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Prevalence of obstructive sleep apnea as assessed by polysomnography in psychiatric patients with sleep-related problems. Sleep Breath 2022; 26:1983-1991. [PMID: 35029795 DOI: 10.1007/s11325-022-02566-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Patients with psychiatric disorders often complain of sleep disturbances and are frequently suspected of obstructive sleep apnea (OSA). However, data regarding sleep problems evaluated by attended polysomnography (PSG) remain limited in this population. We analyzed the results of attended PSG from psychiatric patients with sleep-related problems to determine the prevalence and features of sleep disorders among this population. METHODS We retrospectively investigated the attended PSG results of patients with psychiatric disorders: major depressive disorder, bipolar disorder, neurodevelopmental disorder, schizophrenia, neurocognitive disorder, anxiety disorder, somatic symptom disorder. RESULTS Of 264 patients, 158 men (60%), mean age was 47 ± 19.9 years. More than half of the patients with major depressive disorder (62%), bipolar disorder (70%), schizophrenia (58%), neurocognitive disorders (55%), and somatic symptom disorder (56%) had OSA. Among the psychiatric patients with OSA, 62% of these patients had moderate to severe OSA. The risk factors for OSA were snoring, male, age, and body mass index. The presence of OSA was not associated with the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale score, or benzodiazepine, antipsychotic, or antidepressant use. Other sleep disorders were insomnia (19%), central disorders of hypersomnia (8%), restless legs syndrome/periodic limb movement of sleep (8%), rapid eye movement sleep behavior disorder (7%), and central sleep apnea syndrome (3%). CONCLUSIONS PSG revealed that moderate to severe OSA was common in psychiatric patients with or without snoring. Subjective symptoms and psychotropics did not predict OSA. Therefore, PSG is needed to reveal sleep conditions in patients with psychiatric disorders.
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The Association between Use of Benzodiazepine Receptor Agonists and the Risk of Obstructive Sleep Apnea: A Nationwide Population-Based Nested Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189720. [PMID: 34574645 PMCID: PMC8467455 DOI: 10.3390/ijerph18189720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent upper airway collapse. Benzodiazepine receptor agonists (BZRAs) are associated with pharyngeal muscle relaxation, increased apnea duration, and hypoxia, which might worsen OSA. This study aimed to examine the association between the use of BZRAs and the risk of OSA. The study was conducted using data from the National Health Insurance Database of Taiwan between 2002 and 2011. We only included new users who were never exposed to any BZRAs and identified 1848 participants with OSA, and 1848 matched controls. A logistic regression model was used to determine the association between the use of BZRAs and the development of OSA. BZRA exposure was divided into usage patterns, dosage, duration, and pharmacokinetic class. We found an increased risk of OSA in current users and recent past users compared with distant past users. Patients with a higher cumulative dose of BZRAs were more likely to develop OSA compared to those with a lower cumulative dose. We found an increased risk of OSA in patients treated with BZRAs, especially for current users and those with higher cumulative doses. A reduced risk of OSA was found in Z-drug users compared with benzodiazepine users.
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Neeland IJ, Eliasson B, Kasai T, Marx N, Zinman B, Inzucchi SE, Wanner C, Zwiener I, Wojeck BS, Yaggi HK, Johansen OE. The Impact of Empagliflozin on Obstructive Sleep Apnea and Cardiovascular and Renal Outcomes: An Exploratory Analysis of the EMPA-REG OUTCOME Trial. Diabetes Care 2020; 43:3007-3015. [PMID: 33004464 PMCID: PMC7770278 DOI: 10.2337/dc20-1096] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To explore the effects of empagliflozin on the incidence of obstructive sleep apnea (OSA) and its effects on metabolic, cardiovascular (CV), and renal outcomes among participants with or without OSA in the EMPA-REG OUTCOME trial. RESEARCH DESIGN AND METHODS Participants with diabetes and CV disease were randomized to empagliflozin (10 and 25 mg) or placebo daily in addition to standard of care. OSA was assessed by investigator report using Medical Dictionary for Regulatory Activities version 18.0, and CV outcomes were independently adjudicated. Analyses were performed using multivariable-adjusted Cox regression models. RESULTS OSA was reported in 391 of 7,020 (5.6%) participants at baseline. Those with OSA were more likely to be male (83% vs. 71%) and to have moderate to severe obesity (BMI ≥35 kg/m2; 55% vs. 18%). Over a median of 3.1 years, empagliflozin had similar placebo-adjusted reductions in HbA1c, waist circumference, and systolic blood pressure, regardless of OSA status, but a larger effect on weight (adjusted mean ± SE difference at week 52: OSA vs. no OSA -2.9 ± 0.5 vs. -1.9 ± 0.1 kg). Incidence of 3-point major adverse CV events, CV death, heart failure hospitalization, and incident or worsening nephropathy in the placebo group was 1.2- to 2.0-fold higher for those with baseline OSA compared with those without. Empagliflozin significantly reduced the risk for outcomes regardless of OSA status (P-interaction all >0.05). Fifty patients reported a new diagnosis of OSA through 7 days after medication discontinuation, and this occurred less often with empagliflozin treatment (hazard ratio 0.48 [95% CI 0.27, 0.83]). CONCLUSIONS In EMPA-REG OUTCOME, participants with OSA had greater comorbidity and higher frequency of CV and renal events. Empagliflozin had favorable effects on risk factors and CV and renal outcomes regardless of preexisting OSA and may also reduce the risk for new-onset OSA.
