Sommeil du sujet âgé consultant en première ligne : A propos de 50

127
Sommeil du sujet âgé consultant en première ligne : A propos de 50 cas
# %#
+A??7;>6GEG<7FN9P5A@EG>F3@F7@BD7?;QD7>;9@7BDABAE6753E
$,-&!+!%!$.A>@V
Pré-requis: $7E FDAG4>7E 6G EA??7;> 6G EG<7F N9P EA@F 3EE7L
8DPCG7@FE&P3@?A;@E;>EEA@FEAGH7@FEAGE6;39@AEF;CGPE7F?3>BD;E
7@5:3D97
But : FG6;7D >7E 53D35FPD;EF;CG7E 6G EA??7;> 5:7L >7 EG<7F N9P
5A@EG>F3@F7@BD7?;QD7>;9@7
Méthodes : -@77@CGRF7FD3@EH7DE3>73PFPDP3>;EP7EGDG@P5:3@F;>>A@
3>P3FA;D7675;@CG3@F7EG<7FEN9PE673@E7FB>GE5A@EG>F3@F63@E>7
57@FD7 67 E3@FP 67 43E7 6\LL3:D3 7F 63@E G@ 534;@7F BD;HP 67 >3
?R?76P>P93F;A@
Résultats : $\;@6;576\788;535;FP6GEA??7;>PF3;F67$7EDPH7;>E
@A5FGD@7E PF3;7@F BDPE7@FE 5:7L  EG<7FE  $\;@EA?@;7
;@7JB>;CGP7678;@67@G;F3PFPD3BBADFP7B3DEG<7FE(3D?;
>7E EG<7FE 7@CGRFPE   A@F PFP 5A@E;6PDPE 5A??7 3K3@F 3G
?A;@EG@FDAG4>76GEA??7;>$3B>3;@F7;@EA?@;7PF3;FBDPE7@F75:7L
EG<7FE$3EA?@A>7@576;GD@77J57EE;H77FAG:KB7DEA?@;7
PF3;7@FBDPE7@F7E5:7L67EEG<7FE7EDA@8>7?7@FE@A5FGD@7EA@F
PFPD3BBADFPEB3DEG<7FE&7G8EG<7FEBDPE7@F3;7@F67E
B3GE7E D7EB;D3FA;D7E 3G 5AGDE 67 >7GD EA??7;> %3>9DP >3 9D3@67
8DPCG7@57 67E FDAG4>7E 6G EA??7;> 5:7L >7E EG<7FE 7@CGRFPE
E7G>7?7@F  EG<7FE B3D?; 7GJ  A@F 5A@EG>FP >7GD ?P675;@
FD3;F3@F BAGD 57 ?AF;8 (3D?; >7E B3F;7@FE 3K3@F G@ FDAG4>7 6G
EA??7;>  EG<7FE  BD7@3;7@F 67E :KB@AF;CG7E 6A@F  
B3D3GFA?P6;53F;A@
Conclusion : $7E FDAG4>7E 6G EA??7;> 5:7L >7 EG<7F N9P 3;@E; CG7
>\3GFA?P6;53F;A@ B3D >7E :KB@AF;CG7E EA@F 8DPCG7@FE 7F EAGE
6;39@AEF;CGPE !>E 67HD3;7@F RFD7 EKEFP?3F;CG7?7@F D75:7D5:PE 7@
5A@EG>F3F;A@67BD7?;QD7>;9@7
EA??7;>FDAG4>7E6GEA??7;>EG<7FN9P7@CGRF7H;7;>>;EE7?7@F
# %#
+>77B;@7>67D>K5A@EG>F3@FE;@F:78DA@F>;@74AGF53E7E
$,-&!+!%!$.A>@V
Background: +>77B6;EAD67DE;@F:77>67D>K3D75A??A@ AI7H7D
F:7K3D7A8F7@G@67D6;39@AE763@6BAAD>KEGBBADF76
;?,AEFG6KF:75:3D35F7D;EF;5EA8E>77B;@F:77>67D>K5A@EG>F3@F3F
F:78DA@F>;@7
Methods:  5DAEEE75F;A@3> EGDH7K I3E 5A@6G5F76 A@ 3 D3@6A?
E3?B>7 A8 8;8FK B7DEA@E 3976  K73DE 3@6 AH7D 5A@EG>F3@F ;@ F:7
57@F7DA843E;5:73>F:A8LL3:D33@6;@3BD;H3F7BD35F;57;@F:7E3?7
67>793F;A@
Results: ,:7E>77B788;5;7@5K;@67JI3E&;9:FF;?73I3=7@;@9E
I7D7BD7E7@F;@B7DEA@E-@7JB>3;@76>3F7@;9:F3I3=7@;@9
I3ED7BADF764KEG4<75FE
?A@9F:7D7EBA@67@FEI7D75A@E;67D76FA:3H73F>73EF
A@7E>77B6;EAD67D,:7EG4<75F;H75A?B>3;@FA8;@EA?@;3I3EBD7E7@F
;@  A8 EG4<75FE  J57EE;H7 63KF;?7 E>77B;@7EE 3@6AD
:KB7DEA?@;3I7D7BD7E7@F;@A8EG4<75FE&A5FGD@3>E@AD;@9I3E
D7BADF764KB7DEA@E&;@7EG4<75FE:36D7EB;D3FADK
B3GE7E 6GD;@9 E>77B 7EB;F7 F:7 :;9: ;@5;67@57 A8 E>77B 6;EAD67D
3?A@9F:7D7EBA@67@FEA@>KB7DEA@E3?A@9F:7?5A@EG>F76
F:7;D7@7D3>(D35F;F;A@7D8ADF:;ED73EA@?A@9B3F;7@FEI;F:E>77B
6;EAD67D  B7DEA@E  I7D7 F3=;@9 :KB@AF;5E 8DA? I:;5: 
4KE7>8?76;53F;A@
Conclusion: +>77B6;EAD67DE;@F:77>67D>K3EI7>>3EE7>8?76;53F;A@
I;F: :KB@AF;5E 3D7 5A??A@ 3@6 G@67D 6;39@AE76 ,:7K E:AG>6 47
EAG9:FEKEF7?3F;53>>K;@8DA@F>;@75A@EG>F3F;A@
+>77BE>77B6;EAD67D7>67D>KEGDH7K39;@9
*K?*38D38;!?Q@77@*A?6:3@7%3>7=>=3F74&7ED;@7D3?
