The percentage of compliant continuous positive airway pressure (CPAP)-treated apnoeic patients that continue to experience residual excessive sleepiness (RES) is unknown.RES was defined by an Epworth Sleepiness Scale (ESS) score of o11. In total, 502 patients from 37 French sleep centres using CPAP .3 h?night -1 attending their 1-yr follow-up visit were eligible. ESS and polysomnographic data as well as symptoms, quality of life, depression scores and objective CPAP compliance at 1 yr were collected. Overall, 60 patients remained sleepy on CPAP (ESS 14.3¡2.5) leading to a prevalence rate of RES of 12.0% (95% confidence interval (CI) 9.1-14.8). After having excluded associated restless leg syndrome, major depressive disorder and narcolepsy as confounding causes, the final prevalence rate of RES was 6.0% (95% CI 3.9-8.01). Patients with RES were younger and more sleepy at diagnosis. The relative risk of having RES was 5.3 (95% CI 1.6-22.1), when ESS before treatment was o11. Scores of emotional and energy Nottingham Health Profile domains were two times worse in patients with RES.As 230,000 obstructive sleep apnoea patients are currently treated in France by continuous positive airway pressure, more than 13,800 of them might suffer from residual excessive sleepiness.

Objective: Mechanisms of dyspnea in obesity remain unclear. This study was undertaken to determine the relationships between dyspnea and pulmonary function including inspiratory muscle endurance (IME) in morbidly obese patients before bariatric surgery. Research methods and procedures: Fifty-five patients with a mean7s.d. body mass index (BMI) of 49.477.0 kg/m 2 were included. Dyspnea was evaluated by the Baseline Dyspnea Index (BDI; 0-12, 0 ¼ maximal dyspnea). Pulmonary function tests included a plethysmography, maximal inspiratory pressure (PImax) and IME was assessed by the incremental threshold loading test, determining the maximal pressure sustained for 2 min (Plim 2 ) and Plim 2 /PImax ratio. Patients were classified according to their BMI in two groups: BMI p49 (n ¼ 27) and 449 kg/m 2 (n ¼ 28

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Purpose Mandibular repositioning devices (MRDs) are an effective treatment option for obstructive sleep apnea syndrome (OSAS), particularly in patients who refuse or cannot tolerate continuous positive airway pressure (CPAP). However, sex differences in the response to therapy and predictors of response are not clearly defined. This analysis of data from the long-term prospective ORCADES trial compared MRD efficacy in men and women with OSAS. Methods The ORCADES study included patients with newly diagnosed mild-to-moderate or severe OSAS who refused or were non-compliant with CPAP. MRD therapy was titrated over 3–6 months. The primary endpoint was treatment success (≥ 50% decrease in apnea-hypopnea index (AHI)). Complete response was defined using a range of AHI cut-off values (< 5/h, < 10/h, < 15/h). Results Overall treatment success rates were 89% in women and 76% in men ( p = 0.019); corresponding rates in those with severe OSAS (AHI > 30/h) were 100% and 68% ( p = 0.0015). In women vs. men, overall complete response rates at AHI cut-off values of < 5/h, <10/h, and < 15/h were 49 vs. 34% ( p = 0.0052), 78 vs. 62% ( p = 0.016), and 92 vs. 76% ( p = 0.0032). On multivariate analysis, significant predictors of MRD treatment success were overbite and baseline apnea index in men, and neck circumference and no previous CPAP therapy in women. There were sex differences in the occurrence of side effects. Temporomandibular joint pain was the most common reason for stopping MRD therapy. Conclusions MRD therapy was effective in women with OSA of any severity, with significantly higher response rates compared with men especially in severe OSAS. Trial registration www.clinicaltrials.gov (NCT01326143).

In OSA patients, the relationship between aortic root diameter and nocturnal BP persists on CPAP therapy. Further studies that evaluate the potential protective effect of OSA treatment on aortic root dilatation should monitor nocturnal diastolic BP.