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Salles-Dias LP, Brandao-Rangel MAR, Cristina-Rosa A, Morais-Felix RT, Oliveira-Freitas S, Oliveira LVF, Moraes-Ferreira R, Bachi ALL, Coutinho ET, Frison CR, Abbasi A, Melamed D, Vieira RP. Functional analysis of airway remodeling is related with fibrotic mediators in asthmatic children. J Asthma 2024; 61:1284-1293. [PMID: 38577973 DOI: 10.1080/02770903.2024.2338862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/14/2024] [Accepted: 03/31/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Asthmatic children present variable degrees of airway inflammation, remodeling, and resistance, which correlate with disease control and severity. The chronic inflammatory process of the airway triggers airway remodeling, which reflects the degree of airway resistance. Pro-inflammatory and pro-fibrotic mediators are centrally involved in this process. OBJECTIVE To investigate whether the levels of pulmonary and systemic pro-inflammatory and pro-fibrotic mediators present a correlation with the resistance of the respiratory system and of the proximal and distal airways. METHODS 39 Asthmatic children (persistent mild and moderate) and 39 non-asthmatic children (both between 6 and 13 years old) were evaluated for anthropometric characteristics, lung function and mechanics, and pulmonary and systemic immune responses. RESULTS Asthmatic children showed an increased number of blood eosinophils (p < 0.04), basophils (p < 0.04), monocytes (p < 0.002) and lymphocytes (p < 0.03). In addition, asthmatic children showed impaired lung function, as demonstrated by FEV1 (p < 0.0005) and FEV1/FVC (p < 0.004), decreased total resistance of the respiratory system (R5Hz; p < 0.009), increased resistance of the proximal airways (R20Hz; p < 0.02), increased elastance (Z5Hz; p < 0.02) and increased reactance (X5Hz; p < 0.002) compared to non-asthmatic children. Moreover, the following inflammatory factors were significantly higher in asthmatic than non-asthmatic children: GM-CSF in the breath condensate (BC) (p < 0.0001) and in the serum (p < 0.0001); TGF-beta in the BC (p < 0.0001) and in the serum (p < 0.004); IL-5 in the BC (p < 0.02) and in the serum (p < 0.01); IL-4 in the serum (p < 0.0002). CONCLUSIONS Impulse oscillometry is a sensitive method to detect airway resistance in persistent mild and moderate asthmatic children, an event followed by increased levels of pro-inflammatory and pro-fibrotic mediators.
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Affiliation(s)
- Lucas P Salles-Dias
- Post-graduate Program in Bioengineering, Universidade Brasil, São Paulo, SP, Brazil
| | - Maysa A R Brandao-Rangel
- Post-graduate Program in Sciences of Human Movement and Rehabilitation, Federal University of São Paulo (UNIFESP), Santos, SP, Brazil
| | - Amanda Cristina-Rosa
- Post-graduate Program in Sciences of Human Movement and Rehabilitation, Federal University of São Paulo (UNIFESP), Santos, SP, Brazil
| | - Rayssa T Morais-Felix
- Post-graduate Program in Sciences of Human Movement and Rehabilitation, Federal University of São Paulo (UNIFESP), Santos, SP, Brazil
| | | | - Luis V F Oliveira
- Post-graduate Program in Human Movement and Rehabilitation and in Pharmaceutical Sciences, Evangelical University of Goias (UniEvangélica), Anápolis, GO, Brazil
| | - Renilson Moraes-Ferreira
- Post-graduate Program in Sciences of Human Movement and Rehabilitation, Federal University of São Paulo (UNIFESP), Santos, SP, Brazil
| | - Andre L L Bachi
- Post-graduation Program in Health Science, University of Santo Amaro, Rua Isabel Schmidt, São Paulo, SP, Brazil
| | - Elisa T Coutinho
- Post-graduate Program in Sciences of Human Movement and Rehabilitation, Federal University of São Paulo (UNIFESP), Santos, SP, Brazil
| | - Claudio R Frison
- Post-graduate Program in Sciences of Human Movement and Rehabilitation, Federal University of São Paulo (UNIFESP), Santos, SP, Brazil
| | - Asghar Abbasi
- Division of Respiratory & Critical Care Physiology & Medicine, Lundquist Institute for Biomedical Innovation at Harbor - UCLA Medical Center, Torrance, CA, USA
| | | | - Rodolfo P Vieira
- Post-graduate Program in Bioengineering, Universidade Brasil, São Paulo, SP, Brazil
- Post-graduate Program in Sciences of Human Movement and Rehabilitation, Federal University of São Paulo (UNIFESP), Santos, SP, Brazil
- Post-graduate Program in Human Movement and Rehabilitation and in Pharmaceutical Sciences, Evangelical University of Goias (UniEvangélica), Anápolis, GO, Brazil
