Objectif Évaluer la performance diagnostique d’un dispositif numérique basé sur smartphone, utilisant un algorithme d’intelligence artificielle (IA) pour estimer l’indice d’apnées-hypopnées (IAH) et classer la sévérité du SAHOS, en comparaison à la polysomnographie (PSG) de référence, dans le cadre d’une étude multicentrique européenne. Méthodes Étude prospective comparative menée dans 9 centres hospitalo-universitaires en France, Allemagne et Espagne, incluant des adultes pour lesquels une PSG était indiquée en pratique courante, quelle qu’en soit la raison. Le smartphone, fixé au thorax par une bande adhésive, enregistrait simultanément via une application dédiée les signaux de la centrale inertielle et du microphone. L’algorithme d’IA traitait ces données pour estimer l’IAH. La lecture des PSG était centralisée, en aveugle des sorties du dispositif, selon les recommandations AASM 2023. Résultats Sur 491 inclusions, 295 enregistrements exploitables ont été analysés à ce jour. L’âge moyen était de 47±15 ans, l’IMC de 28±6kg/m2 et 53 % étaient des hommes (Fig. 1). L’IAH médian de référence était 13,8 événements/h (IQR : 6,0–26,6) : 58 normaux, 100 légers, 77 modérés et 60 sévères. La corrélation entre l’IAH estimé par l’IA du smartphone et celui mesuré par PSG était élevée (r=0,89). Pour un IAH≥15 événements/heure, la sensibilité était de 87 % (IC95 % : 82–93), la spécificité de 77 % (71–84), la valeur prédictive positive (VPP) de 77 % (71–83) et la valeur prédictive négative (VPN) de 88 % (82–93). Pour un IAH≥30, la sensibilité était de 84 % (73–91), la spécificité de 92 % (89–95), la VPP de 74 % (63–84) et la VPN de 96 % (93–98). Conclusion Un smartphone utilisant l’intelligence artificielle appliquée aux signaux inertiels et acoustiques thoraciques permet de détecter ou d’éliminer un SAHOS modéré à sévère avec de bonnes performances diagnostiques. L’analyse complète des données sur l’ensemble des sujets de l’étude est en cours et affinera ces résultats, tandis qu’une étude complémentaire en ambulatoire, menée de façon concomitante, fournit déjà des résultats intermédiaires qui valident l’approche en conditions de vie réelle. Enfin, une évaluation médico-économique déterminera dans quelle mesure ce dispositif innovant peut améliorer l’accès au diagnostic et fluidifier le parcours patient.

obstructive sleep apnea is underdiagnosed due to limited access to polysomnography (PSG). We aimed to assess the performances of Apneal®, an application recording sound and movements thanks to a smartphone’s microphone, accelerometer and gyroscope, to estimate patients’ apnea-hypopnea index (AHI). monocentric proof-of-concept study with a first manual scoring step, then automatic detection of respiratory events from recorded signals using a sequential deep-learning model (version 0.1 of Apneal® automatic scoring of respiratory events, end 2022), in adult patients. 46 patients (women 34

Background: Clinical trials have demonstrated the effectiveness of biologics in treating chronic rhinosinusitis with nasal polyps (CRSwNP). However, real-world evidence regarding patient outcomes and predictors of clinical response remains limited. Methodology: In this multicentric 18-month follow-up study, 326 adult patients who initiated biologic therapy for severe uncontrolled CRSwNP were included. Patient characteristics, including clinical and inflammatory markers, and comorbidities were collected at baseline and at 3, 6, 12, and 18 months of follow-up. We examined success rates based on current guidelines and identified potential factors associated to clinical response at 6 months. Results: We observed a significant decrease of Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score (interquartile range) of 60.5 (47-74) at baseline to 26.0 (11-41) at 3 months. A significant decrease of nasal symptoms and endoscopic nasal polyp score was observed at 3 months. After 6 months of biologic treatment, 59% of patients were classified as excellent responders according to the EUFOREA-EPOS 2023 criteria. Multivariate analysis revealed a suggestive association between baseline eosinophil blood count, type of biologic and an excellent response at 6 months. Conclusions: This real-world study confirms the effectiveness of biologics as an add-on therapy in patients with severe uncontrolled CRSwNP. Biologics lead to rapid and sustained improvement in clinical symptoms. A significant proportion of patients exhibit an excellent response, with no need for systemic corticosteroids.