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Affiliation(s)
- Ian J Neeland
- University Hospitals Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Bjorn Eliasson
- Department of Medicine, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nikolaus Marx
- Department of Internal Medicine I (Cardiology), RWTH University Hospital, Aachen, Germany
| | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale School of Medicine, Yale University, New Haven, CT
| | - Christoph Wanner
- Department of Medicine, Wuerzburg University Clinic, Wuerzburg, Germany
| | - Isabella Zwiener
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Brian S Wojeck
- Section of Endocrinology, Yale School of Medicine, Yale University, New Haven, CT
| | - Henry K Yaggi
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, CT
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Anthony N, Bourneau-Martin D, Ghamrawi S, Lagarce L, Babin M, Briet M. Drug-induced vitiligo: a case/non-case study in Vigibase ® , the WHO pharmacovigilance database. Fundam Clin Pharmacol 2020; 34:736-742. [PMID: 32246859 DOI: 10.1111/fcp.12558] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 02/06/2023]
Abstract
Vitiligo is a common depigmenting disorder ensuing the loss of epidermal melanocytes. It is a multifactorial disease with immunological, genetic and environmental factors including drug exposure. The purpose of the study was to investigate the drugs and therapeutic subclasses associated with vitiligo occurrence reported in VigiBase® , the WHO pharmacovigilance database. A case/non-case study was carried out by defining cases as vitiligo reports and non-cases as all other reports. The reporting odds ratio (ROR) was calculated for the 'suspected' drugs and drug classes according to ATC level 4. During the study period, 741 cases of vitiligo were registered. Mean age was 49 ± 20 years. The disproportionality analysis showed an association between vitiligo and pembrolizumab (ROR 116.9, 95% Confidence Interval (CI) 94.8, 144.3), nivolumab (ROR 22.6, 95% CI 15.8, 32.4), ipilimumab (ROR 41.7, 95% CI 25.0, 69.7), imiquimod (ROR 152.8, 95% CI 103.0, 226.7), adalimumab (ROR 3.8, 95% CI 2.5,5.8), infliximab (ROR 2.6, 95% CI 1.65, 4.01), alemtuzumab (ROR 27.8, 95% CI 17.6, 43.9), and ustekinumab (ROR 9.3, 95% CI 5.6, 15.6). Concerning the pharmacological classes ATC level 4, a significant association was found with monoclonal antibodies, interferons, selective immunosuppressants, TNF-alpha inhibitors, interleukin inhibitors, and topical antivirals. This study confirmed the expected associations between vitiligo and immune checkpoint inhibitors and strengthened the emerging signal about the association between vitiligo and imiquimod, TNF-alpha inhibitors and interferons. New signals were shown with selective immunosuppressants including alemtuzumab and interleukin inhibitors.