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Tiotiu Cepuc A, Steiropoulos P, Novakova S, Nedeva D, Novakova P, Chong-Neto H, Fogelbach GG, Kowal K. Airway Remodeling in Asthma: Mechanisms, Diagnosis, Treatment, and Future Directions. Arch Bronconeumol 2024:S0300-2896(24)00367-3. [PMID: 39368875 DOI: 10.1016/j.arbres.2024.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Revised: 08/27/2024] [Accepted: 09/20/2024] [Indexed: 10/07/2024]
Abstract
Airway remodeling (AR) with chronic inflammation, are key features in asthma pathogenesis. AR characterized by structural changes in the bronchial wall is associated with a specific asthma phenotype with poor clinical outcomes, impaired lung function and reduced treatment response. Most studies focus on the role of inflammation, while understanding the mechanisms driving AR is crucial for developing disease-modifying therapeutic strategies. This review paper summarizes current knowledge on the mechanisms underlying AR, diagnostic tools, and therapeutic approaches. Mechanisms explored include the role of the resident cells and the inflammatory cascade in AR. Diagnostic methods such as bronchial biopsy, lung function testing, imaging, and possible biomarkers are described. The effectiveness on AR of different treatments of asthma including corticosteroids, leukotriene modifiers, bronchodilators, macrolides, biologics, and bronchial thermoplasty is discussed, as well as other possible therapeutic options. AR poses a significant challenge in asthma management, contributing to disease severity and treatment resistance. Current therapeutic approaches target mostly airway inflammation rather than smooth muscle cell dysfunction and showed limited benefits on AR. Future research should focus more on investigating the mechanisms involved in AR to identify novel therapeutic targets and to develop new effective treatments able to prevent irreversible structural changes and improve long-term asthma outcomes.
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Affiliation(s)
- Angelica Tiotiu Cepuc
- Department of Pulmonology, University Hospital Saint-Luc, Brussels, Belgium; Pole Pneumology, ENT, and Dermatology - LUNS, Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium.
| | - Paschalis Steiropoulos
- Department of Pulmonology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Silviya Novakova
- Department of Allergology, University Hospital "Sv. Georgi" Plovdiv, Bulgaria
| | - Denislava Nedeva
- Clinic of Asthma and Allergology, UMBAL Alexandrovska, Medical University Sofia, Sofia, Bulgaria
| | - Plamena Novakova
- Department of Allergy, Medical University Sofia, Sofia, Bulgaria
| | - Herberto Chong-Neto
- Division of Allergy and Immunology, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | | | - Krzysztof Kowal
- Department of Experimental Allergology and Immunology and Department of Allergology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
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Cerfeuillet V, Allimonnier L, Le Guellec S, Ménard L, Bokov P, Plantier L. Association of forced oscillation technique measurements with respiratory system compliance and resistance in a 2-compartment physical model. Respir Med Res 2023; 84:101027. [PMID: 37717385 DOI: 10.1016/j.resmer.2023.101027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND The forced oscillation technique (FOT) may be useful for diagnosis and follow-up of respiratory diseases. It is unclear how global or regional alterations in airway resistance (Raw) and lung compliance (CL) alter FOT measurements. METHODS A 2-compartment physical model of the respiratory system allowed to simulate variations in Raw, CL, and their heterogeneity during tidal breathing in an adult human. Five-Hz respiratory system resistance (Rrs5) and reactance (Xrs5), area of reactance (AX), resonance frequency (Fresp) and intrabreath variation in Rrs5 and Xrs5 were measured by FOT. Frequency dependance of resistance could not be studied in this model. Relationships between model characteristics (Raw, CL, and heterogeneity) and FOT measurements were explored by multiple regression. RESULTS Rrs5 and intrabreath variation in Rrs5 and Xrs5 strongly associated with model characteristics (R2=0.753, 0.5 and 0.658). Associations of Xrs5, AX, and Fresp with model characteristics were weak (R2=0.214, 0.349 and 0.076). Raw heterogeneity was the main determinant of Rrs5 (Coeff=0.594), AX (Coeff=0.566) and intrabreath variation in Rrs5 and Xrs5 (Coeff=0.586 and 0.732). Regional extremes in Raw strongly determined Rrs5 (Coeff=1.006). Xrs5 did not strongly associate with any model characteristic. CONCLUSION Raw heterogeneity and maximal regional Raw were the main determinants of FOT measurements, in particular Rrs5. Associations between CL and FOT measurements were weak.