PURPOSE:Amyloidosis is a multi-systemic disease with a poor prognosis. We hypothesized that amyloid proteins could deposit along the olfactory and gustatory systems and cause olfactory and gustatory impairment. The objective was to assess the prevalence of olfactory and gustatory disorders in a population of patients diagnosed with cardiac amyloidosis (CA). METHODS:CA patients from three amyloid subtypes (hereditary or wild-type transthyretin (ATTRv and ATTRwt) and light chain (AL)) and a control group of patients with chronic non-amyloidotic heart failure were enrolled prospectively in this case-control study. Nasal endoscopy, olfactory and gustatory questionnaires, "shortened Sniffin' Sticks" test (sSST) and Taste Band Strips test were performed. RESULTS:Thirty-eight CA patients (mean age of 80.8 +/- 8.6 years; 65.8 % males) and 13 control patients (mean age of 63.2 +/- 16.4 years; 53.8 % males) were included. The mean total score on the sSST for CA patients was significantly lower than that of the control group (15.4±6.2 vs 20.3 +/- 5.3, respectively, p = 0.02). Five out of 38 (13.1 %) CA patients were complaining of dysosmia compared to 3/13 (23.1 %) patients in the control group. Taste impairment was noted in 24/37 (64.9 %) CA patients vs 6/12 (50 %) patients in the control group (p > 0.05). CONCLUSION:This study comparing olfactory function of CA patients to chronic non-amyloidotic heart failure patients found that CA patients had significantly more olfactory impairments. Olfactory impairments could therefore be a new "red flag" that may help in early diagnosis and treatment of CA.

The new cross-disciplinary sleep medicine residency program (SMR) was created in 2017 in France and effectively implemented beginning in 2019. This first French specific sleep medicine residency program aims to train specialists in sleep medicine by complementing the knowledge from their original Specialized Studies Diplomas (SSD). The SMR lasts one year, offering comprehensive theoretical cross-disciplinary training and two practical internships of six months each. This study, based on a standardized questionnaire, aims to provide an initial assessment of this training and its impact on the professional careers of physicians who completed the SMR, five years after its implementation. The 42 participants in this study, with an average age of 30.3 years, primarily came from Paris (21.4%) and Strasbourg (16.7%), followed by Bordeaux, Dijon, Lille, and Marseille (7.1%), Besançon, Caen, and Toulouse (4.8%), and Angers, Grenoble, Lyon, Martinique, Montpellier, Nancy, Poitiers, and Reims (2.4%). Psychiatry and pulmonology were the most represented specialties among nine specialties, with the other seven being general medicine, neurology, geriatrics, otolaryngology, cardiology, occupational medicine, and public health. Regarding practical training, combined internships (paired with SSD internship) and internships outside the subdivision were popular, highlighting the importance of diversified training. The majority of participants (76.2%) had defended their medical thesis, with 66.7% of them related to sleep medicine. Additionally, 52.4% worked in a sleep center, and 81% had activities related to sleep medicine. For participants who did not have a permanent position (residents, junior doctors, chief residents, assistants), 72.5% considered a hospital career, and 45% considered an academic career. Regarding research trajectories, 69% of participants had already published at least one scientific article, and 38.1% held or were enrolled in a master's degree in research. The survey revealed a high level of satisfaction among participants (97.6%). In conclusion, the SMR is perceived as enriching and has a direct impact on the academic and professional career paths of its participants. These results highlight the significant role of this new innovating transversal training in the development of sleep medicine in France.