*#'!$)%#
'#$%,&$#&%,,&$
ARTICLE ORIGINAL

R. Rafrafi - Sommeil du sujet âgé
128
@,G@;E;75A??7 63@E >7 ?A@67>7 @A?4D7 67 B7DEA@@7E
N9P7EE\355DASF3H75 >\3>>A@97?7@F 67 >\7EBPD3@57 67H;77F
>7EBDA9DQE67>3?P675;@7!>7EFB3EEP677@M
7@7F3FF7;@6D34;7@FUF7@7F7@
7FF73G9?7@F3F;A@5A@E;6PD34>767>3BDABADF;A@67E
EG<7FE N9PE 3 ;@5;FP M G@ B>GE 9D3@6 ;@FPDRF BAGD >7E
B3F:A>A9;7E6GQ?7 N976A@F>7EFDAG4>7E6GEA??7;>@
7887F >7 EA??7;> 5A??7 FAGF7 3GFD7 8A@5F;A@
B:KE;A>A9;CG7 E\3>FQD7 3H75 >\N97 7@ CG3@F;FP 7F 7@ CG3>;FP
BAGD67H7@;D?A;@EBDA8A@663@EE3EFDG5FGD7B>GE;@EF34>7
?A;@EDPB3D3F7GD7FB>GE8D39;>712;@E;67EEG<7FEN9PE
67B>GE673@EE7B>3;@6D3;7@FDP9G>;QD7?7@F67FDAG4>7E6G
EA??7;>[12&P3@?A;@E4;7@CG78DPCG7@FE>7EFDAG4>7E6G
EA??7;> 6G EG<7F N9P 67?7GD7@F EAGE 6;39@AEF;CGPE
9P@PD3>7?7@F?3>BD;E7@5:3D977FEAGH7@F?3>6;EF;@9GPE6G
H;7;>>;EE7?7@FB:KE;A>A9;CG7
FD3H7DE57FD3H3;>@AGE@AGEEA??7EBDABAEPE676P5D;D7>7
EA??7;>6GEG<7FN9P5A@EG>F3@F7@BD7?;QD7>;9@76\PH3>G7D
>38DPCG7@5767E6;88PD7@F7EB>3;@F7ED7>3F;H7E3GEA??7;>67
D75:7D5:7D>\7J;EF7@576\G@767?3@67EBP5;8;CG7 67EA;@E7F
7@8;@ 67 6PF7D?;@7D >3 DPBA@E7 6G 5ADBE ?P6;53> M 57FF7
67?3@67
PAT I E N T S E T M E T H O D E S
-@7 PFG67 FD3@EH7DE3>7 3 PFP ?7@P7 63@E G@7 6P>P93F;A@ 6G
9D3@6,G@;E>>73;@5>GEB7DEA@@7EN9P7E67B>GE67
3@E5A@EG>F3@F7@?P675;@7 9P@PD3>7 6\G@6;EB7@E3;D7>A53>
B7DEA@@7E7F6\G@534;@7FBD;HP67>3?R?76P>P93F;A@
 B7DEA@@7E $7E EG<7FE 7@CGRFPE PF3;7@F 5A@E7@F3@FE M
B3DF;5;B7D !>E PF3;7@F 5A@EP5GF;H7?7@F ;@5>GE E3@E 5D;FQD7
6\7J5>GE;A@
$7?3FPD;7>6\PFG6735A?BD;EG@:PFPDACG7EF;A@@3;D767
;F7?E P5D;F 7@ 3D347 6;3>75F3> 7F 36?;@;EFDP B3D G@ E7G>
7@CGRF7GD!>3PFPP>34ADP7@E\;@EB;D3@F67>35>3EE;8;53F;A@
;@F7D@3F;A@3>7 67E FDAG4>7E 6G EA??7;> !+ !! 12 7F 6G
CG7EF;A@@3;D7 P>34ADP B3D (3DA>3 +* 12 $7E ;F7?E A@F PFP
F7EFPE>ADE6\G@7BDP7@CGRF7
$7CG7EF;A@@3;D75A?BD7@3;F>7ECG3FD7DG4D;CG7EEG;H3@F7E[
7E ;@8AD?3F;A@E 9P@PD3>7E 5A@57D@3@F >7E 6A@@P7E
EA5;A6P?A9D3B:;CG7E >7E 3@FP5P67@FE ?P6;53GJ >7E
?P6;53?7@FE BD;E B3D >7 EG<7F 7@CGRFP 7F BAGH3@F ;@F7D8PD7D
3H75 >7 EA??7;> >\;@6;57 67 ?3EE7 5ADBAD7>>7 7F >3
5A@EA??3F;A@67E7J5;F3@FE
-@77JB>AD3F;A@6GEA??7;>[6GD3@F>767D@;7D?A;E3G?AK7@
67E5D;FQD7EEG;H3@FE[:AD3;D7E675AG5:7D7F67>7H7D@A?4D7
67 DPH7;>E @A5FGD@7E 7F >7GD 6GDP7 ;@6;57 6\788;535;FP 6G
EA??7;>[CG;7EF>7D3BBADF7@FD7>7F7?BE67EA??7;>DP7>7F
>7F7?BEFAF3>67EP<AGD3G>;F8DPCG7@577F6GDP767EE;7EF7E
$3 E3F;E835F;A@ 9>A43>7 5A@57D@3@F >7 EA??7;> 3;@E; CG7
>\7J;EF7@57 6\G@7 EA?@A>7@57 6;GD@7 7J57EE;H7 A@F PFP
PH3>GP7E3G?AK7@6\G@7P5:7>>7H;EG7>>73@3>A9;CG7
-@7 67E5D;BF;A@ 67E B>3;@F7E D7>3F;H7E 3G EA??7;>[ B3D G@7
PH3>G3F;A@EG4<75F;H767>3B3DF6GEG<7FN9P
$\7J;EF7@57 6\G@7 67?3@67 67 EA;@E BAGD G@ FDAG4>7 6G
EA??7;>>35A@6G;F76GB3F;7@F8357MEA@FDAG4>77F>3BD;E7
7@ 5:3D97 ?P6;53>7  G F7D?7 67 57 CG7EF;A@@3;D7  >7
6;39@AEF;5 67 FDAG4>7 6G EA??7;> 3 PFP BADFP E; >7 EG<7F
DPBA@63;F3G?A;@EMG@67E5D;FQD7EEG;H3@FE[5A@8AD?P?7@FM
57GJ67>\!+!!
