Have you ever heard of sleep apnea syndrome? Potentially severe sleep disorder in which breathing stops and resumes repeatedly.
Between 5 and 7% of the population stops breathing several times during the night. This problem, described as sleep apnea, has a significant impact on health. In addition to altering the quality of sleep, it increases the risk of cardiovascular disorders.
According to the National Institute of Sleep and Vigilance (NISV) survey, conducted in 2015 on sleep, 4% of French people suffer from sleep apnea. Men would be more affected by this disorder than women.
The populations most at risk for sleep apnea are the elderly, overweight or those who snore significantly.
Recognized for only a few years, obstructive sleep apnea syndrome is a periodic obstruction of the upper respiratory tract during sleep. The many stops of breathing cause more or less serious problems. Discover the basics of this disorder in a few questions. Let’s go to the discovery of this enemy that strikes the night!
I – What Are Sleep Apneas?
Sleep apnea is an intermittent absence of breathing during sleep due to loosening of the muscles that control the tongue and soft palate to keep the upper airway open. They can occur 30 to 500 times a night and last from 60 to 90 seconds. They cause a decrease in the amount of available oxygen in the blood and cause many micro-awakenings that strongly affect sleep quality with long term cardiovascular and cerebrovascular risks.
II – Who Is Concerned with Sleep Apnea Syndrome?
For example, 5 to 7% of French people would be victims of Sleep Apnea, but only 15% of them would be diagnosed. In order to effectively combat the disease and to avoid or reduce its consequences, screening must occur as soon as possible. It consists of a sleep recording and can be done at the hospital or at your home.
III – What Are the Signs of Sleep Apnea?
Often, the spouse is alerted as witnessing the two most frequent manifestations: snoring and breathing stops during sleep. Other signs can also alert you: falling asleep during the day, feeling continually tired, being depressed or irritable … These are not just the signs of a time when everything is going too fast!
1 – From Banal Snoring to Sleep Apnea
Unexplained fatigue, daytime sleepiness, and other uncontrollable drowsiness should encourage the usual buzzer to consult. Sleep apnea syndrome should not be confused with ordinary snoring.
*** Why are we snoring?
When lying down, the various organs of the throat – uvula, soft palate – relax and relax. These flexible and mobile elements begin to vibrate during inspiration or both breaths (inspiration, expiration).
The following elements promote humming:
– Excess weight
– The soft palate too long
– Infectious foci are more or less chronic: sinusitis, rhinitis …
– Respiratory allergies
– Excesses of table
– Anomalies of the jaws: narrowness, retrognathism …
– Hypertrophic vegetations and tonsils in children
*** To prevent snoring you can:
– Treat the ENT sphere,
– Slow down tobacco and alcohol,
– Avoid sleeping on your back,
– Avoid taking sleeping pills,
– To solve pediatric rhino-pharyngeal problems.
*** From snoring to sleep apnea syndrome
Sleep apnea is linked to breathing difficulties leading to lack of oxygenation of the body. When these disorders worsen, respiratory stops intervene. Short at first, they can reach 30 to 40 seconds. This is the beginning of a vicious circle: the blood pressure rises, the cardiac vessels increase their flow, the heart accelerates. Over the months, if these signs persist, they may raise the risk of hypertension or infarction. Daytime sleepiness, especially at the wheel, poor sleep interspersed with apnea, increased snoring, are all warning signs.
Be careful, it’s not because you snore that you suffer from sleep apnea! Both problems can be independent. If you have suspicions, the diagnosis will be confirmed by a consultation in a sleep center: by spending the night, you can have a record of different parameters of your sleep. An apnea problem will be easily detected.
2 – Alarm Signals…
The sleeper does not necessarily realize this problem. Often, it is the spouse who is concerned about the respiratory arrest. In addition to these nocturnal manifestations, several signs may suggest a sleep apnea problem:
– excessive fatigue;
– Sleepiness during the day;
– Snoring more and noisier;
– poor quality sleep;
– Loss of memory;
– Headaches when waking up;
– Sometimes high blood pressure.
IV – What Are the Causes of Sleep Apnea?
The source of this syndrome is a succession of stops of breathing during sleep.
These repeated stops of breathing are either due for the majority of cases to obstructions of the pharynx (obstructive sleep apnea syndrome) or to a malfunction of the brainstem, which no longer signals the body to inspire. central sleep apnea).
V – Consequences and Symptoms of Sleep Apnea
Apnea disrupts sleep and results in:
– Disorders of sleep
– Attention disorders
– Loss of libido
– A tired wake-up
– mood disorders
– Excessive sleepiness during the day, which could lead to a risk of an accident at work or on the road
– The onset of certain diseases such as depression, type 2 diabetes, cardiovascular risks, high blood pressure, infarction…
For more details:
In the short term, sleep disturbance can lead to drowsiness during the day, as people fall asleep suddenly and unexpectedly, risking accidents at home or in the workplace, as well as accidents. When we know that almost a third of highway fatalities are due to drowsiness, how many are related to sleep apnea?
