Abstract
Sleep disorders are frequent in the general population and their prevalence is higher in patients with metabolic or cardiovascular disorders, leading to repercucpapssions on quality of life and cardiovascular prognosis.Among these disorders, obstructive sleep apnea syndrome (OSA) is considered as an independent cardiovascular risk factor. The first line treatment for OSA is continuous positive airway pressure (CPAP), which improves the symptoms associated with OSA, in particular daytime sleepiness, but with effectiveness in preventing cardiovascular events remaining debated.The objectives of this thesis were on the one hand to improve the understanding of the physiopathological and clinical links between sleep disorders, including OSA, and cardiovascular diseases and on the other hand to specify the clinical and physiopathological impacts of different treatments of OSA.We provided some answers to the first objective by demonstrating that 1 / the presence of OSA was not associated with ventricular remodeling in patients with an acute myocardial infarction and that 2 / parameters indicating poor sleep, and in particular a decrease in total sleep time and the intake of drugs acting on the central nervous system, were associated with the occurrence of major cardiovascular events in patients with heart failure. Regarding the second objective, we demonstrated that an individualized 8-week exercise training program improved objectively assessed daytime sleepiness and the apnea hypopnea index in REM sleep, these two parameters being markers of the severity of OSA and being associated with cardiovascular risk.This work is part of a longer-term project that should provide some answers in order to move towards precision medicine in the definition and management of sleep-disordered breathing.