!@EA?@;76\7@6AD?;EE7?7@F[F7?BE6\7@6AD?;EE7?7@F
?;@GF7E
&A?4D767EDPH7;>E @A5FGD@7E EGBPD;7GDAGP93> MFDA;E8A;E
B3D@G;F
!@EA?@;7?3F;@3>7DPH7;>?3F;@3>3H3@F>\:7GD7:34;FG7>>76G
>7H7DEG4<75F;H7?7@FD3BBADFP7B3D>7EG<7F
*7F7@F;EE7?7@F6;GD@7@P93F;8EA??7;>@A@DPB3D3F7GD
KB7DEA?@;7 6GDP7 6G EA??7;>  : : 7FAG
EA?@A>7@576;GD@77J57EE;H76;88;5G>FPEM?3;@F7@;DG@PF3F
67H7;>>7B7@63@F>3<AGD@P7B7@63@F3G?A;@EE7?3;@7E
7DF3;@EEK?BFU?7E6GEK@6DA?76\3B@P76GEA??7;>7F6G
EK@6DA?767E?AGH7?7@FEBPD;A6;CG7E67E?7?4D7E3G5AGDE
6G EA??7;> A@F PFP D75:7D5:PE[ ;@6PB7@63??7@F 67 >3
5A@EPCG7@57:KB7DEA?@;7AG;@EA?@;7
$\3@3>KE7 EF3F;EF;CG7 67E 6A@@P7E 5A?BD7@3;F 6\34AD6 G@7
3@3>KE767E5D;BF;H767>\P5:3@F;>>A@7F67E6;88PD7@FEFDAG4>7E
6G EA??7;> @EG;F7 A@F PFP D75:7D5:P7E >7E 5ADDP>3F;A@E
7@FD7>7E6;88PD7@FEFDAG4>7E6GEA??7;>7F7@FD7>7EFDAG4>7E
6GEA??7;>7F>7EH3D;34>7E5>;@;CG7E7F6P?A9D3B:;CG7E$7
F7EF 67 :;  J] 3 PFP GF;>;EP BAGD >7E H3D;34>7E
CG3>;F3F;H7E  [ >7 F7EF F 67 +FG67@F BAGD >7E H3D;34>7E
CG3@F;F3F;H7E[7F>7E5A788;5;7@FE67+B73D?3@7F(73DEA@BAGD
>7E5ADDP>3F;A@E
R E S U LTAT S
#%,#$%"&$,,#$.
$\P5:3@F;>>A@6\PFG675A?BADF3;FB7DEA@@7E:A??7E[
[  87??7E[    $3 ?AK7@@7 6\N97 67
>\P5:3@F;>>A@ PF3;F 67  3@E 3@E 57FF7 EPD;7  EG<7FE
7@CGRFPE  3H3;7@F G@ ;@6;57 67 ?3EE7 5ADBAD7>>7
EGBPD;7GDM$7BAGD57@F3976\A4PE;FP!%WMPF3;F67
 $7 @;H73G 6\P6G5F;A@ PF3;F H3D;P[  7@E7;9@7?7@F
EGBPD;7GD AG E75A@63;D7  7F B>GE D3D7?7@F BD;?3;D7
AG3@3>B:34QF7
-@7B3F:A>A9;75:DA@;CG7PF3;FD3BBADFP7B3D>3?3<AD;FP67E
EG<7FE 7@CGRFPE  B3F:A>A9;7 6AG>AGD7GE7 6;88;5G>FPE
D7EB;D3FA;D7E B3F:A>A9;7E 53D6;AH3E5G>3;D7E 7E
?P6;53?7@FE BAGH3@F 3>FPD7D >3 CG3>;FP 6G EA??7;> PF3;7@F
BD;E B3D   67E EG<7FE 7@CGRFPE  !> E\39;EE3;F
7EE7@F;7>>7?7@F676;GDPF;CG7E@BEK5:AFDAB7E@7F
3@F;:;EF3?;@;CG7E
$#!% "&%%%' &$ &$&%+,.
