What is sleep apnea and how does it manifest?
Sleep apnea (otherwise known as obstructive sleep apnea-hypopnea syndrome, or OSAS) is a nocturnal breathing disorder characterized by repeated episodes of interruptions (apneas) or reductions (hypopneas) of breathing at the sleep course. These breathing pauses last an average of 10 to 30 seconds and occur at least 5 times per hour of sleep. In total, these breaks can be repeated a hundred times during the same night, at varying frequencies.
The importance of this syndrome is measured according to the number of apneas/hypopneas per hour of sleep. It is measured using an index: the apnea/hypopnea index (AHI)
- Between 5 and 15: sleep apnea is considered mild
- Between 16 and 40: sleep apnea is considered moderate
- If this index is greater than 30, the apnea is considered severe
These abnormally frequent pauses in breathing are due to repeated obstructions of the respiratory tracts in the back of the throat. As a result, these breaks cause a lack of oxygen in the sleeper. The brain, faced with this lack of oxygen, awakens the sleeper to resume breathing. These awakenings, or rather these “micro-awakenings”, are of short duration and are often forgotten upon awakening.
Do you know ? In France, this syndrome affects between 1 and 3 million peoplebut close to 80% of them would not be diagnosed.
The consequences of this syndrome, in the short and long term:
Sleep apnea has significant consequences on our activities. On a daily basis, sleep apnea causes persistent headaches, concentration, mood or memory disorders, daytime sleepiness or even uncontrollable drowsiness, direct consequences of very disturbed and jerky sleep. It can also have consequences for the spouse, because sleep apnea is accompanied by loud snoring.
Did you know ? Snoring is not considered a health problem and is only rarely accompanied by pauses in breathing. Scientists estimate that 30 % at 45% adults snore regularly.
In the long term, untreated sleep apnea can have major health consequences. The syndrome promotes, among other things, cardiovascular diseases such as:
• Heart failure
• High blood pressure
• Coronary artery disease
• A myocardial infarction (heart attack)
• Heart rhythm disturbances (cardiac arrhythmia)
• A stroke (cerebrovascular accident)
But there are other long-term consequences of this syndrome:
• Diabetes
• A metabolic syndrome
• Abnormalities of fats in the blood
• Depression due to lack of sleep
• Accidents at work and on the road due to increased drowsiness. For information, people with this disorder have 2 to 7 times greater risk of being victims of a traffic accident.
The factors contributing to this syndrome
In the majority of cases, apneas and hypopneas are due to excessive relaxation of the tongue and the muscles of the throat, which are not sufficiently toned and thus block the passage of air for breathing. This is called airway obstruction. There are various factors that prevent the proper functioning of the upper airways (mouth, nose, throat, larynx and trachea). It’s about :
• Overweight or obesity, present in 70% cases, which makes it the main risk factor, particularly because excess fat in the neck reduces the caliber of the respiratory tract. Obesity increases by approximately 7 times the risk of sleep apnea.
• Age, because sleep apnea is more common in seniors due to the lack of tone in the muscles. After 65 years, the frequency of the syndrome is double or triple. Today, 30 % people over 65 would be affected;
• Sex: men are two to four times more exposed than women under 60. After this age, the frequency of this syndrome is the same;
• ENT (otolaryngological), surgical, allergic, etc. problems. leading to more or less permanent nasal obstruction;
• Abnormalities of the jaw (mandible too small), tongue (very bulky tongue) or palate (uvula, tonsils);
• Medicines (sedatives, sommières, anxiolytics), smoking or stimulating substances (alcohol, narcotics).
How to prevent sleep apnea?
If you suffer from low-grade sleep apnea, there are a few solutions to improve the quality of your sleep and thus reduce the symptoms of this syndrome. Here are a few :
- Lose weight (a loss of 10% reduced weight of 25% the severity of the apneas);
- Practice regular physical activity;
- Sleep on your side to prevent narrowing of the airways;
- Raise the head of the bed a few centimeters to have the neck and torso slightly inclined and thus facilitate the opening of the respiratory tract;
- Avoid sleeping pills, smoking and stimulating substances before sleeping which increase relaxation of the muscles of the throat and tongue and create inflammation of the airways;
- Treating allergies to prevent nasal congestion from interfering with breathing
When and who to consult?
Most people with sleep apnea don’t know it. Most of the time, it is the spouse who notices the presence of repeated snoring or apnea. It is strongly advised to consult a specialist if:
• Snoring is very loud and disturbs your sleep or the sleep of your spouse;
• If you wake up frequently at night (micro-awakenings) with the impression of having trouble breathing;
• If your spouse notices respiratory arrests during your sleep;
• You always feel tired when you wake up (drowsiness) and you fall asleep frequently during the day (uncontrollable drowsiness).
Your GP can refer you to a sleep study specialist. In practice, you will have to spend a night in the hospital or in a specialized center to carry out all the tests and determine the severity of this syndrome. Electrodes will be placed in different places on your body to observe brain and muscle activity, blood oxygen levels and different stages of sleep.
All these parameters can determine the apnea-hypopnea index (AHI), specific to each patient. Depending on the results obtained, the doctor may advise you to wear a gutter (mandibular advancement orthosis) or a respiratory mask (treatment by continuous positive pressure ventilation), the latter reducing the symptoms after 4 to 6 weeks. To date, there is no medication to cure sleep apnea.
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In the most serious cases, if ventilation treatment does not work, surgery can be performed to reduce snoring and apnea (uvulo-palato-pharyngoplasty, tonsillectomy and adenoidectomy, nose surgery, tracheotomy, etc.). However, their long-term effectiveness is relatively low since apnea often tends to reappear after the procedure.
LR