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Affiliation(s)
- Valentin Cerfeuillet
- Centre d'étude des pathologies respiratoires / Inserm UMR1100, Université de Tours, Tours, France
| | - Laurine Allimonnier
- Centre d'étude des pathologies respiratoires / Inserm UMR1100, Université de Tours, Tours, France
| | - Sandrine Le Guellec
- Centre d'étude des pathologies respiratoires / Inserm UMR1100, Université de Tours, Tours, France
| | - Luke Ménard
- Centre d'étude des pathologies respiratoires / Inserm UMR1100, Université de Tours, Tours, France
| | - Plamen Bokov
- AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique -Centre du Sommeil - CRMR Hypoventilations alvéolaires rares, Paris, France; Université de Paris Cité, NSERM NeuroDiderot, F-75019, Paris, France
| | - Laurent Plantier
- Centre d'étude des pathologies respiratoires / Inserm UMR1100, Université de Tours, Tours, France; Service de Pneumologie et Explorations Fonctionnelles Respiratoires, CHRU de Tours, Tours, France.
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Lu D, Yu Q, Chen L, Liao Q, Lan J, Chen SB, Wang C, Zeng W, Wu L, Fan C, Lu P, Yu H. HRCT quantitative analysis of airway remodeling and airway trapping in the small airway asthma phenotype and its correlation with pulmonary function. J Asthma 2023; 60:32-42. [PMID: 34962447 DOI: 10.1080/02770903.2021.2023821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We aimed to explore whether large airway remodeling and small airway structural changes exist in subjects with small airway asthma phenotype and to evaluate the relationships between quantitative high-resolution computed tomography (qHRCT) parameters and lung function. METHODS We enrolled 15 subjects with small airway asthma phenotype and 18 healthy controls. The two groups were matched by age, sex and body square area (BSA) with propensity score matching (PSM). Pulmonary function and qHRCT parameters [wall thickness (WT), wall area (WA), lumen area (LA), wall area percentage (WA%) of the 4th-6th generations in the right upper lobe apical segmental bronchus (RB1), adjusted by BSA, WT/BSA, WA/BSA, and LA/BSA, relative volume change -860 HU to -950 HU (RVC-860 to -950) and the expiration to inspiration ratio of mean lung density (MLDE/I)) were compared between the groups. Correlation analysis was employed to assess the relationship between qHRCT parameters and pulmonary function. RESULTS The small airway asthma phenotype had significantly higher WA%, RVC-860 to -950 and MLDE/I and lower LA/BSA than the healthy control. Additionally, we found moderate to strong correlations between impulse oscillation (IOS) indices and WA6% and WT6/BSA. No significant correlation was found between bronchial parameters and air trapping parameters (p > 0.05). CONCLUSIONS Combining physiological tests with imaging approaches can lead to better evaluation of small airway disfunction (SAD) in asthmatic patients. Additionally, despite nonexistent airflow obstruction in patients with small airway asthma phenotype, large airway remodeling and small airway structural changes may appear simultaneously in the early stage of disease.
