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Biomedical subjects

R Poirrier

Publications and source records attributed to R Poirrier.

At least 19 recordsLinked to original sources
PubMed2002

[Narcolepsy-cataplexy].

The diagnosis of narcolepsy-cataplexy is based on three axes: 1) the medical history is strongly suggestive when diurnal sleep attacks (narcolepsy) and drop attacks (cataplexy) are reported or observed; 2) the polysomnography is mandatory and shows nocturnal and diurnal (multiple sleep latency test) REM sleep onsets; 3) HLA typing, practically helps to exclude the diagnosis when HLA DR15-DQB1*0602 is not present. New pathogenetic hypotheses have been proposed, mostly based the absence of hypocretin in narcoleptic cerebrospinal fluid. This neurotransmitter was previously known exclusively by its involvement in alimentary behaviours. The new therapies remain symptomatic, but they are powerful to prevent somnolence, daytime sleepiness, cataplexy and insomnia associated with this syndrome.

Carrier Proteins↗
PubMed2002

[Our experience with geniopexy in the treatment of OSAS].

OBJECTIVE: We examine geniopexy efficacy in OSAS treatment. STUDY DESIGN: Seven patients, aged 36 to 61 years, were studied. The mean body mass index was normal. RESULTS: Surgical late complications (modified symphysis proprioception) occurred in 4 patients. No patient was improved in sleep problems. Retromaxilly and retromandibuly were found in all patients by cephalometric study. DISCUSSION: Our results are quite different from these described successfully by other centers. Geniopexy do not move maxillar and mandibular skeletal bones, which are retruded in our serie. This explains maybe our bad results. Actually, we propose for this patients maxillo-mandibular advancement.

Adult↗
PubMed2001

Decreased amount of slow wave sleep in nocturnal bruxism is not improved by dental splint therapy.

OBJECTIVE: To test the efficacy of dental treatment of bruxism on sleep quality, using slow wave sleep as the primary outcome parameter. METHODS: The study design consisted of an open label, unpaired comparison between normals and patients and a paired comparison between pre- and post-treatment patient recordings. Twenty patients suffering from bruxism (13 male, 7 female, mean age 35 years) and 6 normal volunteers (3 male, 3 female, mean age 30 years) participated in the study. Polysomnographic recordings were performed in a sleep laboratory in a general hospital both before and after treatment. The treatment was derived from a model that ascribes bruxism to a dental malocclusion, and consisted solely of dental therapy (Jeanmonood 1988). RESULTS: The untreated bruxism group had worse sleep than normals when comparing slow wave sleep (21% versus 32% slow wave sleep percentage in sleep period time) during the second polysomnographic recording, after one night adaptation. Therapy did not improve sleep quality; bruxism patients showed only minor, non-significant differences in sleep quality when comparing pre- and post-treatment recordings.

Adult↗
PubMed2001

[Photoperiod phototherapy and wakefulness-sleep rhythm disorders].

Bright light therapy is a recent physical treatment in chronodisabled situations. The most recognized indication is the seasonal affective disorder. However, any disease or dysfunction where a misalignment of sleep-wake and circadian rhythms may be suspected is a potential tool for this treatment. Analyses of the literature throughout the interpretation methods of the evidence based medicine indicate that bright light therapy, if not a standard, could be recommended in a number of circadian rhythm sleep disorders, mainly the delayed and advanced sleep phase syndromes. Time aspects are essential for the success of phototherapy. From this point of view, easy and practical technological means or methods, allowing to shape a Phase Response Curve in each individual to be treated, should be clear progress. A future extension of indications will also depend on the checking of essential hypotheses linking circadian and sleep-wake rhythms in diseases such as psychophysiological insomnia, multiple sclerosis, brain dysgeneses or dementias. At last, a non negligible advantage of bright light therapy appears to be its relative safety.

Humans↗
PubMed2001

Surgical management of maxillomandibular advancement in sleep apnea patients: specific technical considerations.

Maxillomandibular advancement is an integral part of the surgical treatment of patients suffering from obstructive sleep apnea. A number of publications report its efficacy and have attempted to define predictive success criteria. However, few authors have shown an interest in the surgical specificity of this intervention and in the difficulties that can be encountered, which differ from those seen in conventional orthognathic surgery. In this article, a series of patients treated with maxillomandibular osteotomy to correct obstructive sleep apnea syndrome (n = 17) are compared with patients who underwent surgery for the correction of dentofacial disharmonies (n = 33). Observations emphasized the importance of respecting a strict surgical and postsurgical protocol to avoid any technical traps linked to maxillomandibular advancement, both in preoperative simulations and during and after surgery. Results concerning sleep parameters will be the subject of a future publication.

Adolescent↗
PubMed2000

[Could mouth breathing lead to obstructive sleep apnea syndromes. A preliminary study].

