Contributions Sommeil Neurophysiologie & autres ..

Spironolacton restore sleep architecture case report

Didier Cugy — 2019-07-29T10:48:05Z

Observation :
Since more 15 years Mrs N. VER was followed for a primary sleep hypersomnia. Her first complaint in 2003 is daytime somnolence (Epworth Score of 20)
Clinical investigations with PSG and MSLT were performed in 2003, 2004, 2010, 2014 and 02-2018. Mean latency was higher than 8min in 2003, 2004 and 2018 but lower in 2010, 2014. HLA phenotype is DR11/DR13 DQ03/03. PSG show on all polysomnography a sleep fragmentation (30 arousal), a reduction of rem sleep duration (8-10% of TST). All ECG signal show an ST elevation.
Mrs VER present comorbidity (Hypertension, Bipolar disease). Cardiologist introduce at the begining of 2018 Spironolacton
A polysomnography was performed in 09-2018. Very surprisingly, there is an improvement in sleep architecture with a significant reduction in the number of arousal (7 / h) and an increase in the duration of REM sleep (21% of TST).
Discussion :
Animal studies report than mineralocorticoid receptor blockers (MRB) restore 24-h blood pressure circadian rhythm (1), human studies show MRB improve bloop pressure circadian rythm (2) it was also reported in other pathologies like fibromyalgia than MBR improve sleep efficiency, sleep endocrine studies (4) show a reduction of nocturnal plasma GH maxmimum after sleep onset. Improvment of chronobiological rythms appear to be an effect of MRB. It is necessary to complete this case report with further studies.
Bibliography :
(1) Yan Zhang & al, Eplerenone restores 24-h blood pressure circadian rhythm and reduces advanced glycation end- products in rhesus macaques with spontaneous hypertensive metabolic syndrome - DOI : 10.1038/srep23957Yan Zhang1,3,
(2) Yang & al, Effect of spironolactone on patients with resistant hypertension and obstructive sleep apnea - CLINICAL AND EXPERIMENTAL HYPERTENSION 2016, VOL. 38, NO. 5, 464–468 http://dx.doi.org/10.3109/10641963.2015.1131290
(3) Heinrich Wernze & al, Long-term efficacy of spironolactone on pain, mood, and quality of life in women with fibromyalgia : An observational case series - DOI : https://doi.org/10.1016/j.sjpain.2013.12.003
(4) Axel Steiger & al, Functional properties of Deoxycorticosterone and spironolactone : Molecular characterization
and effects on sleep-endocrine activity, J. Psychiatr Research,Vol 27, N°3 pp 275 284, 1993

Circannual variations of biological and clinical parameters observed from 204 293 healtcare checkups.

Didier Cugy — 2017-07-15T12:08:34Z

Materials and methods : We have a 204293 patient database (100701 women and 103592 men) from healtchare checkup since 2004 to 2017 integrating biological, clinical and ESS questionnaire. We search infra day (circannual effect) biological rhythm by averaging method after segmentation of population from sex and age. Datas are analyzed by using Multiple ANOVA.

Results : we found significal circannual effect for : - BMI p<0,001 (lower during autumn), Creatinin p =0,04 (higher during summer), Cholesterol p=0,04 (lower during summer). Some parameters were also highly influenced by aging and sex.

Discussion : Seasonal variations of cholesterol were reported by Kreindl & al (1). They report increase of LDL in winter and HDL in Summer. Our report agree with Kristal Bonneh & al (2) findings showing a maximum for cholesterol in winter and minimum in summer. We hypothesis to explain Circanual variations of creatinin and BMI by summer climate who allow more physical activity or by difference in food intake.

Conclusion : Database analysis is in agreement with report showing seasonnal/circannual variations of cholesterol. Observed results don't allow us following thesis whether changes are of environmental origin or in relation to a circannual endogenous rhythm

Bibliography :
1) [Seasonal variations in the lipid profile of apparently healthy young adults living in Santiago, Chile]. Arch Latinoam Nutr. 2014 Sep ;64(3):145-52.
2) Circannual variations in blood cholesterol levels. Chronobiol Int. 1993 Feb ;10(1):37-42.

Retrospective analysis of serum ferritin, ALAT and gammaGT reported to the typology "morningness / eveningness" assessed using the MEQ questionnaire.

Didier Cugy — 2015-07-05T13:52:29Z

The systematic use of self-questionnaires MEQ scale (1) during sleep consultation allow us to determine chronobiological type of patients : DET (definitely evening type), ET (evening type), NT (neither type), MT (morning type), DMT (definitely morning type). The use of a database containing all patient data (questionnaires, clinical, biology) allows us to analyse biological parameters according to the typologies .

Method :
We have a 6846 patient database (2854 women and 3892 men) integrating typology Morningness / eveningness evaluated using MEQ questionnaire. Inside this base 583 patients had ferritin assay, 571 ALAT and 583 Gamma GT. Withdrawals for bioassays ferritin ALAT and GAMMA GT were carried out in the usual way between 7am and 9am. Assays were reported by ANOVA with groups determined by the MEQ survey (DET, MET, NT, MMT, DMT). We also check the typology by versus average age.

Results :
It is identified significant differences between Average age, Ferritin levels (p <0.05) ALAT (p < 0.05) and gamma GT (p <0.05) in relation to the type (DM, MM, M, MS, DE) and sex (women are more evening type and men more morning type)

Discussion :
The interaction between the typology on physiological (sex, age) and biological parameters which are mainly linked to liver metabolism (Ferritin, ALAT, GGT) lets interrogate ourself on the interaction of the liver metabolism and the typology.
It is necessary to notice than the time of blood sampling is habitually fixed between 7 and 9am and than observed differences depending on the type could be directly related to the typology or to a phase effect in relation to circadian variations of the observed parameters.
It is very difficult to determine if the part of the observed effect is mainly in conjonction with typology, age or time of blood sampling.
In any case, it seems necessary to take into account the sex, age and/or the typology of the patient in terms of Morningness/eveningness for the interpretation of the normality of these biological parameters.

Bibliography :
(1) Taillard J & al ; Validation of Horne and Ostberg morningness-eveningness questionnaire in a middle-aged population of French workers ; J Biol Rhythms. 2004 Feb ;19(1):76-86.