SUMMARY :
- Sleep apnea: what are we talking about?
- Sleep apnea: what causes and risk factors?
- Sleep apnea: what are the symptoms?
- Sleep apnea: what are the risks?
- How is sleep apnea diagnosed?
- What are the treatments for sleep apnea?
- Sleep apnea and Covid-19: a more severe infection?
Sleep apnea: what are we talking about?
In France, around 8% of adults aged 20 to 44, 20% of 45-64 year olds and 30% of over 65s suffer from sleep apnea syndrome. Sleep apnea is defined as “complete respiratory arrest in the upper airways (nose, mouth) for more than 10 seconds“explains Dr. Yves-Victor Kamami, ENT doctor.
“In a very concrete way, for at least 10 seconds, the patient does not breathe at all, there is no air entering his body, he is choking“develops the specialist.
Warning ! Sleep apnea (which is characterized by complete respiratory arrest) should not be confused with hypopnea, which refers to partial respiratory arrest: “in case of hypopnea, there is a little air passing through the upper airways, breathing is reduced but not completely stoppedHowever, sleep apnea and hypopnea are often associated: doctors also speak of obstructive sleep apnea-hypopnea syndrome (OSAHS).
Sleep apnea: what causes and risk factors?
Sleep apnea is, on average, twice as common in men than in women. Several risk factors have been identified:
- Aging. Age is associated with loss of tone in the upper airways: “the tissues sag in the throat, they are more flabby, which hinders the passage of air“says Dr. Kamami.
- Obesity. A body mass index (BMI) greater than 30 is a significant risk factor for sleep apnea: “there is an infiltration of fat in the tissues, especially the tongue, which blocks breathing“.
- Smoking. “In smokers, one can observe an enlarged turbinates, these mucous membranes located in the nose which increase in size in reaction to tobacco smoke.“explains the ENT doctor. Again, this phenomenon can result in more labored breathing and sleep apnea during the night.
To know. Experts estimate that about 60% of patients with metabolic syndrome and 16% of diabetics suffer from sleep apnea.
Sleep apnea: what are the symptoms?
Sleep apnea is characterized by symptoms that are well known today:
- Snoring. This is “the” main symptom of sleep apnea: snoring is loud (between 80 and 100 dB, or the equivalent of a dog’s bark), stops suddenly before resuming loudly.
- The startled awakenings during the night, sometimes with a feeling of suffocation.
- Daytime sleepiness. Linked to the fragmentation of sleep, daytime sleepiness results in persistent fatigue, difficulty concentrating, “memory lapses”, a lack of concentration, “bar ups” during monotonous moments (when driving , for example)…
- Frequent urge to urinate overnight. This amazing symptom results from a biological mechanism: to respond to the blood flow, the heart produces a hormone (ANF) whose function is to allow the elimination of salt by the kidneys … which causes the production of urinating and the urge to pee.
- Morning headaches. Headaches upon waking up are caused by the lack of oxygen (therefore excess carbon dioxide in the blood) that accompanies each sleep apnea.
To know. “Patients are often sent to the ENT doctor by their spouse who has noticed breathing stops during the night, or micro-awakenings interspersed with snoring“notes Dr. Kamami.
Sleep apnea: what are the risks?
Is this serious doctor? Yes, because sleep apnea can have serious consequences on general health. “When the patient experiences sleep apnea for several seconds, the body is not supplied with oxygen: this is called hypoxia., explains the specialist. Over time, these episodes of hypoxia can trigger or worsen pathologies.“
- On the side of the consequences on the brain, we can cite an increased risk of cerebrovascular accident (stroke) and an increased risk of developing Alzheimer’s disease in the long term.
- On the side of the consequences on the heart and the cardiovascular system, we can mention arterial hypertension (“about 1/3 of apnea sufferers are hypertensive“underlines Dr. Kamami) and an increased risk of myocardial infarction (heart attack).
To know. Depression, glaucoma, erectile dysfunction and diabetes are also long-term consequences of unsupported sleep apnea.
How is sleep apnea diagnosed?
The diagnosis of sleep apnea is made by the ENT doctor. First, the specialist performs a clinical examination: “it is a question of seeing at which level the upper airways are blocked during the apneic episodes: the nose, the uvula or the tongue“says Dr. Kamami.
Then the ENT doctor can offer a recording of the sleep – this is called ventilatory polygraphy.