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Affiliation(s)
- Norah Anthony
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre hospitalo-Universitaire d'Angers, 4 rue larrey, 49100, Angers, France
| | - Delphine Bourneau-Martin
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre hospitalo-Universitaire d'Angers, 4 rue larrey, 49100, Angers, France
| | - Sarah Ghamrawi
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre hospitalo-Universitaire d'Angers, 4 rue larrey, 49100, Angers, France
| | - Laurence Lagarce
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre hospitalo-Universitaire d'Angers, 4 rue larrey, 49100, Angers, France
| | - Marina Babin
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre hospitalo-Universitaire d'Angers, 4 rue larrey, 49100, Angers, France
| | - Marie Briet
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre hospitalo-Universitaire d'Angers, 4 rue larrey, 49100, Angers, France.,Université d'Angers, Angers, France.,Laboratoire MitoVasc, UMR CNRS 6214 INSERM 1083, Angers, France
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Dumortier L, Bricout VA. Obstructive sleep apnea syndrome in adults with down syndrome: Causes and consequences. Is it a "chicken and egg" question? Neurosci Biobehav Rev 2020; 108:124-138. [DOI: 10.1016/j.neubiorev.2019.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/11/2019] [Accepted: 10/26/2019] [Indexed: 12/31/2022]
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Wang SH, Chen WS, Tang SE, Lin HC, Peng CK, Chu HT, Kao CH. Benzodiazepines Associated With Acute Respiratory Failure in Patients With Obstructive Sleep Apnea. Front Pharmacol 2019; 9:1513. [PMID: 30666205 PMCID: PMC6330300 DOI: 10.3389/fphar.2018.01513] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/10/2018] [Indexed: 01/05/2023] Open
Abstract
Aims: Obstructive sleep apnea (OSA) and insomnia commonly coexist; hypnotics are broadly prescribed for insomnia therapy. However, the safety of hypnotics use in OSA patients is unclear. We conducted a retrospective case-control study to investigate the risk of adverse respiratory events in hypnotics-using OSA patients. Methods: We obtained data from the Taiwan National Health Insurance Database from 1996 to 2013. The case group included 216 OSA patients with newly diagnosed adverse respiratory events, including pneumonia and acute respiratory failure. The control group included OSA patients without adverse respiratory events, which was randomly frequency-matched to the case group at a 1:1 ratio according to age, gender, and index year. Hypnotics exposure included benzodiazepines (BZD) and non-benzodiazepines (non-BZD). A recent user was defined as a patient who had taken hypnotics for 1–30 days, while a long-term user was one who had taken hypnotics for 31–365 days. Results: Multivariable adjusted analysis showed recent BZD use is an independent risk for adverse respiratory events (OR = 2.70; 95% CI = 1.15–6.33; P < 0.001). Subgroup analysis showed both recent and long-term BZD use increased the risk of acute respiratory failure compared to never BZD use (OR = 28.6; 95% CI = 5.24–156; P < 0.001, OR = 10.1; 95% CI = 1.51–67.7; P < 0.05, respectively). Neither BZD nor non-BZD use increased the risk of pneumonia in OSA patients. Conclusion: BZD use might increase the risk of acute respiratory failure in OSA patients.
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Affiliation(s)
- Sheng-Huei Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Shan Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-En Tang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hung-Che Lin
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsuan-Te Chu
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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Revol B, Jullian-Desayes I, Bailly S, Mallaret M, Tamisier R, Agier MS, Lador F, Joyeux-Faure M, Pépin JL. Baclofen and sleep apnoea syndrome: analysis of VigiBase, the WHO pharmacovigilance database. Eur Respir J 2018; 51:51/1/1701855. [PMID: 29326335 DOI: 10.1183/13993003.01855-2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/20/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Bruno Revol
- HP2 laboratory, Inserm U1042 unit, University Grenoble Alps, Grenoble, France.,EFCR laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France.,Pharmacovigilance Dept, Grenoble Alps University Hospital, Grenoble, France
| | - Ingrid Jullian-Desayes
- HP2 laboratory, Inserm U1042 unit, University Grenoble Alps, Grenoble, France.,EFCR laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Sébastien Bailly
- HP2 laboratory, Inserm U1042 unit, University Grenoble Alps, Grenoble, France.,EFCR laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Michel Mallaret
- Pharmacovigilance Dept, Grenoble Alps University Hospital, Grenoble, France
| | - Renaud Tamisier
- HP2 laboratory, Inserm U1042 unit, University Grenoble Alps, Grenoble, France.,EFCR laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Marie-Sara Agier