The aim of this preliminary work is to determine an easy method to diagnose "buccal breather" children and "nasal breather" children. Then, to establish a possible connection with the syndrome of obstructive sleep apnea. 22 children agreed to participate. Clinical, orthophonic, orthodontic, postural and polysomnographical exams have been carried out. The proposed clinical exam turns out to be a good means of diagnosing between buccal breathers and nasal breathers. The aerophonoscope reveals velar inadequacies in buccal breathers. The latter also present osseous discrepancies mainly in the mandible. The polysomnography reveals a higher apnea/hypopnea index and more agitated sleep in buccal breathers. Mandibular lowering movements are more frequent and similar to those of adults suffering from apnea. These elements similar to those encountered in adults suffering from apnea make us think that buccal breathing could be the origin of obstructive sleep apnea, several decades later.

Adolescent↗
PubMed1997

[Orthodontic contribution in sleep apnea].

This study details the role that the orthodontist can play, when faced with sleeping obstructive apneas and snoring phénomena. Of special importance are knowledge of cranio-facial growth, radiographic exam and cephalometric analysis: they mainly help to understand all the aspects of this specific syndrome, and reveal the interest for a neuro-orthodontic or a neuro-surgical orthodontic approach.

Adult↗
PubMed1993

[Obstructive sleep apnea syndromes].

Snoring and excessive sleepiness are the hallmarks of obstructive sleep apnea syndrome but other clinical manifestations are present and a precise assessment of the disease involves clear definitions of the various kinds of apnea. Several pathogenetic factors (functional, anatomical, neurological, genetical) are still being discussed. However new insights of the pathophysiology of apneas allow more reliable treatments. Central nervous and cardiovascular complications as well as the traumatic morbidity, associated with excessive daytime sleepiness, make it a major public health problem.

Adult↗
PubMed1993

[Evaluation of sleep apnea syndromes].

The evaluation of sleep apnea syndrome is based on polysomnography. Different sensor and recording techniques are reported. Some widely used neurophysiological and cardiorespiratory analysis criteria are proposed. Many sleep laboratories develop ambulatory and automatized methods for screening breathing disorders associated with sleep. The main principles of these approaches are briefly reviewed.

Humans↗
PubMed1993

[Treatment of obstructive sleep apnea syndromes].

The detection, correction or withdrawal of any cause or associated factor including obesity, drugs or alcohol is essential in the treatment of obstructive sleep apnea syndrome. Treatment is mainly mechanical or surgical, but not medical. Nasal continuous positive airway pressure (NCPAP) has now largely replaced tracheostomy and successful long-term domestic use of this method has been reported on many occasions. Oropharyngeal surgery can solve a large part of social snoring problems. However criteria for procedure selection and evaluation of results are still needed to clarify the indication of this operation in patients with full clinical expression of the syndrome. In this regard, a comprehensive preoperative evaluation and a logical approach to the reconstruction of the upper-airway has recently led to the association of palatopharyngoplasty and maxillo-mandibular surgery, with an excellent long-term success rate.

Combined Modality Therapy↗
PubMed1992

Cerebral glucose utilization during stage 2 sleep in man.

Using [18F]fluorodeoxyglucose method and positron emission tomography, we performed paired determinations of the cerebral glucose utilization at one week intervals during sleep and wakefulness, in 12 young normal subjects. During 6 of 28 sleep runs, a stable stage 2 SWS was observed that fulfilled the steady-state conditions of the model. The cerebral glucose utilization during stage 2 SWS was lower than during wakefulness, but the variation did not significantly differ from zero (mean variation: -11.5 +/- 25.57%, P = 0.28). The analysis of 89 regions of interest showed that glucose metabolism differed significantly from that observed at wake in 6 brain regions, among them both thalamic nuclei. We conclude that the brain energy metabolism is not homogeneous throughout all the stages of non-REMS but decreases from stage 2 SWS to deep SWS; we suggest that a low thalamic glucose metabolism is a metabolic feature common to both stage 2 and deep SWS, reflecting the inhibitory processes observed in the thalamus during these stages of sleep. Stage 2 SWS might protect the stability of sleep by insulating the subject from the environment and might be a prerequisite to the full development of other phases of sleep, especially deep SWS.

Adult↗
PubMed1991

[Obstructive sleep apnea syndromes].

With the exception of cases where a lesion creates a clearly identifiable and surgically removable anatomical obstacle on the upper air duct (tumors, cysts, hypertrophic tonsils, vegetations,...), currently the continuous positive air pressure is the treatment of choice. One drawback is that in most cases it is no more than a symptomatic treatment. The most efficient alternative treatment is using extensive maxillofacial surgery. Another promising way is prevention through specific mouth breathing treatment from the earliest age on.

