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Sleep apnea syndrome occurs when, during sleep, breathing stops for 10 seconds or longer, with an index of 5 times or more an hour. It is clinically characterized by loud snoring at night, continuous or interrupted by pauses followed by loud breathing. Sleep is fitful, broken by arousals, and yields little rest. There is daytime excessive sleepiness with repeated involuntary falling asleep, often unknown by the subject. In this article, we describe an observation of central sleep apnea syndrome in a female patient receiving an opiate replacement therapy. An analysis of the before and after methadone withdrawal polysomnograhic tracing was done for this patient. This diagnosis etiology and physiopathology are critically approached. Clinicians should be careful in treating induced sleep disorders in such patients. Prescribing benzodiazepines during an opiate withdrawal of the methadone type is not recommended when central apnea occurs.

Position du problème: Le syndrome d'apnées du sommeil se définit par la survenue, pendant le sommeil, d'arrěts respiratoires de durée supérieure ou égale à 10 secondes, selon un index supérieur ou égal à 5 par heure. Cliniquement, il se caractérise par la présence de ronflements nocturnes sonores continus ou entrecoupés de pauses avec reprise respiratoire bruyante. Le sommeil est agité, entrecoupé d'éveils, peu reposant. Il existe une hypersomnolence diurne avec présence d'endormissements involontaires répétés et souvent méconnus par le sujet. Description clinique: Dans cet article, une observation de syndrome d'apnées du sommeil d'origine centrale chez une patiente en thérapeutique de substitution par opiacés est décrite. Méthodologie: Une analyse du tracé polysomnographique avant et après sevrage de méthadone est réalisée chez cette patiente. Discussion: L'étiologie et la physiopathologie de ce diagnostic font l'objet d'une approche critique. Le rappel d'une attention nécessaire de la part du clinicien face à de tels patients dans le cadre du traitement de troubles du sommeil induits est posé. Conclusion: La présence d'apnées centrales est une contre-indication à la prescription de benzodiazépines durant le sevrage d'opiacés de type méthadone.

Christian Dina, Nabila Bouatia-Naji, Xavier Jeunemaitre and colleagues from the Leducq Transatlantic MITRAL Network report the results of a genome-wide association study of nonsyndromic mitral valve prolapse. They identify six susceptibility loci and provide functional evidence implicating LMCD1 and TNS1 as genes influencing mitral valve development. Nonsyndromic mitral valve prolapse (MVP) is a common degenerative cardiac valvulopathy of unknown etiology that predisposes to mitral regurgitation, heart failure and sudden death 1 . Previous family and pathophysiological studies suggest a complex pattern of inheritance 2 , 3 , 4 , 5 . We performed a meta-analysis of 2 genome-wide association studies in 1,412 MVP cases and 2,439 controls. We identified 6 loci, which we replicated in 1,422 cases and 6,779 controls, and provide functional evidence for candidate genes. We highlight LMCD1 (LIM and cysteine-rich domains 1), which encodes a transcription factor 6 and for which morpholino knockdown of the ortholog in zebrafish resulted in atrioventricular valve regurgitation. A similar zebrafish phenotype was obtained with knockdown of the ortholog of TNS1 , which encodes tensin 1, a focal adhesion protein involved in cytoskeleton organization. We also showed expression of tensin 1 during valve morphogenesis and describe enlarged posterior mitral leaflets in Tns1 −/− mice. This study identifies the first risk loci for MVP and suggests new mechanisms involved in mitral valve regurgitation, the most common indication for mitral valve repair 7 .