chez l'enfant
De nombreuses études ont été publiées chez l'adulte rapportant des profils proétomiques différents chez l'adulte apnéique et non apnéique : la revue de Feliciano et al. en 2015 [49] conclut à une hétérogénéité métho
dologique et de résultats qui empêchent tout transfert en routine.
En 2009, Gozal et al. ont rapporté une étude de pro
téomique utilisant des électrophorèses 2D et l'étude en spectrométrie de masse. La concentration urinaire de cer
taines protéines semble être différente dans la population des enfants apnéiques et non apnéiques : uromoduline, urocortine3, orosomucoïde1 et kallicréine [50–52]. Cette approche reste l'apanage d'une seule équipe et mérite des travaux complémentaires.
Conclusion
Si l'on veut tendre vers « une gestion du risque le plus tôt possible dans la vie des individus » du syndrome métabolique, il faut donc aborder de front un grand nombre de paramètres, comportements et pathologies.
Tableau 6.2 Risque d'obésité et temps de sommeil*
Durée de sommeil par rapport aux recommandations Excessivement
1,92 1,15–3,20 1,60 1,22–2,10 1,43 1,07–1,91
* D'après Chen X, Beydoun MA, Wang Y. Is sleep duration associated with childhood obesity ? A systematic review and meta-analysis. Obesity 2008 ; 16(2) : 265-74.
RR : risque relatif ; IC : intervalle de confiance.
6. Syndrome métabolique de l'enfant et médecine du sommeil
L'effort de chacun dans son domaine est déjà porteur de progrès et l'intégration physiologique du syndrome peut faire espérer un effet domino positif. Cette physio
pathologie complexe comporte aussi le risque de l'échec
thérapeutique en cas d'action trop spécifique ou peu coordonnée. Le caractère transversal, multidisciplinaire de la future « somnologie » répond à cette nécessité (figure 6.3).
Bien-être psychosocial
Homéostasie glucidique
Inflammation prolifération
adipocyte
Leptine Ghréline
Cortisol
Inactivité physique
Prise de poids
Obésité
Altération tolérance glucose
Altération balance énergétique
Hormones métaboliques et
neuroendocrines Comportement
alimentaire sucres graisses
SAOS Privation chronique de
sommeil/fragmentation
Mode de vie comportement
Environnement TV, hygiène de
sommeil
Prédispositions génétiques
Statut socioéconomique
Figure 6.3
Privation de sommeil : obésité et syndrome d'apnées–hypopnées obstructives du sommeil (SAHOS).
Source : adapté de Knutson KL, Van Cauter E. Associations between sleep loss and increased risk of obesity and diabetes. Ann N Y Acad Sci. 2008 ; 1129 : 287–304.
Syndrome d'apnées–hypopnées obstructives du sommeil de l'enfant
46
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Chapitre
Syndrome d'apnées-hypopnées obstructives du sommeil de l'enfant
© 2016, SFORL. Publié par Elsevier Masson SAS. Tous droits réservés
7
PLAN DU CHAPITRE
Enregistrements de type 1 et 2 :
polysomnographie 50
Enregistrements de type 3 :
polygraphie ventilatoire 56
Enregistrements de type 4 59
Nouvelles méthodes 60
Conclusion 60