In the long term, the heart works more during the pauses of breathing to compensate the decrease of oxygenation of the brain, resulting in heart fatigue and thus a major risk of hypertension, stroke, and infarction.
VI – Types of Sleep Apnea
Sleep apnea can be of two types:
1 – Central Sleep Apnea
Central apnea is caused by central nervous system failure. “During sleep, the body simply” forgets “to breathe,” says Dr. Marc Sapène, a pulmonologist at the Bel-Air clinic in Bordeaux and president of the Sleep Apnea Alliance. “They are very rare and require neurological management”.
2 – Obstructive Sleep Apnea Syndrom
Obstructive apneas, by far the most frequent, have a purely mechanical reason. This is called Obstructive Sleep Apnea Syndrome (OSAS), “characterized by repeated phases of apnea at night for at least 10 seconds, related to total or partial obstruction of the airways,” says Dr. Sapène.
VII – Symptoms and Diagnosis
The diagnosis of OSA is not easy to ask. The person must already consult for either a snoring problem or for symptoms associated with sleep apnea: drowsiness, morning headaches, problems with concentration, libido problems, irritability, etc. Untreated, OSAS can cause associated pathologies (cardiac arrhythmias, high blood pressure, diabetes, stroke, etc.). In these cases, the OSAS can be spotted by various specialists: ENT, pulmonologist, cardiologist, neurologist…
The diagnosis is based on the interview of the patient and various medical examinations:
A sleep test is requested (performed at home or in a sleep center), to obtain various measures: respiratory profile, heart rate, oxygen level, etc.
It is complemented by polysomnography that records brain activity, studies the quality of sleep and detects respiratory abnormalities.
*** Severity and risk factors
The severity of OSAS is then assessed by an index of apnea/hypopnea (IAH):
– We talk about lightweight SAOS for an IAH included in 5 and 15 / hour
– Moderate OSH for an HPI between 15 and 30 / hour
– Severe SAOS for an HPI higher than 30 / hour.
Sleep apnea can affect everyone. Even children are concerned, as are menopausal women, pregnant women, and so on. But there are still factors that greatly increase the risk of developing this syndrome:
– Obesity (risk multiplied by 7);
– Age: risk between 2 and 3 times higher after 65 years;
– Sex: men are 2 to 3 times more affected than women.
VIII – Possible complications of sleep apnea
You have a serious tendency to snore, and you often feel tired in the morning. Be careful, you may be suffering from sleep apnea. These involuntary breathing pauses during the night are a real danger for the body. In addition to the major cardiovascular risks, this disorder is responsible for road accidents or even depression.
1 – Sleep Apnea: A Risk of Cardiovascular Disease
One of the known impacts of sleep apnea is a cardiovascular impact. Indeed, the lack of oxygen in the blood forces the heart to work more, and therefore to get tired more quickly. Hypertension and cardiovascular disorders appear.
A Swedish study showed that sleep apnea increased the risk of heart problems by seven (angina pectoris, infarction …). But other works presented at the 16th annual congress of the European Society of Pneumology have proved that a suitable treatment allowed to cancel this over-risk.
2 – Sleep Apnea: A Risk of Road Accident
Sleep apnea has a significant impact on alertness during the day.
Because the respiratory stops occur as soon as the person starts to go into a deep sleep: then the muscles relax completely, causing an obstruction in the airways. Choking triggers a micro-alarm that allows you to breathe again … and this happens all night. In short, the person has the impression to have slept eight hours, when in fact it is as if she had just dozed, being awake several tens to hundreds of times…
Sleep is not at all restorative, and drowsiness is strong during the day. The lack of sleep would also have similar effects to alcohol: decreased reflexes decreased the field of vision…
Patients suffering from apnea would be seven times more likely to be involved in a traffic accident.
3 – Sleep Apnea: A Risk of Depression
But sleep apneas do not only have physiological repercussions. They can also have a significant psychological impact.
Thus, an American study linked this sleep disorder to the risk of depression.
The researchers studied people with mild, moderate and severe apneas. And they were able to show a risk of black ideas proportional to the intensity of the disease:
– Mild apneas: risk of depression multiplied by 1.6;
– Average apnea: risk of depression multiplied by 2;
– Severe apnea: risk of depression multiplied by 2.6;
The researchers also showed that when apnea symptoms worsened, the risk of depression was at its peak, close to 80%.