$3 ?AK7@@7 6\;@6;57 6\788;535;FP 6G EA??7;> 5:7L >7E
B7DEA@@7E7@CGRFP7EPF3;F673H75G@76GDP7?AK7@@76G
EP<AGD3G>;F67:7F?@7FG@76GDP7?AK7@@76GEA??7;>
DP7>67:7F?@$\:7GD76G5AG5:7DPF3;F7@?AK7@@7M
:[?@EA;F:?@3BDQE>75AG5:7D6GEA>7;>7F
>\:7GD76G>7H7DM:[?@EA;F:?@3H3@F>7>7H7D6G
EA>7;> (7@63@F >3 <AGD@P7   EG<7FE 7@CGRFPE 
83;E3;7@F>3E;7EF7(3D?;7GJ83;E3;7@F67EE;7EF7E
DP9G>;QD7E8DPCG7@578A;EE7?3;@7 $36GDP767EE;7EF7E

LA TUNISIE MEDICALE - 2013 ; Vol 91 (n°02)
129
H3D;3;F7@FD77F ?;@GF7E3H75 G@7 ?AK7@@7 67
?;@GF7E-@75ADDP>3F;A@EF3F;EF;CG7?7@FE;9@;8;53F;H73PFP
D7FDAGHP7 7@FD7 >3 8DPCG7@57 67E E;7EF7E 7F >7 @A?4D7 67E
DPH7;>E@A5FGD@7EB$36GDP7?AK7@@76GEA??7;>
FAF3> 6GD3@F >7E  :7GD7E PF3;F 67  :  ?@ >>7 PF3;F
E;9@;8;53F;H7?7@FB>GE5AGDF75:7L>7E:A??7ECG75:7L>7E
87??7E:[?;@HE:?@[B$7EEG<7FE3K3@F
G@ ;@6;57 67 ?3EE7 5ADBAD7>>7   3H3;7@F G@7 6GDP7
?AK7@@76GEA??7;>E;9@;8;53F;H7?7@FB>GE>A@9G7CG757GJ
3K3@F G@ !%   B 7 ?R?7 57FF7 6GDP7 PF3;F
E;9@;8;53F;H7?7@FB>GE5AGDF75:7L>7EEG<7FEN9PE67B>GE67
 3@E B A@57D@3@F >7E DPH7;>E @A5FGD@7E >7GD
8DPCG7@57 H3D;3;F 7@FD7  7F  E7>A@ >3 DPB3DF;F;A@[ 67 >3
8;9GD7
)G3D3@F7CG3FD7EG<7FEE7DPH7;>>3;7@FB>GE;7GDE8A;E3G
5AGDE67>3@G;F7F EG<7FEE7>7H3;7@F3GB>GE67GJ
8A;EB3D@G;F-@75ADDP>3F;A@EF3F;EF;CG7?7@FE;9@;8;53F;H73
PFP@AFP77@FD7>7@A?4D767EDPH7;>E@A5FGD@7E7F>3BD;E767
6;GDPF;CG7E B G5G@7 5ADDP>3F;A@ @\3 PFP FDAGHP7
7@FD7 DPH7;>E @A5FGD@7E 7F E7J7 AG N97  $7E ?AF;8E 67
DPH7;>E[ PF3;7@F H3D;34>7E $7E B>GE 8DPCG7??7@F 5;FPE EA@F
D7BDPE7@FP63@E>38;9GD7
!>7EFM@AF7DCG7EG<7FEE7DPH7;>>3;7@F7@8;@67@G;F
E3@E3G5G@7D3;EA@[;@EA?@;7;@7JB>;CGP7678;@67@G;F$7
DP7@6AD?;EE7?7@F PF3;F 835;>7 5:7L  67E EG<7FE CG; E7
>7H3;7@F@AF3??7@F5:7L>7E87??7EB
-@7 ;@EA?@;7 ?3F;@3>7 DPH7;> 7@ 8;@ 67 @G;F E3@E
DP7@6AD?;EE7?7@F3PFPD7FDAGHP75:7LB3DF;5;B3@FE
'&% $&%' "&%,&$ &$&%+,
$3 8;9GD7  3 PFP DP3>;EP7 M B3DF;D 67E P5:7>>7E H;EG7>>7E
3@3>A9;CG7E CG; FD36G;E7@F >3 B>3;@F7 EG4<75F;H7 CG3@F M >3
CG3>;FP6GEA??7;>.;@9FE;JEG<7FEA@FDPBA@6GB3D
G@7H3>7GD;@87D;7GD7M3H7567EH3>7GDEAE5;>>3@F7@FD7
 BAGD G@7 ;@E3F;E835F;A@ FAF3>7 7F  BAGD G@7
E3F;E835F;A@ FAF3>7 -@7 H3>7GD ;@8PD;7GD7 M  3 PFP
5A@E;6PDP7 5A??7 ;@6;53F7GD 6\G@7 ?3GH3;E7 CG3>;FP 6G
EA??7;>-@75ADDP>3F;A@EF3F;EF;CG7?7@FE;9@;8;53F;H73PFP
@AFP7 7@FD7 ?3GH3;E7 CG3>;FP 6G EA??7;> 7F 5A@EA??3F;A@
67E7J5;F3@FEB3;@E;CG7>7E7J78P?;@;@B
7F>\PF3F5;H;>6;HAD5PAGH7G8B
# &$&$ *$&%+,.
$\7@CGRF73B7D?;E67D7BPD7DG@9DAGB767B3F;7@FE3K3@F67E
FDAG4>7E6GEA??7;>;@E;EG<7FE3H3;7@F3G?A;@E
G@ FDAG4>7 6G EA??7;>  @AF7D CG7 5:3CG7 EG<7F BAGH3;F
BDPE7@F7DB>GE;7GDEFDAG4>7E6GEA??7;>$7F34>73GDPEG?7
>7E6;88PD7@FEFDAG4>7E
:3CG7B3F;7@FB7GF3HA;DG@AGB>GE;7GDEFDAG4>7E6GEA??7;>
Figure 1 : *PB3DF;F;A@6G@A?4D767DPH7;>E@A5FGD@7E Figure 3 : H3>G3F;A@67>3CG3>;FP6GEA??7;>
Figure 2 : *PB3DF;F;A@67E?AF;8E6GDPH7;>
Trouble du sommeil*
INSOMNIE
!@EA?@;76\7@6AD?;EE7?7@F
*PH7;>E@A5FGD@7E8DPCG7@FE
!@EA?@;7?3F;@3>7
+A??7;>@A@DPB3D3F7GD
HYPERSOMNIE ET /OU SOMNOLENCE
DIURNE EXCESSIVE
+A?@A>7@576;GD@77J57EE;H7;EA>P7