Background:Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition often associated with type 2 inflammation. While biologics are a promising treatment for patients with uncontrolled CRSwNP, real-world evidence is needed to optimize their use. The InternatioNal seVerE CRSwNP (INVENT) registry aims to consolidate data on biologic use in CRSwNP from local and national registries. This study describes the identification of mandatory and optional variables for inclusion in the INVENT registry using a modified Delphi process. Methods:A narrative literature review was performed to identify variables reported in real-world studies of biologic treatment for CRSwNP. A modified Delphi study was conducted between December 2024 and March 2025 involving 23 experts from Europe and Australia. Experts rated the clinical relevance of candidate variables in two online survey rounds using 9-point Likert scales. A positive response was defined as ≥70% of respondents rating a variable 7-9 and ≤15% rating it 1-3. Final agreement on mandatory and optional variables was reached through panel discussion. A validation survey was then conducted across registry centers to assess the feasibility of collecting the selected variables. Results:The Delphi process resulted in consensus on a core set of mandatory and optional variables across nine domains: demographics, medical history, previous and current biologic therapy, biomarkers, comorbidities, asthma, CRSwNP-specific outcomes, and follow-up variables. The validation survey confirmed that most mandatory variables were available or obtainable across participating centers, supporting the feasibility of data collection. Conclusions:This international Delphi study identified a consensus-based set of clinically-relevant and feasible variables for inclusion in the INVENT registry. The selected variables reflect current best practices in the management of CRSwNP and will enable robust comparisons of biologic effectiveness in real-world settings. The INVENT registry is well-positioned to inform treatment decisions, optimize use of biologics, and support a personalized approach to CRSwNP care.

Obstructive sleep apnea (OSA) is a common chronic condition that is growing in prevalence, associated with important comorbidities, and has several different phenotypes. Continuous positive airway pressure (CPAP) is the gold standard OSA treatment, but its effectiveness relies on consistent adherence, which can often be difficult to maintain. This narrative review discusses current challenges in the care pathways for CPAP therapy management in OSA, including fragmented care/lack of continuity, inadequate management of comorbidities, suboptimal implementation of digital medicine solutions, and existing reimbursement paradigms. Key tasks to be shared between the appropriate healthcare professionals and providers include technical CPAP follow-up (adherence, effectiveness, alert management), management of comorbidities, and multimodal non-invasive monitoring. What this looks like and who provides the different aspects of care should vary by OSA phenotype, ranging from simple follow-up in primary care (uncomplicated OSA with good CPAP adherence) to multidisciplinary specialist management (high-risk OSA with comorbidities), with regular reassessment to ensure continued alignment with the chosen care plan. In addition to better defining these pathways, how they are reimbursed also needs to be addressed. We suggest that there should be a multidisciplinary approach to symptom reduction and adherence, longitudinal assessment of patient-reported outcomes, and a focus on long-term cardiometabolic health as part of managing CPAP-treated patients with OSA. Facilitated by the appropriate use of digital technologies, these approaches should lead to more personalized care and greater patient engagement, resulting in better long-term adherence and treatment effectiveness. The ultimate goal should be to do better for less.

Ciliary dysfunction may result in chronic airway inflammation and infection causing injury and structural changes to the airway epithelium, leading to a variety of diseases, like bronchiectasis and primary diffuse chronic rhinosinusitis (CRS). Currently, ciliary beating analysis has mainly been studied through the measure of the ciliary beating frequency (CBF) by high-speed digital video microscopy (HSDV). However, a normal CBF has been described in different forms of primary and acquired ciliary dyskinesia.