“The patient is given a machine, a polygraph, which measures the level of oxygen in the blood at night (if it drops below 90%, there is oxygen desaturation, this is a sign of sleep apnea), which monitors the nighttime heart rate (sleep apnea can cause the heart to race), which counts how many times the patient chokes during the night (apneic episodes), and who identifies when position the patient has sleep apnea (most often: on the back)“explains the doctor.
To know. We talk about mild sleep apnea when the patient chokes 10 to 20 times per hour during the night. Between 20 and 30 times per hour, this is average sleep apnea. Over 30 times per hour, severe sleep apnea.
What are the treatments for sleep apnea?
- Mild or moderate sleep apnea
In the event of mild or moderate sleep apnea (between 10 and 30 episodes of apnea in the space of an hour during the night, therefore), several treatments may be offered depending on where the respiratory blockage is located.
When the blockage is in the nose, the laser can be interesting: the operation lasts about 5 minutes, under local anesthesia, and it is painless.
When the blockage is in the uvula / soft palate, the laser is also preferred: the operation lasts about 15 minutes, under local anesthesia. If it is painless, the patient experiences sore throat-like pain for about ten days. Laser operations are reimbursed by Social Security.
When the blockage is at the level of the tongue, an orthosis could be considered: this small dental appliance (which is used to keep the tongue forward, to prevent it “falling” into the throat, cutting off breathing) can be bought in pharmacies (around 70 euros) or made to measure by the dentist (around 700 euros). The orthosis is reimbursed by Social Security if sleep apnea is accompanied by serious heart problems.
- Severe sleep apnea
The number one treatment for severe sleep apnea is continuous positive airway pressure (CPAP): “it’s about a mask that the patient wears at night on his nose: connected to a machine by a hose, this device sends a continuous flow of air, thus preventing the tissues of the throat and nose from blocking breathing“explains Dr. Kamami.
“CPAP devices have evolved a lot in recent years: they are now increasingly light, therefore more comfortable to wear, but also quieter and equipped with humidifiers to prevent the airways from drying out.“adds the specialist. In addition, on some masks, the hose is connected at the level of the forehead rather than at the level of the nose – for more comfort. CPAP, in the context of severe sleep apnea (index greater than 30), is reimbursed by Social Security.
When CPAP is not well tolerated by the patient (this affects approximately 1 in 2 patients, especially for reasons of claustrophobia), the doctor may suggest a laser intervention or a orthosis.
Sleep apnea: complementary approaches. It has been said: obesity is a major risk factor for sleep apnea. “A dietetic and sports support can therefore be interesting, in addition to the treatment, suggests Dr. Kamami. Patients can also turn to maxillofacial physiotherapy which helps to lose weight in the tongue.“In addition, in some patients, nasal strips used while running may improve nighttime breathing.
Sleep apnea: what about surgery? “Surgery may be indicated for patients who suffer from sleep apnea complicated by a deviated nasal septum or polyps in the nose., answers the ENT doctor. On the other hand, the uvula and soft palate surgery (UPPP) formerly performed to treat sleep apnea, is now only done exceptionally, due to significant side effects – pain, risk of wrongdoing when swallowing …“
Sleep apnea and Covid-19: a more severe infection?
Infection with the SARS-CoV-2 coronavirus can cause pulmonary fibrosis, a condition that corresponds to progressive perforation of the alveoli that make up the lungs.
As the National Academy of Medicine explains, “pulmonary fibrosis is a frequent consequence of the respiratory distress observed in the acute phase [du Covid-19] (…) It is mainly attributed to the increased production of pro-inflammatory cytokines.“
“In patients who suffer from sleep apnea, Covid-19 is therefore likely to further reduce lung function: patients breathe even less well, they quickly get short of breath“says Dr. Kamami.
In patients with sleep apnea who test positive for Covid-19, it is therefore recommended not to use the CPAP mask for ten days “to avoid pushing viral particles into the lungs, which can turn into pulmonary fibrosis“develops the ENT doctor.
Thanks to Dr. Yves-Victor Kamami, ENT doctor in Paris and author of Snoring: finally sleep peacefully (ed. du Dauphin).
Sources:
- Inserm
- No more snoring – Dr. Gérard Vincent and Damien Bidaine, eds. Eyrolles
- National Academy of Medicine
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