+A?@A>7@576;GD@77J57EE;H77F;@EA?@;7
+A?@A>7@576;GD@77J57EE;H77F:KB7DEA?@;7
,AF3>7J;EF7@576\G@FDAG4>76GEA??7;>
Effectif
(Pourcentage)
Tableau 1 : ;88PD7@FEFDAG4>7E6GEA??7;>6GEG<7FN9P

R. Rafrafi - Sommeil du sujet âgé
130
Ins o mni e<:
$3 B>3;@F7 EG4<75F;H7 67 >\;@EA?@;7 PF3;F BDPE7@F7 5:7L 
EG<7FE
-@7 5ADDP>3F;A@ EF3F;EF;CG7?7@F E;9@;8;53F;H7 3 PFP @AFP7
7@FD7>3B>3;@F7;@EA?@;77F>7E7J78P?;@;@B3;@E;
CG7>\PF3F5;H;>EPB3DPAGH7G8B
G5G@7 5ADDP>3F;A@ EF3F;EF;CG7?7@F E;9@;8;53F;H7 @\3 PFP
@AFP7 7@FD7 >3 B>3;@F7 ;@EA?@;7 7F >3 5A@EA??3F;A@ 67E
7J5;F3@FE
Hy pers o mnni e et/ o u s o mno l ence di urne ex ces s i v e<:
$3EA?@A>7@576;GD@77J57EE;H7[PF3;FBDPE7@F75:7LEG<7FE
 >>7 PF3;F D3BBADFP7 B3D  EG<7FE CG; BDPE7@F3;7@F
3GEE; G@7 ;@EA?@;7  )G3FD7 EG<7FE E7 B>3;9@3;7@F 6\G@7
EA?@A>7@57 6;GD@7 7J57EE;H7 ;EA>P7 )G3FD7 EG<7FE 3H3;7@F
G@7 ;@EA?@;7 ;EA>P7 E3@E EA?@A>7@57 6;GD@7 7J57EE;H7 !>
7J;EF3;F G@ 53E 6\:KB7DEA?@;7 3EEA5;P7 M G@7 EA?@A>7@57
6;GD@77J57EE;H7
G5G@7 5ADDP>3F;A@ @\3 PFP A4<75F;HP7 7@FD7 >3 EA?@A>7@57
6;GD@77J57EE;H77F>7E7J7B
Sus p i c i o n d’un tro ubl e s p éci fi que du s o mme i l
(s y ndro me d’apnée du s o mmei l et s y ndro me des
mo uv ements péri o diques des membres )<:
3@E @AFD7 PFG67 >7 6;39@AEF;5 67 FDAG4>7 EBP5;8;CG7 6G
EA??7;>@\3B3EPFPD7F7@G+7G>E57DF3;@EP>P?7@FEAD;7@F3@F
H7DE576;39@AEF;5A@FPFPD75:7D5:PE
(3D?;>7EEG<7FE7@CGRFPEA@FD3BBADFP>\7J;EF7@57
67DA@8>7?7@FE@A5FGD@7E$7EEG<7FE3K3@FG@;@6;5767?3EE7
5ADBAD7>>7 EGBPD;7GD M  BDPE7@F3;7@F G@ DA@8>7?7@F
@A5FGD@7B>GE8DPCG7@FCG7>7EEG<7FE?3;9D7EB&7G8
EG<7FEBDPE7@F3;7@F67EB3GE7ED7EB;D3FA;D7E3G5AGDE67
>7GDEA??7;>-@75ADDP>3F;A@EF3F;EF;CG7?7@FE;9@;8;53F;H73
PFP@AFP77@FD7>7EB3GE7ED7EB;D3FA;D7E3G5AGDE6GEA??7;>7F
>\A4PE;FPB3;@E;CG7>7E7J7?3E5G>;@B
@8;@ >7E ?AGH7?7@FE 3@AD?3GJ 67E ?7?4D7E ;@8PD;7GDE
B7@63@F>7EA??7;>A@FPFPD3BBADFPEB3DEG<7FE
($%/&$!,"&$ $.
%3>9DP>39D3@678DPCG7@5767EFDAG4>7E6GEA??7;>67EEG<7FE
7@CGRFPE  E7G>7?7@F  6\7@FD7 7GJ @ A@F
5A@EG>FP >7GD ?P675;@ FD3;F3@FBAGD57?AF;8 $7 6;39@AEF;5
D7F7@G PF3;F 3>ADE G@7 B3F:A>A9;7 BEK5:;3FD;CG7 3@J;A
6PBD7EE;H77F>7FD3;F7?7@FBD7E5D;FPF3;FG@747@LA6;3LPB;@7
G5G@ FDAG4>7 EBP5;8;CG7 6G EA??7;> @\3 PFP 6PF75FP $7E
7JB>;53F;A@E D3BBADFP7E B3D >7E EG<7FE N9PE 5A@57D@3@F >7GD
BDABD7 FDAG4>7 6G EA??7;> @ EA@F DPEG?P7E 63@E >3
8;9GD7-@?R?7EG<7FB7GF3H3@57DB>GE;7GDE7JB>;53F;A@EM
>38A;E$7EBD;@5;B3>7E53GE7E3>>P9GP7EPF3;7@FG@7?3>36;7
EA?3F;CG7 ?3> PCG;>;4DP7 BAGD  EG<7FE  7F >7
H;7;>>;EE7?7@FB:KE;A>A9;CG7BAGDB3DF;5;B3@FE
(3D?;>7EB3F;7@FE 3K3@FG@FDAG4>7 6GEA??7;> @ 
 BD7@3;7@F 67E :KB@AF;CG7E 3H75 G@7 BDP6A?;@3@57
8P?;@;@7 E;9@;8;53F;H7 B !> E\39;EE3;F 6\G@7
BD7E5D;BF;A@ ?P6;53>7 63@E  67E 53E @  6\G@7
3GFA?P6;53F;A@ 63@E  67E 53E @  7F 6\G@ FD3;F7?7@F
:A?PAB3F:;CG7AGB:KFAF:PD3B;CG763@E67E53E@$7
D7EF767EB3F;7@FE@GF;>;E3;7@FB>GFUF67E?AK7@E
F:PD3B7GF;CG7E @A@ ?P6;53?7@F7GJ F7>E CG7 F;E3@7 >;D7 AG
DP5;F7D>75AD3@83;D7>3BD;QD7HA;D>3FP>PZ
G@?R?7EG<7FB7GF3H3@57DB>GE;7GDE7JB>;53F;A@EM>38A;E
D I S C U S S I O N
%,#-%$%%$&%#' .