Obstructive sleep apnea (OSA) is frequent and responsible for cardiovascular complications and excessive daytime sleepiness. It is underdiagnosed due to the difficulty to access the gold standard for diagnosis, polysomnography (PSG). Alternative methods using smartphone sensors could be useful to increase diagnosis. The objective is to assess the performances of Apneal, an application that records the sound using a smartphone's microphone and movements thanks to a smartphone's accelerometer and gyroscope, to estimate patients' AHI. In this article, we perform a monocentric proof-of-concept study with a first manual scoring step, and then an automatic detection of respiratory events from the recorded signals using a sequential deep-learning model which was released internally at Apneal at the end of 2022 (version 0.1 of Apneal automatic scoring of respiratory events), in adult patients during in-hospital polysomnography.46 patients (women 34 per cent, mean BMI 28.7 kg per m2) were included. For AHI superior to 15, sensitivity of manual scoring was 0.91, and positive predictive value (PPV) 0.89. For AHI superior to 30, sensitivity was 0.85, PPV 0.94. We obtained an AUC-ROC of 0.85 and an AUC-PR of 0.94 for the identification of AHI superior to 15, and AUC-ROC of 0.95 and AUC-PR of 0.93 for AHI superior to 30. Promising results are obtained for the automatic annotations of events.This article shows that manual scoring of smartphone-based signals is possible and accurate compared to PSG-based scorings. Automatic scoring method based on a deep learning model provides promising results. A larger multicentric validation study, involving subjects with different SAHS severity is required to confirm these results.

Introduction: Sickle cell disease (SCD) patients are particularly reactive to decreased partial pressure of oxygen. A moderate decrease in PO2 results in a significant desaturation of hemoglobin (Hb) due to the rightward shift of the Hb dissociation curve. Any repetition of hypoxic episodes, however brief, promotes hemoglobin S (HbS) polymerization and thus activates endothelial erythrocyte adhesion. Thus, permanent or intermittent hypoxemia may trigger vaso-occlusive complications (VOC). Some studies have demonstrated apneas or hypopneas due to upper airway obstruction in children with SCD. The aim of this study was to investigate the relationship between the occurrence of VOC (either nocturnal, priapism, or diurnal) and/or the presence of respiratory disorders, upper airway obstruction, or biological characteristics in adult SCD patients. Materials and Methods: This is a prospective, monocentric study provided by the Sickle Cell Referral Center, ENT specialists, and Functional Exploration Unit of the Henri Mondor University Hospital, approved by the Ethics Committee, and registered on clinical trials with ID NTC02539771. Patients were screened during routine visits at baseline and enrolled in three different groups (G). G1: patients with priapism and/or nocturnal crisis, G2: patients with diurnal VOCs requiring hospitalization in the last 6 months, G3: patients with few or no symptoms. All patients underwent clinical examination, blood sampling, polysomnography, ENT examination, rhinomanometry, rhinometry, respiratory function tests with arterial blood gas, baseline transcutaneous saturation, walk test, and cardiac ultrasound. Sleep apnea was classified depending on the Apnea- Hypopnea Index (AHI): 5-15(mild), 15-30 (moderate), and more than 30(severe). The number of VOCs, hospitalizations, and ICU admissions was collected. Statistical analyses were performed depending on the type of data (quantitative, qualitative or ordinal) using the most appropriate tests. Results: We included 107 patients (104 SS and 3 Sβ°thalassemia) in this study. The mean age was 41± 10 years and the BMI was 22.9± 5. Hydroxycarbamide was prescribed in 79% of all patients (84% in G1 and 58% in G3 (p=0.009)), and 10% were smokers. We found 52% of sleep apnea (30% of mild and 23% of moderate and severe). This rate was the same in the symptomatic (G1) and asymptomatic (G3) groups. Males were overrepresented in G1 due to the inclusion criteria of priapism in this group (p<0.009). Patients in G1 had more hospitalizations for VOC, more ACS and more ICU stays in the previous 12 months (p<0.0001). Hb level and leukocytes were significantly higher in G1(p=0.03), and no differences in Hb F, MCH, platelets, dense cells, and LDH was detected between G1 and G3. The total lung capacity, CO diffusing capacity (DLCO) and alveolar volume were all significantly reduced in G1 (p<0.001). On polysomnography, the differences were in stage 1 of sleep and its duration (p=0.02). Rhinomanometry and ENT examination showed differences in nasal obstruction in G1. In all patients with apnea, we compared patients with vs. without VOCs; those with VOCs had significantly higher WBC, platelets, and HB (p< 001), but there were no differences in Hb F, dense cells, and MCH. In patients with VOC and apnea, the depression scale (CES-D) was more important (p=0.03), and Respiratory-corrected DLCO significantly decreased (p=0.01). If we compare all patients with vs. without apnea, there were more mens, more snoring and a decreased basal PaO2, an anomaly in the functional respiratory tests and nasal obstruction in the group apnea. ( p<0.01) Conclusion: The incidence of sleep apnea is very high in SCD adult patients. In this study, the frequency of all types of apnea was 52% and moderate to severe apnea 23%. Symptomatic and asymptomatic patients had the same rate. Patients did not have a classic sleep apnea profile in terms of age and BMI. Altered functional respiratory tests and nasal obstruction are risk factors. Further analyses will be performed to determine risk and protective factors in adult SCD patients with sleep apnea and different profiles.