- Pharmacovigilance Dept, Tours University Hospital, Tours, France
| | - Frédéric Lador
- Sleep Laboratory and Division of Pulmonology, Dept of Medicine Specialties, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Joyeux-Faure
- HP2 laboratory, Inserm U1042 unit, University Grenoble Alps, Grenoble, France.,EFCR laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France.,These authors contributed equally to this work
| | - Jean-Louis Pépin
- HP2 laboratory, Inserm U1042 unit, University Grenoble Alps, Grenoble, France .,EFCR laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France.,These authors contributed equally to this work
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Gautier-Veyret E, Pépin JL, Stanke-Labesque F. Which place of pharmacological approaches beyond continuous positive airway pressure to treat vascular disease related to obstructive sleep apnea? Pharmacol Ther 2017; 186:45-59. [PMID: 29277633 DOI: 10.1016/j.pharmthera.2017.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete upper airway obstruction, occurring during sleep, leading to chronic intermittent hypoxia (IH), which harms the cardiovascular system. OSA is associated with both functional and structural vascular alterations that contribute to an increased prevalence of fatal and non-fatal cardiovascular events. OSA is a heterogeneous disease with respect to the severity of hypoxia, the presence of daytime symptoms, obesity, and cardiovascular comorbidities. Various clusters of OSA phenotypes have been described leading to more highly personalized treatment. The aim of this review is to describe the various therapeutic strategies including continuous positive airway pressure (CPAP), oral appliances, surgery, weight loss, and especially pharmacological interventions that have been evaluated to reduce vascular alterations in both OSA patients and preclinical animal models. Conventional therapies, predominantly CPAP, have a limited impact on vascular alterations in the presence of co-morbidities. A better knowledge of pharmacological therapies targeting IH-induced vascular alterations will facilitate the use of combined therapies and is crucial for designing clinical trials in well-defined OSA phenotypes.
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Affiliation(s)
- Elodie Gautier-Veyret
- Univ. Grenoble Alpes, HP2, F-38041 Grenoble, France; INSERM U1042, 38041 Grenoble, France; Centre hospitalier Universitaire Grenoble Alpes, 38043 Grenoble, France.
| | - Jean-Louis Pépin
- Univ. Grenoble Alpes, HP2, F-38041 Grenoble, France; INSERM U1042, 38041 Grenoble, France; Centre hospitalier Universitaire Grenoble Alpes, 38043 Grenoble, France
| | - Françoise Stanke-Labesque
- Univ. Grenoble Alpes, HP2, F-38041 Grenoble, France; INSERM U1042, 38041 Grenoble, France; Centre hospitalier Universitaire Grenoble Alpes, 38043 Grenoble, France
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Montastruc F, Sommet A, Montastruc JL. Concomitant medications and obstructive sleep apnoea. Br J Clin Pharmacol 2017; 83:2315-2316. [DOI: 10.1111/bcp.13337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/19/2017] [Accepted: 05/25/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- François Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle Midi-Pyrénées, INSERM U 1027, CIC INSERM 1436; Faculté de Médecine de l'Université Paul-Sabatier et Centre Hospitalier Universitaire de Toulouse; France
| | - Agnès Sommet
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle Midi-Pyrénées, INSERM U 1027, CIC INSERM 1436; Faculté de Médecine de l'Université Paul-Sabatier et Centre Hospitalier Universitaire de Toulouse; France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle Midi-Pyrénées, INSERM U 1027, CIC INSERM 1436; Faculté de Médecine de l'Université Paul-Sabatier et Centre Hospitalier Universitaire de Toulouse; France
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Revol B, Jullian-Desayes I, Pepin JL, Joyeux-Faure M. Drugs and obstructive sleep apnoea. Br J Clin Pharmacol 2017; 83:2317-2318. [DOI: 10.1111/bcp.13361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 06/23/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Bruno Revol
- HP2 laboratory, Inserm U1042 unit; University Grenoble Alps; Grenoble France
- EFCR laboratory, Thorax and Vessels; Grenoble Alps University Hospital; Grenoble France
- Pharmacovigilance Department; Grenoble Alps University Hospital; Grenoble France
| | - Ingrid Jullian-Desayes
- HP2 laboratory, Inserm U1042 unit; University Grenoble Alps; Grenoble France
- EFCR laboratory, Thorax and Vessels; Grenoble Alps University Hospital; Grenoble France
| | - Jean-Louis Pepin
- HP2 laboratory, Inserm U1042 unit; University Grenoble Alps; Grenoble France
- EFCR laboratory, Thorax and Vessels; Grenoble Alps University Hospital; Grenoble France
| | - Marie Joyeux-Faure
- HP2 laboratory, Inserm U1042 unit; University Grenoble Alps; Grenoble France
- EFCR laboratory, Thorax and Vessels; Grenoble Alps University Hospital; Grenoble France
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