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Affiliation(s)
- Dongzhu Lu
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qing Yu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lichang Chen
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qiannuan Liao
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Junkang Lan
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shu-Bing Chen
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Cuilan Wang
- Department of Pulmonary and Critical Medicine, Shenzhen Hospital of Southern Medical University, Southern Medical University, Shenzhen, China
| | - Wenyi Zeng
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lingling Wu
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chaofan Fan
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Peifeng Lu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Huapeng Yu
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Novel Lung Growth Strategy with Biological Therapy Targeting Airway Remodeling in Childhood Bronchial Asthma. CHILDREN 2022; 9:children9081253. [PMID: 36010143 PMCID: PMC9406359 DOI: 10.3390/children9081253] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022]
Abstract
Anti-inflammatory therapy, centered on inhaled steroids, suppresses airway inflammation in asthma, reduces asthma mortality and hospitalization rates, and achieves clinical remission in many pediatric patients. However, the spontaneous remission rate of childhood asthma in adulthood is not high, and airway inflammation and airway remodeling persist after remission of asthma symptoms. Childhood asthma impairs normal lung maturation, interferes with peak lung function in adolescence, reduces lung function in adulthood, and increases the risk of developing chronic obstructive pulmonary disease (COPD). Early suppression of airway inflammation in childhood and prevention of asthma exacerbations may improve lung maturation, leading to good lung function and prevention of adult COPD. Biological drugs that target T-helper 2 (Th2) cytokines are used in patients with severe pediatric asthma to reduce exacerbations and airway inflammation and improve respiratory function. They may also suppress airway remodeling in childhood and prevent respiratory deterioration in adulthood, reducing the risk of COPD and improving long-term prognosis. No studies have demonstrated a suppressive effect on airway remodeling in childhood severe asthma, and further clinical trials using airway imaging analysis are needed to ascertain the inhibitory effect of biological drugs on airway remodeling in severe childhood asthma. In this review, we describe the natural prognosis of lung function in childhood asthma and the risk of developing adult COPD, the pathophysiology of allergic airway inflammation and airway remodeling via Th2 cytokines, and the inhibitory effect of biological drugs on airway remodeling in childhood asthma.
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Abstract
PURPOSE OF REVIEW 'Biomarkers of remodeling' represent a loose collection of features referring to several biological adaptations of the lung to cope with stressing factors. In addition, remodel-'ing' infers a dynamic process that would require a spatiotemporal resolution. This review focuses on different aspects of remodeling in pediatric and adult care. RECENT FINDINGS This review will cover aspects of pediatric remodeling, adult remodeling and techniques and procedures to adequately assess remodeling across different age spectra. In pediatrics, the onset and first features of remodeling are discussed and the continuation into adolescence is addressed. For adults, this review addresses predominant features of remodeling throughout the adult life span and whether there are currently interventions available to treat or reverse remodeling. SUMMARY The term 'remodeling' is often referred to via biomarkers that reflect the endstage of a process, although it rather reflects a continuous process starting in childhood and progressing to all age-levels in patients with asthma. Hence, only few biomarkers or surrogates are able to 'capture' its spatiotemporal component, and hardly any are ready for routine use in clinical practice. Given the clinical impact of the remodeling processes, new biomarkers are needed to adequately treat patients with asthma and objectively monitor treatment response beyond symptom control and lung function.
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Zhang J, Dong L. Status and prospects: personalized treatment and biomarker for airway remodeling in asthma. J Thorac Dis 2020; 12:6090-6101. [PMID: 33209441 PMCID: PMC7656354 DOI: 10.21037/jtd-20-1024] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Airway remodeling, as a major characteristic of bronchial asthma, is critical to the progression of this disease, whereas it is of less importance in clinical management. Complying with the current stepwise treatment standard for asthma, the choice of intervention on the clinical status is primarily determined by the patient’s treatment response to airway inflammation. However, a considerable number of asthmatic patients, especially severe asthmatic subjects, remain uncontrolled though they have undergone fortified anti-inflammation treatment. In the past few years, a growing number of biologics specific to asthma phenotypes have emerged, bringing new hope for patients with refractory asthma and severe asthma. While at the same time, the effect of airway remodeling on asthma treatment has become progressively prominent. In the era of personalized treatment, it has become one of the development directions for asthma treatment to find reliable airway remodeling biomarkers to assist in asthma phenotypes classification, and to further combine multiple phenotypes to accurately treat patients. In the present study, the research status of airway remodeling in asthma is reviewed to show the basis for classifying and treating such disease. Besides, several selected airway remodeling biomarkers and possibility to use them in individual treatment are discussed as well. This study considers that continuously optimized mechanisms and emerging biomarkers for airway remodeling in the future may further support individual therapy for asthma patients.