Background: Among all studies describing COVID-19 clinical features during the first wave of the pandemic, only a few retrospective studies have assessed the correlation between olfac-tory dysfunction (OD) and the evolution of disease severity. The main aim was to assess whether OD is a predictive factor of COVID-19 severity based on the patient’s medical management (outpa-tient care, standard hospital admission, and ICU admission). Methods: A national, prospective, mul-ticenter cohort study was conducted in 20 public hospitals and a public center for COVID-19 screen-ing. During the first wave of the pandemic, from 6 April to 11 May 2020, all patients tested positive for COVID-19 confirmed by RT-PCR underwent two follow-up ENT consultations within 10 days of symptom onset. The main outcome measures were the evolution of medical management (out-patient care, standard hospital admission, and ICU admission) at diagnosis and along the clinical course of COVID-19 disease. Results: Among 481 patients included, the prevalence of OD was 60.7%, and it affected mostly female patients (74.3%) under 65 years old (92.5%), with fewer comor-bidities than patients with normal olfactory function. Here, 99.3% (290/292) of patients with OD presented with non-severe COVID-19 disease. Patients reporting OD were significantly less hospi-talized than the ones managed as outpatients, in either a standard medical unit or an ICU. Conclu-sions: As regards the clinical course of COVID-19 disease, OD could predict a decreased risk of hospitalization during the first wave of the pandemic.

Excessive daytime sleepiness (EDS) is frequent among patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and can persist despite the optimal correction of respiratory events (apnea, hypopnea and respiratory efforts), using continuous positive airway pressure (CPAP) or mandibular advancement device. Symptoms like apathy and fatigue may be mistaken for EDS. In addition, EDS has multi-factorial origin, which makes its evaluation complex. The marketing authorization [Autorisation de Mise sur le Marché (AMM)] for two wake-promoting agents (solriamfetol and pitolisant) raises several practical issues for clinicians. This consensus paper presents recommendations of good clinical practice to identify and evaluate EDS in this context, and to manage and follow-up the patients. It was conducted under the mandate of the French Societies for sleep medicine and for pneumology [Société Française de Recherche et de Médecine du Sommeil (SFRMS) and Société de Pneumologie de Langue Française (SPLF)]. A management algorithm is suggested, as well as a list of conditions during which the patient should be referred to a sleep center or a sleep specialist. The benefit/risk balance of a wake-promoting drug in residual EDS in OSAHS patients must be regularly reevaluated, especially in elderly patients with increased cardiovascular and psychiatric disorders risks. This consensus is based on the scientific knowledge at the time of the publication and may be revised according to their evolution.