3@E@AFD7B3KE>7EFDAG4>7E6GEA??7;>6GEG<7FN9PEA@F
6A@58DPCG7@FE3H75>\;@EA?@;77@FRF767>;EF7&P3@?A;@E
;>E EA@F EAGH7@F EAGE 6;39@AEF;CGPE  ?3> BD;E 7@ 5:3D97 7F
7@FD3S@7@FG@7EGD5A@EA??3F;A@?P6;53?7@F7GE7;@363BFP7
HA;D763@97D7GE7 $3BD;@5;B3>7>;?;F767@AFD7FD3H3;>PF3;F>3
F3;>>7DP6G;F767>\P5:3@F;>>A@7FE3@A@D7BDPE7@F3F;H;FP67>3
BABG>3F;A@ 9P@PD3>7 67E 5A@EG>F3@FE 7@ BD7?;QD7 >;9@7
7B7@63@FHG>39D3@67BDPH3>7@5767EFDAG4>7E6GEA??7;>
63@E57FF7FD3@5:76\N97>\3@3>KE767EDPEG>F3FE@\3B3E PFP
7@FD3HP7  6P83GF 67 BAGHA;D ?7@7D G@7 7@CGRF7 EGD G@
P5:3@F;>>A@ D7BDPE7@F3F;8 67 >3 BABG>3F;A@ 9P@PD3>7 67E
5A@EG>F3@FE7@BD7?;QD7>;9@7@AFD75:A;JE\7EFBADFPEGD>3
6P>P93F;A@ 6\LL3:D3 CG; 5A?BD7@6 G@7 8ADF7 67@E;FP
BABG>3;D7GD43;@77FDGD3>767EA;@EBG4>;5E7FBD;HPE%3;E
>7@;H73G6\P6G53F;A@63@E@AFD7P5:3@F;>>A@E7D3;FEGBPD;7GD
M57>G;67>3BABG>3F;A@9P@PD3>775;BAGDD3;F3?P>;AD7D>3
8;34;>;FP67EDPBA@E7ED3BBADFP7EB3D>7EEG<7FEN9PE
$#!% &$ &$&%+,.
$7H;7;>>;EE7?7@F7EF3EEA5;PM>3?A6;8;53F;A@67>3EFDG5FGD7
6GEA??7;>'@@AF78DPCG7??7@FG@73H3@5767B:3E77FG@
D355AGD5;EE7?7@F67>3BPD;A676GDKF:?75;D536;7@>7EEG<7FE
N9PE3K3@F F7@63@57ME7 5AG5:7D 7FME7 DPH7;>>7D B>GEFUF
7FF753D35FPD;EF;CG73PFPD7FDAGHP763@E@AFD7PFG67$\;@6;57
6\788;535;FP6GEA??7;>PF3;F67E7FD36G;E3@F7@5>;@;CG7
B3D G@7 B7D57BF;A@ 6\G@ EA??7;> :35:P 7F ?A;@E
DP5GBPD3F7GD@7887F>\7@D79;EFD7?7@FBA>KEA?@A9D3B:;CG7
5:7L>7EG<7FN9P?A@FD7G@7788;535;FP6GEA??7;>343;EEP7M
 6G F7?BE FAF3> 6G EA??7;> 3;@E; CG\G@
8D35F;A@@7?7@F6GEA??7;>3H753G9?7@F3F;A@6G@A?4D77F
67>36GDP767EDPH7;>E;@FD3EA??7;>12
3@E@AFD7EPD;7>36GDP7?AK7@@767EA??7;>6GD3@F:3
PFP5A?B3D34>7M57>>7D7FDAGHP763@E>3EPD;767DAG>J12
Figure 4 : F;A>A9;7EEGBBAEP7E67EFDAG4>7E5:7L>7EEG<7FE
BDPE7@F3@F67EB>3;@F7ED7>3F;H7E3GEA??7;>

:7F63@E>\PFG6767%7E>;7D7F3>12:5:7L>7E:A??7E
7F67:[?@5:7L>7E87??7E
$7E 6A@@P7E 67 DPH7;>E @A5FGD@7E A@F PFP 3GEE; D3BBADFP7E
63@E>3>;FFPD3FGD7
$7E6;88PD7@F7EPFG67EA@F7@7887FD3BBADFPG@7?A6;8;53F;A@
67>35A@F;@G;FP6GEA??7;>5:7L>7EG<7FN9P (D;@9G7K12
D7FDAGH7G@73G9?7@F3F;A@67>38DPCG7@5767EPH7;>EME7BFM
B3D@G;F3;@E;CG\G@3>>A@97?7@F67>7GD6GDP7MM
?@3@E>3EPD;767DAG>J12>7@A?4D76\PH7;>E@A5FGD@7E
H3D;77@FD75;@C7F6;J
'@7@123;@E;EFPEGD>\3>FPD3F;A@67>3CG3>;FP6GEA??7;>B3D
G@ F7?BE B3EEP 3G >;F FDAB >A@9 67E E;7EF7E BDA>A@9P7E3G
5AGDE67>3<AGD@P77F67E:7GD7E 67>7H7D;DDP9G>;QD7E3@E
@AFD7 PFG67 @AGE 3HA@E D7FDAGHP >7E ?R?7E DPEG>F3FE 3;@E;
CG\G@7 5ADDP>3F;A@ BAE;F;H7 7@FD7 >7 @A?4D7 67 DPH7;>E
@A5FGD@7E7F>38DPCG7@5767EE;7EF7EGEE;>\3G9?7@F3F;A@
67>38DPCG7@577F67>36GDP767EE;7EF7EB7GFRFD75A@E;6PDP7
5A??7 G@7 53GE7 67 >\;@EA?@;7 ?3;E 3GEE; 5A??7 G@7
5A@EPCG7@576757>>75;7F57BAGD5A?B7@E7D>\3>FPD3F;A@67
>3CG3>;FP6GEA??7;>@A5FGD@7
'&% $&%' "&%,&$ &$&%+,.
