardiorespiratory consequences of sleep apnoea syndrome in patients with massive obesity.

Assessment of cardiorespiratory consequences of sleep apnoea syndrome (SAS) is difficult owing to confounding factors, especially obesity, that are strongly associated with SAS. This study was designed to assess the cardiorespiratory consequences of SAS by comparing the results of a comprehensive cardiorespiratory evaluation in apnoeic and nonapnoeic patients with massive obesity. In a retrospective chart-review study, we studied 60 patients with massive obesity defined by a body mass index (BMI) >40 kg.m(-2), presenting no chronic respiratory disease, who underwent an extensive assessment of cardiorespiratory consequences of obesity, including overnight polysomnography, lung function tests, arterial blood gas analysis, evaluation of vascular risk factors, myocardial scintigraphy with dipyridamole stress-test, isotopic ventriculography, Doppler echocardiography and Holter electrocardiogram recording. SAS defined by an apnoea + hypopnoea index (AHI) > or = 10 was diagnosed in 42% of patients (25 out of 60). Mean+/-SD AHI of SAS-positive (SAS+) patients was 38+/-24. Age, BMI, ventilatory function parameters, prevalence of smoking history and diabetes mellitus did not differ significantly in SAS+ versus SAS-negative (SAS-) groups. The following complications were observed more frequently in SAS+ than in SAS- patients: daytime hypoxaemia (35 vs 9%, p<0.02), pulmonary arterial hypertension (36 vs 7%, p<0.05) and increased interventricular septal thickness (50 vs 15%, p<0.03). No association was found between SAS on the one hand and systemic arterial hypertension, coronary artery disease, left ventricular dysfunction and nocturnal cardiac arrhythmias on the other. Nocturnal apnoeas in massive obesity may thus be associated with moderate daytime hypoxaemia, mild pulmonary arterial hypertension and moderate left ventricular hypertrophy, but not with severe cardiorespiratory complications.

Adult↗
PubMed1995

Rat mammary-gland transferrin: nucleotide sequence, phylogenetic analysis and glycan structure.

The complete cDNA for rat mammary-gland transferrin (Tf) has been sequenced and also the native protein isolated from milk in order to analyse the structure of the main glycan variants present. A lactating-rat mammary-gland cDNA library in lambda gt10 was screened with a partial cDNA copy of rat liver Tf and subsequently rescreened with 5' fragments of the longest clones. This produced a 2275 bp insert coding for an open reading frame of 695 amino acid residues. This includes a 19-amino acid signal sequence and the mature protein containing 676 amino acids and one N-glycosylation site in the C-terminal domain at residue 490. Phylogenetic analysis was carried out using 14 translated Tf nucleotide sequences, and the derived evolutionary tree shows that at least three gene duplication events have occurred during Tf evolution, one of which generated the N- and C-terminal domains and occurred before separation of arthropods and chordates. The two halves of human melanotransferrin are more similar to each other than to any other sequence, which contrasts with the pattern shown by the remaining sequences. Native rat milk Tf is separated into four bands on native PAGE that differ only in their sialic acid content: one biantennary glycan is present containing either no sialic acid residues or up to three. The complete structures of the two major variants were determined by methylation, m.s. and 400 MHz 1H-n.m.r. spectroscopy. They contain either one or two neuraminic acid residues (alpha 2-->6)-linked to galactose in conventional biantennary N-acetyl-lactosamine-type glycans. Most contain fucose (alpha 1-->6)-linked to the terminal non-reducing N-acetylglucosamine.

Animal Population Groups↗
PubMed1995

[Hysterectomy. Indications, abuse, psychological impact].

Statistical surveys have established that, in France, hysterectomy was carried out too frequently: 50 to 70,000 hysterectomies (perhaps only 40,000) are carried out each year in our country. This fact, together with the deleterious psychological effects of this operation, have urged the authors to express some remarks on the current practice of hysterectomy in France. The currently approved indications are the following: invasive cancer, benign lesions with intractable disabling symptoms and technical requirements (e.g. cure of prolapse in the elderly). Bleeding due to fibromyomas should be managed with conservative means as much as possible. Infections are within the scope of medical treatment. When an hysterectomy is indicated, the vaginal route should be preferred whenever possible, due the lesser impact on the body image and personality. The adverse psychological effects of hysterectomy are due to several factors: fear of the operation, pain, possible complications, breach of the femininity, alteration of the body image, fear of menopause and ageing. These effects could be reduced by an accurate information of the patient on the actual consequences of the operation, which are far from considerable, specially if the hormonal secretion is preserved. Also, a certain period of time between the decision and the operation might help to further reduce this psychological impact.

Adaptation, Psychological↗