Adult↗
PubMed1990

Cerebral glucose utilization during sleep-wake cycle in man determined by positron emission tomography and [18F]2-fluoro-2-deoxy-D-glucose method.

Using the [18F]fluorodeoxyglucose method and positron emission tomography, we studied cerebral glucose utilization during sleep and wakefulness in 11 young normal subjects. Each of them was studied at least thrice: during wakefulness, slow wave sleep (SWS) and rapid eye movement sleep (REMS), at 1 week intervals. Four stage 3-4 SWS and 4 REMS fulfilled the steady state conditions of the model. The control population consisted of 9 normal age-matched subjects studied twice during wakefulness at, at least, 1 week intervals. Under these conditions, the average difference between the first and the second cerebral glucose metabolic rates (CMRGlu was: -7.91 +/- 15.46%, which does not differ significantly from zero (P = 0.13). During SWS, a significant decrease in CMRGlu was observed as compared to wakefulness (mean difference: -43.80 +/- 14.10%, P less than 0.01). All brain regions were equally affected but thalamic nuclei had significantly lower glucose utilization than the average cortex. During REMS, the CMRGlu were as high as during wakefulness (mean difference: 4.30 +/- 7.40%, P = 0.35). The metabolic pattern during REMS appeared more heterogeneous than at wake. An activation of left temporal and occipital areas is suggested. It is hypothetized that energy requirements for maintaining membrane polarity are reduced during SWS because of a decreased rate of synaptic events. During REMS, cerebral glucose utilization is similar to that of wakefulness, presumably because of reactivated neurotransmission and increased need for ion gradients maintenance.

Adult↗
PubMed1987

[Study of regional cerebral glucose metabolism, in man, while awake or asleep, by positron emission tomography].

Measurements of regional cerebral glucose uptake by the 18F-fluorodeoxyglucose technique (18FDG) and positron emission tomography (PET) along with polygraph recordings were made serially during relaxed wakefulness and different stages of nocturnal sleep in two right-handed normal volunteers. During stage III-IV sleep, values declined diffusely in both hemispheric regions (-31%), thalamus (-33%), cerebellum (-33%) and brain stem (-25%). During paradoxical sleep regional values increased diffusely compared with slow wave sleep. Compared to wakefulness, regional metabolic values seemed to increase but the results were more variable from one volunteer to the other. These preliminary data indicate important regional alterations in cerebral metabolism between sleep states.

Adult↗
PubMed1985

[Value of the sleep EEG as a biological marker of depressive states. Comparison with 3 neuroendocrine tests].

In a sample of 12 endogenous depressive inpatients (8 primary and 4 secondary depressives), we compared the diagnostic usefulness of REM latency (recorded during at least 4 consecutive nights) with 3 neuroendocrine tests: dexamethasone suppression test and GH response after clonidine (a alpha-adrenergic agonist) and apomorphine (a dopaminergic agonist) challenges. Shortened REM latency (less than 50 min during at least 1 night) was present in 67% of depressives. However, REM latency presented a clear night to night intra-patient variability that makes it necessary to record at least 3 consecutive nights for the best sensitivity. Non-suppression after dexamethasone was present in 50% of depressives, blunted GH response after clonidine, in 75% and blunted response after apomorphine, in 42%. A total of 92% of patients exhibited at least one abnormal biological parameter (100% of primary and 75% of secondary depressives); 67% of patients exhibited at least two disturbed parameters and these patients constituted the whole primary depressive group (100%). These results show that these 4 potential biological markers of depression are not necessarily distributed in the same population. This suggests the potential usefulness of their concurrent use for improved accuracy of diagnosis.

Adult↗
PubMed1984

Concurrent use of REM latency, dexamethasone suppression, clonidine, and apomorphine tests as biological markers of endogenous depression: a pilot study.

In a sample of 12 major depressive inpatients, endogenous subtype (8 primary and 4 secondary) defined by Research Diagnostic Criteria, we compared the sensitivity of four potential biological markers: latency of rapid eye movement (REM) sleep (recorded during at least 4 consecutive nights), dexamethasone suppression, and the clonidine and apomorphine tests. Shortened REM latency (less than 50 minutes during at least 1 night) identified 67% of depressives (87% of primary and 25% of secondary); nonsuppression after dexamethasone identified 50% of depressives (62% of primary and 25% of secondary); blunted growth hormone (GH) response after clonidine identified 75% of depressives (100% of primary and 25% of secondary); and blunted GH response after apomorphine identified 42% of depressives (62% of primary and 0% of secondary). Ninety-two percent of patients were correctly identified by at least one biological marker (100% of primary and 75% of secondary depressives). Of 67% of patients positive on at least two biological markers, all were primary depressives (100%). These four biological markers do not necessarily identify the same population, suggesting that their concurrent use may yield the highest level of diagnostic sensitivity.

Adult↗