3@E @AFD7 PFG67  67E EG<7FE 7@CGRFPE A@F <G9P CG\;>E
3H3;7@FG@EA??7;>67?3GH3;E7CG3>;FPPH3>G3F;A@9>A43>7
B3D>\P5:7>>7H;EG7>>73@3>A9;CG7
7FF7;@E3F;E835F;A@9>A43>77EFG@76A@@P75A??G@763@E>3
>;FFPD3FGD7 $3 BDPH3>7@57 67E EG<7FE N9PE BDPE7@F3@F 67E
B>3;@F7ED7>3F;H7E3GEA??7;>H3D;76763@E>\7@CGRF767
(D;@9G7K12M63@E>3EPD;767DAG>J127F63@E>3
EPD;767$ADD3;@12
(AGD ;5:F7@ 7F $;4?3@ 12 >3 B>GB3DF 67E EG<7FE N9PE
EAG88D7@F67FDAG4>7EBEK5:AB:KE;A>A9;CG7E6GEA??7;>>;PE
M >\N97 &P3@?A;@E  M  E7G>7?7@F 67E B7DEA@@7E
N9P7EE7B>3;9@7@F676;88;5G>FPEME\7@6AD?;DAGMBDA>A@97D
>7GD EA??7;> 57 CG; 6;88PD7@5;7D3;F >7 H;7;>>;EE7?7@F 67 >3
B3F:A>A9;7 @ 7887F >3 BDPE7@57 67E E;7EF7E 7F 67E DPH7;>E
@A5FGD@7E B7GFRFD75A@E;6PDP75A??7B:KE;A>A9;CG7E5:7L
>7EG<7FN9PB3D5A@FD7>\7J;EF7@576\G@7EA?@A>7@576;GD@7
>3 E7@E3F;A@ 67 EA??7;> @A@ DPB3D3F7GD 7F >3 67?3@67 67
EA;@E 6A;H7@F 3FF;D7D >\3FF7@F;A@ 6G BD3F;5;7@ H7DE G@7
B3F:A>A9;76GEA??7;>
$%# &$&$ *$&%+,.
;7@CG7>3E3F;E835F;A@6GEA??7;>3;FPFP?3GH3;E75:7L
67EEG<7FE67EB3DF;5;B3@FEBDPE7@F3;7@F67EFDAG4>7E
6G EA??7;> BD;@5;B3>7?7@F G@7 ;@EA?@;7  ;@E; ;>
E7?4>7D3;F CG7 >\;@6;57 67 E3F;E835F;A@ 9>A43>7 EAGE 7EF;?7
>7E FDAG4>7E 6G EA??7;> 7@ 9P@PD3> 7F >\;@EA?@;7 7@
B3DF;5G>;7D
$3 >;FFPD3FGD7 ;@F7D@3F;A@3>7 E\355AD67 EGD >3 BDPH3>7@57 67
M67FDAG4>7E6GEA??7;>5:7L>7EEG<7FEN9PE1
  2 $\;@EA?@;7 7EF >7 FDAG4>7 6G EA??7;> >7 B>GE
EAGH7@FD7@5A@FDP3H75G@7BDPH3>7@57PH3>GP7MM
63@E>3EPD;767#3?7>7F3??35=12+7>A@$ADD3;@12
>\;@EA?@;7 EPHQD77FB7DE;EF3@F77EFB>GE8DPCG7@F75:7L>7E
B7DEA@@7EN9P7EM
$\;@EA?@;7DPEG>F7D3;F67>\;@FD;53F;A@ 67B>GE;7GDE835F7GDE
>>7 BAGDD3;F E\7JB>;CG7D B3D >\:KBA?P>3FA@;@7D9;7 12
BDPE7@F75:7L>7EG<7FN9PCG;;@6G;D3;FG@73H3@5767B:3E7
$7EDPH7;>E@A5FGD@7E8DPCG7@FEBAGDD3;7@FE\7JB>;CG7DB3D>3
8D39?7@F3F;A@ B:KE;A>A9;CG7 6G EA??7;> 12  7E
B7DFGD43F;A@E EA?3F;CG7E F7>>7E CG\G@7 B3F:A>A9;7
6AG>AGD7GE7 7F >7E FDAG4>7E BEK5:;3FD;CG7E 3@J;A6PBD7EE;8E
5A@FD;4G7D3;7@F M >\3BB3D;F;A@ 67 >\;@EA?@;7 12 +7>A@
>;I;E7 7F 3> 12  >3 @K5FGD;7  EK?BFU?7 8DPCG7@F 7@
9PD;3FD;7 3G9?7@F7 >3 BDPH3>7@57 67 >\;@EA?@;7 M  7F
3>FQD7 >3 CG3>;FP 6G EA??7;> $\;@EA?@;7 B7GF DPEG>F7D 67
>\7887F;3FDA9Q@76757DF3;@E?P6;53?7@FE3@E@AFD7PFG67
G@7 5ADDP>3F;A@ EF3F;EF;CG7?7@F E;9@;8;53F;H7 3 PFP @AFP7
7@FD7>3B>3;@F7;@EA?@;77F>7E7J78P?;@;@3;@E;CG7>\PF3F