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Affiliation(s)
- Jintao Zhang
- Department of Respiratory and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liang Dong
- Department of Respiratory and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Bokov P, Bafunyembaka G, Medjahdi N, Bernard A, Essalhi M, Houdouin V, Peiffer C, Delclaux C. Cross-sectional phenotyping of small airway dysfunction in preschool asthma using the impulse oscillometry system. J Asthma 2020; 58:573-585. [PMID: 31958254 DOI: 10.1080/02770903.2020.1719133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective. Asthma is a chronic inflammatory airway disorder known to induce small airways dysfunction (SAD). It is important to develop tools to assess the presence and extent of SAD in daily clinical practice. An Impulse Oscillometry System (IOS) might detect SAD, but the validity of the underlying model (serial Resistive airway and Compliant tissue model: RC model) in diseased lungs remains questionable.Methods. Our objective was to evaluate the usefulness of parameters obtained from six electrical circuit models that were fitted to the measurements of impedance obtained with IOS in asthmatic children characterized by an abnormal lung function defined by an increased baseline interrupter resistance (Rint, z-score > +1.645).Results. The six models were tested in 102 asthmatic children (median age: 5.5 years). Two models allowed the description of 92/102 (90%) children: 74 by the extended RIC model (central and peripheral Resistance, Inertance and peripheral airway Compliance) and 18 by the Mead1969 model (extended RIC plus lung compliance). Thus, peripheral airway compliance and resistance were essential to describe lung function abnormalities of these asthmatic children. Parenchyma impairment (increased lung compliance) which was responsive to salbutamol was present in 18% of asthmatic children. After salbutamol, peripheral airway resistance decreased while peripheral airway compliance increased, arguing for asthma-related SAD. R5-20Hz independently correlated with the two latter parameters but was increased in two thirds of children with increased Rint only.Conclusion. Additional modeling of IOS results can be a reliable tool to assess the presence and extent of SAD in young asthmatic children.
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Affiliation(s)
- Plamen Bokov
- Service de Physiologie Pédiatrique, Centre Pédiatrique Des Pathologies du Sommeil, AP-HP, Hôpital Robert Debré, Paris, France.,Equipe NeoPhen, INSERM co-Tutelle, Université de Paris, UMR1141, Paris, France
| | - Gabriel Bafunyembaka
- Service de Physiologie Pédiatrique, Centre Pédiatrique Des Pathologies du Sommeil, AP-HP, Hôpital Robert Debré, Paris, France
| | - Noria Medjahdi
- Service de Physiologie Pédiatrique, Centre Pédiatrique Des Pathologies du Sommeil, AP-HP, Hôpital Robert Debré, Paris, France
| | - Agnès Bernard
- Service de Physiologie Pédiatrique, Centre Pédiatrique Des Pathologies du Sommeil, AP-HP, Hôpital Robert Debré, Paris, France
| | - Mohamed Essalhi
- Service de Physiologie Pédiatrique, Centre Pédiatrique Des Pathologies du Sommeil, AP-HP, Hôpital Robert Debré, Paris, France
| | - Véronique Houdouin
- Hôpital Robert Debré, AP-HP, Unité de Pneumologie Pédiatrique, Paris, France.,INSERM co-Tutelle, Université de Paris, UMR1149, Paris, France
| | - Claudine Peiffer
- Service de Physiologie Pédiatrique, Centre Pédiatrique Des Pathologies du Sommeil, AP-HP, Hôpital Robert Debré, Paris, France
| | - Christophe Delclaux
- Service de Physiologie Pédiatrique, Centre Pédiatrique Des Pathologies du Sommeil, AP-HP, Hôpital Robert Debré, Paris, France.,Equipe NeoPhen, INSERM co-Tutelle, Université de Paris, UMR1141, Paris, France
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