The question is whether it is the decline in the quality of life associated with depression that is the cause of depression, or whether there is a direct link between lack of sleep and oxygen and a reaction at the level of depression. of the psyche.
IX – Treatments for Obstructive Sleep Apnea Syndrome
1 – Continuous Positive Pressure or CPP
The vast majority of sleep apnea is associated with relaxation of the soft tissues of the upper airway during sleep. The reference treatment is continuous positive airway pressure (CCP) ventilation: an airflow allows the tongue to detach when it collapses and helps keep the airways open. A station positioned near the bed produces the airflow; a pipe connects the machine to the mask with which the patient is to sleep. “It’s a lifelong treatment, which may be a big deal early on when the device is discovered, but the benefits are so great and immediate that patients end up pretty well following that treatment,” says the president. Sleep Apnea Alliance.
In France, equipment is installed by health providers. They are the ones who are reimbursed directly by the Health Insurance, patients do not have to advance fees. The reimbursement rate that providers can claim is directly related to the observance of treatment, a way of actively involving them in the therapeutic education of patients.
In recent years, many improvements have been made to these medical devices, including the arrival on the market of minimalist nasal masks and very quiet stations, design increasingly refined. The size of the stations has been considerably reduced, which allows, for some, to be able to carry them easily and to continue its treatment on holidays. Remember to find out about the different masks and machines on the market to request from your provider.
2 – Lingual Rehabilitation
A myofunctional rehabilitation can be proposed in addition to the PCC. “A bad placement of the tongue, for example, or a lack of tone can play an important role in sleep apnea,” explains Meryl Manoukian, a physiotherapist and kine linguist at the Bel-Air clinic in Bordeaux. “Myofunctional rehabilitation with physiotherapy sessions can help reduce sleep apnea index by up to 50%”.
The rehabilitation is quite long: “It takes at least 6 months of rehabilitation to create reflex and tone in the language, and correct the bad investments. The gestures then become automatic, but we must, of course, maintain them for life with the exercises learned during the sessions “.
Lingual physiotherapy may also be prescribed for PCC patients who are sleeping with their mouths open. This sleeping position prevents the treatment from being effective and must, therefore, be corrected.
3 – Surgical Treatments
Surgery is rarely used to treat sleep apnea. It can be considered to correct a mechanical cause of these apneas: a morphological defect of the jaw or the palate, low implantation of the tongue which favors the obstructions, etc.
– In very specific cases of OSAS caused by a morphological defect in the jaw, surgery may allow the mandible to be slightly advanced and thus help to reduce the symptoms. In children, surgeries will be more effective than in adults or adolescents who have completed their growth.
– The surgery of the base of the tongue is also a possible treatment but “old and little practiced”, commented Dr. Vincent Puel, a cardiologist at the clinic Bel-Air. It consists of removing a tiny part of the tongue where the obstruction occurs at night. The operation is today minimally invasive because performed by robots. “But it’s really a therapeutic niche,” says the expert.
– “The surgery of the palate, or UVPP for Uvulo-Palato-Plasty, is no longer really practiced,” continues Dr. Puel. “They posed a problem because the palate also plays an important role in swallowing and they could cause disorders.”
In addition, these surgeries generally remain quite painful and have little effect on the reduction of apnea/hypopnea index.
3 – Other Mechanical Treatments
Other therapies exist but are almost no longer used. “This is the case of a pacemaker of the language, which works on the same principle as a pacemaker against heart rhythm disorders,” says Dr. Vincent Puel. “The pacemaker is connected to 2 wires: one that passes under the diaphragm and measures apnea, and another that goes behind the tongue to release it when apnea occurs. There are many contraindications. for example, can not benefit “. This surgery, very heavy, is not supported by Social Security.
Some patients may be prescribed orthotics. “It is gutters to place in the mouth and take off the tongue during sleep. But again, if the patient sleeps with their mouths open, the orthosis will not be effective. In these cases again, the treatment must be completed by physiotherapy sessions.
4 – Treatment of Causes of Obstruction
It may happen that apneas are caused by nasal obstructions (respiratory allergies, polyps, diverted nasal septum for example). The treatment will then be that of the cause of the obstruction and generally allows to effectively clear the airways.
Finally, diet and lifestyle measures are important to help reduce sleep apnea: losing weight for overweight people, reducing alcohol consumption in the evening, sleeping preferably on the side.
As a Conclusion on Sleep Apnea Syndrome
Sleep apnea is not a problem to neglect. Insomnia, drowsiness or fatigue are not the only possible consequences of this disorder. In the long term, poor oxygenation of the body will lead to heart problems, high blood pressure and even the risk of heart attack. This is why it is important to consult your doctor and treat the problem as soon as possible.