5;H;> H7G8 AG 6;HAD5P 75; BAGDD3;F E\7JB>;CG7D B3D 67E
PF;A>A9;7EBDA434>7?7@F3@J;A6PBD7EE;H7E@7887F>7E7J7
8P?;@;@7F>7H7GH397EA@F67GJ835F7GDE67D;ECG767EFDAG4>7E
6PBD7EE;8E
(3D?; >7E EG<7FE 7@CGRFPE   E7 B>3;9@3;7@F 6\G@7
EA?@A>7@57 6;GD@7 7J57EE;H7  7 DPEG>F3F 5A@5AD67 3H75 >3
>;FFPD3FGD73@E>\PFG6767>3;E7F3>123H3;7@FG@7
EA?@A>7@576;GD@77J57EE;H73@E@AFD7PFG67>3?3<AD;FP
67EB3F;7@FE3H75;@EA?@;73H3;7@FG@7EA?@A>7@576;GD@7
;@E; 57 EK?BFU?7 5A@EPCG7@57 67 >\;@EA?@;7 BAGDD3;F
5A@EF;FG7D G@ ?AK7@ 6;39@AEF;5 ;@6;D75F FP?A;@ 6\G@
BDA57EEGE@A@B:KE;A>A9;CG7
&$! $%# &$$!,"&$&$ .
$7EK@6DA?76\3B@P76GEA??7;>5ADD7EBA@6M>3DPBPF;F;A@
67B3GE7ED7EB;D3FA;D7E3EEA5;P7MG@7EA?@A>7@576;GD@77FM
G@ E7@F;?7@F 67 EA??7;> @A5FGD@7 @A@ DPB3D3F7GD !> E7
D7FDAGH7EAGH7@F5:7L>7E9D3@6EDA@8>7GDEA4QE7E7F7@FD3S@7
67E 5A?B>;53F;A@E 53D6;AH3E5G>3;D7E 7F ?PF34A>;CG7E +A@
6;39@AEF;57EFBA>KEA?@A9D3B:;CG7
7EK@6DA?7FAG5:77@H;DA@67>3BABG>3F;A@67EEG<7FE
N9PEE7>A@+:3B;DA12
3@E@AFD7PFG67B>GE;7GDEEK?BFU?7E6GEK@6DA?76\3B@P7
6GEA??7;>A@FPFPFDAGHPE!>E\39;F6\34AD667EDA@8>7?7@FE
@A5FGD@7EBDPE7@FE5:7LBDQE67>3?A;F;P67EEG<7FEN9PE67
B>GE673@E@EG;F7>7EB3GE7ED7EB;D3FA;D7E3G5AGDE6G
EA??7;> PF3;7@F 3GEE; BDPE7@F7E 5:7L G@7 BDABADF;A@ @A@
@P9>;9734>767EEG<7FE3@E@AFD7PFG675A??763@E
>3 >;FFPD3FGD7 >7 DA@8>7?7@F @A5FGD@7 @\PF3;F B3E 5ADDP>P 3G
E7J7 @ 7887F >3 BDP6A?;@3@57 ?3E5G>;@7 9P@PD3>7?7@F
D7FDAGHP7 63@E >7 EK@6DA?7 6\3B@P7 6G EA??7;> 6;EB3D3;F
5:7L>7EG<7FN9P(3D3;>>7GDE>7DA@8>7?7@F@A5FGD@77F>7E
B3GE7E D7EB;D3FA;D7E PF3;7@F B>GE 8DPCG7@FE 5:7L >7E EG<7FE
3K3@FG@;@6;5767?3EE75ADBAD7>>7EGBPD;7GDM>\A4PE;FP
PF3@F 9P@PD3>7?7@F 3EEA5;P7 3G EK@6DA?7 6\3B@P7 6G
EA??7;>@8;@B3D?;>7EEG<7FE7@CGRFPECG3FD73H3;7@FG@7
EA?@A>7@57 6;GD@7 7J57EE;H7 ;EA>P7 PHA53FD;57 6\G@7
B3F:A>A9;7 EBP5;8;CG7 6G EA??7;> %3>9DP FAGE 57E
EK?BFU?7E PHA53F7GDE 6G EK@6DA?7 6\3B@P7 6G EA??7;>
3G5G@ 53E @\3 PFP ?P6;53>7?7@F 5A@8;D?P !> E\39;F
HD3;E7?4>34>7?7@F 6\G@7 B3F:A>A9;7 EAGE 6;39@AEF;CGP7
BDA434>7?7@F7@D3;EA@6\G@7?P5A@@3;EE3@5767EBD3F;5;7@E
67 BD7?;QD7 >;9@7 67 E7E EK?BFU?7E  67 E7E ?AK7@E
6;39@AEF;CG7E7F67E3BD;E77@5:3D97
# &#$&( $ $.
;7@CG767EEG<7FE7@CGRFPEE7B>3;9@3;7@F67FDAG4>7E
6G EA??7;>  E7G>7?7@F 6\7@FD7 7GJ A@F 5A@EG>FP >7GDE
LA TUNISIE MEDICALE - 2013 ; Vol 91 (n°02)
131