Obstructive sleep apnea (OSA) is a common condition that is increasing in prevalence worldwide. Untreated OSA has a negative impact on health-related quality of life and is an independent risk factor for cardiovascular diseases. Despite available data suggesting that cardiovascular risk might differ according to clinical phenotypes and comorbidities, current approaches to OSA treatment usually take a “one size fits all” approach. Identification of cardiovascular vulnerability biomarkers and clinical phenotypes associated with response to positive airway pressure (PAP) therapy could help to redefine the standard treatment paradigm. The new PAP-RES (PAP-RESponsive) algorithm is based on the identification of OSA phenotypes that are likely to impact therapeutic goals and modalities. The paradigm shift is to propose a simplified approach that defines therapeutic goals based on OSA phenotype: from a predominantly “symptomatic phenotype” (individuals with high symptom burden that negatively impacts on daily life and/or accident risk or clinically significant insomnia) to a “vulnerable cardiovascular phenotype” (individuals with comorbidities [serious cardiovascular or respiratory disease or obesity] that have a negative impact on cardiovascular prognosis or a biomarker of hypoxic burden and/or autonomic nervous system dysfunction). Each phenotype requires a different PAP therapy care pathway based on differing health issues and treatment objectives.

BACKGROUND:Chronic rhinosinusitis with nasal polyp (CRSwNP) is a typical type 2 inflammation involving interleukin (IL)-4 and IL-13. Dupilumab is a fully human monoclonal antibody targeting IL-4 receptor α subunit, thereby blocking signaling by both cytokines. Our hypothesis was that IL-4 and IL-13, by inducing a severe epithelial dysregulation, are involved in CRSwNP pathogenesis. This study aimed to evaluate the in vitro direct effect of IL-4, IL-13, and dupilumab on nasal epithelial functions. METHODS:Nasal polyps and control mucosa from 28 patients, as well as human nasal epithelial cells (HNEC) from 35 patients with CRSwNP were used. Three major epithelial functions were investigated: the epithelial barrier function (characterized by transepithelial electrical resistance measurements and tight junction protein expression), the ciliary motion (characterized by the ciliary beating efficiency index), and wound healing (characterized by the wound repair rate) under various stimulations (IL-4, IL-13, and dupilumab). The main outcome was a significant change in epithelial functions following exposure to IL-4, IL-13, and dupilumab for 48 h in the basal media. RESULTS:IL-4 (1, 10, and 100 ng/mL) but not IL-13 induced a significant decrease in occludin and zonula-occludens protein expression, ciliary beating efficiency, and wound repair rate in HNEC. Dupilumab (0.04 mg/mL) had no effect on HNEC and specifically restored all epithelial functions altered when cells were exposed to a 48-h IL-4 stimulation. CONCLUSION:Dupilumab, in vitro, restored epithelial integrity by counteracting the effect of IL-4 on the epithelial barrier (increased epithelial permeability, decreased ciliary beating efficiency, and decreased wound repair rate).

Objective: Mask choice is a key parameter in adaptation of ventilation through continuous positive airway pressure i.e. sleep apnea syndrome golden standard treatment. Two parameters of mask poor tolerance are cutaneous over pressure and unintentional leaks. The aim of this study was to create a test bench for masks to compare and localize cutaneous pressure areas, while monitoring leak flow. Methods: The test bench is made of an artificial head on which customs-made pressure sensors were placed. The artificial head and the sensors were developed with various additive manufacturing technologies. Sensors measured electrical capacity variations (%VC) positively correlated with cutaneous pressure. For 4 different masks, different harness tightening conditions were tested. A flowmeter was used to monitor total leaks. Results: When displayed on the nasal bridge of the artificial head, sensors detected tightening conditions: average of + 2%VC when harness was tight. This increase varied according to masks [1; 3]%VC and the sensors position [1.3; 2.2]%VC. Conclusion: This bench test allowed us to compare masks between them. Indeed it allowed us to localize and compare high pressure areas according to the mask. These data could be helpful for physicians and health professionals in the choice of the mask and for manufacturers in the development process