Why treat sleep apnea?

No, sleep apnea is not an Olympic discipline, nor even a breathing practice from yoga, and even less a nocturnal activity consisting of holding one's breath for as long as possible. The reality of sleep apnea , its causes, but above all its consequences are unfortunately much more serious.

More than just the deafening noise of snoring, which is as unsightly as it is annoying for its listeners, sleep apnea is known, but certainly not recognized enough . Knowing how to identify it means being able to treat it and thus protect yourself against its potentially dangerous consequences for your health. Why is it important to treat sleep apnea? Can we achieve a cure for sleep apnea ? Let's take a look at the impact of sleep apnea on health and what lies behind this noisy sleep disorder .

What is sleep apnea?

Sleep apnea is a respiratory disorder characterized by a complete and involuntary cessation of breathing, lasting at least 10 seconds , and occurring at least 5 times per hour according to the INSERM definition ^1. This phenomenon can last more than 10 seconds and can occur up to dozens of times per hour!

This involuntary respiratory arrest manifests itself by a muscular relaxation of the pharynx and a blockage of the trachea, which leads to an obstruction of the airways. Breathing is prevented, air cannot circulate to the lungs. The individual suffering from it needs micro-awakenings at night during sleep, unconsciously, in order to resume breathing. These awakenings not only harm the quality of sleep, but also the heart rate.

There are 3 types of sleep apnea :

• Obstructive sleep apnea (" OSA "): this is the most common and, as its name suggests, it results from muscular relaxation in the pharynx and therefore obstruction of the upper airways
• Central nervous system apnea (“ CNA ”): rarer, it is an anomaly of the respiratory command at the cerebral level, the “order” to breathe is no longer given by the brain (the respiratory tract is not necessarily obstructed)
• Mixed sleep apnea : this is the association of obstructive apnea and central nervous system apnea

Whether it is obstructive sleep apnea syndrome (" OSAS ", the most common form), central sleep apnea (much rarer) or mixed apnea, sleep apnea is a sleep breathing disorder .

On the other hand, the level of severity of sleep apnea is measured by the number of apneas/hypopneas per hour of sleep. This gives the apnea/hypopnea index ("AHI"):

• Mild sleep apnea: between 5 and 15 apneas
• Moderate sleep apnea: between 16 and 30 apneas
• Severe sleep apnea: more than 30 apneas

Sleep apnea in figures

According to INSERM ² , sleep apnea is "a common and rather male syndrome". For adults, it is estimated that it affects:

• 7.9% of 20-44 year olds
• 19.7% of 45-64 year olds
• 30.5% of those over 65

This sleep-related breathing disorder also affects babies and children. According to INSERM, 2% of children aged 2 to 6 years are affected by OSA. According to the Canadian Lung Association ³ , it is even between 0.7 and 10.3% of children who suffer from sleep apnea. A study combining cross-referenced data at the international level ⁴ and homogenizing the factors taken into account shows that between 2 and 10% of the world's population are affected by sleep apnea.

However, all these data on the prevalence of sleep apnea must be put into perspective, due to its "under-diagnosed" nature. Indeed, the " French Federation of Cardiology ⁵ ", in particular, emphasizes that "80% of people who suffer from it are neither diagnosed nor treated...". This state of affairs is corroborated by INSERM. An American study ⁶ reports that, with regard to severe obstructive sleep apnea , it affects 9% of men and 4% of women.

Furthermore, the "masculine" character of this sleep disorder is also revealed in another study ⁷ , confirming here that parity between men and women is not yet respected here, like in other areas!

What causes sleep apnea?

The causes of obstructive sleep apnea are fairly clearly established. Numerous studies ⁸ support this view and identify the following factors as the cause of OSA :

• obesity , overweight: excess fat in the neck reduces the caliber of the airways (fatty deposits on the pharynx)
• Age : Loss of muscle tone with aging promotes relaxation of the throat and tongue muscles, increasing the risk of upper airway obstruction, choking, and ventilation problems.
• sex : men are twice as affected up to the age of 65
• Nasal obstructions: surgical or ENT history, allergies, etc.
• consumption of tobacco, alcohol or sedatives
• individual susceptibility, craniofacial anomalies and anatomical component: size of the jaw, reduced retrolingual space, shape of the palate, etc.
• magnesium deficiency

In addition, sleep apnea after anesthesia is also a risk factor to be taken into account ⁹ due to possible post-operative complications and risks related to anesthesia (increased muscle relaxation), whether or not the surgery is related to OSA. People at risk, who have not yet been diagnosed or have already been treated for sleep apnea, must benefit from special monitoring before (polysomnography test) and after surgery.

As for the causes of central sleep apnea , they are neurological and related to other pathologies that disrupt the brain's "breathing commands":

• disorders following a stroke
• heart disease
• neurological diseases (meningitis, Parkinson's, etc.)
• morbid obesity

Finally, children are unfortunately not left out when it comes to sleep apnea. For them, the main cause ¹⁰ of OSA is swollen adenoids and tonsils. The same factors as for adults can be added to this, namely obesity, overweight, upper respiratory infections, asthma, as well as a soft palate or allergies.

Symptoms and Diagnosis of Sleep Apnea

Sleep apnea is characterized by a very evocative and…noisy symptom! This is obviously snoring . In the case of sleep apnea, the latter is accompanied by interruptions in the breathing mechanism: the individual snores, and the snoring is punctuated by a respiratory arrest of about ten seconds, whereas “simple” snoring is limited to vibrations of the pharynx. Like an alarm, snoring should alert the individual who suffers from it, or the person who perceives it (spouse, friend, family, etc.), and thus allow the search for other possible symptoms. INSERM and most of the studies carried out on this subject ¹¹ have highlighted the main symptoms of sleep apnea , which are listed below:

• loud snoring
• breathing pauses
• daytime sleepiness
• difficulty concentrating and memorizing
• fatigue, headaches, irritability, decreased libido
• frequent urge to urinate during the night

A doctor's appointment and the Epworth sleepiness test can diagnose sleep apnea by measuring the degree of daytime sleepiness , which is one of the main symptoms of this sleep-related breathing disorder. In addition, the use of nocturnal ventilatory polygraphy or, for more in-depth screening, polysomnography can accurately diagnose severe or moderate sleep apnea. These tests can be performed in a clinic, a specialized center or even at home.

What can be the consequences of sleep apnea?

Sleep apnea is not trivial! This breathing disorder can have multiple consequences, from the most benign to much more serious, even dangerous, repercussions on health. As reported by several studies ¹² , the impact of OSA on health is very real :

• risks of cardiovascular disorders : hypertension, cardiac arrhythmia, atherosclerosis, type 2 diabetes
• hypoxia : activation of the sympathetic nervous system and metabolic disorders
• oxidative stress

Sleep apnea therefore causes cardiovascular complications which can cause stroke, myocardial infarction, cardiac arrest, and therefore lead to premature death.

In addition, the risk associated with the phenomenon of " sudden death ," as described in a 2013 study ¹³ , is dangerously increased for people suffering from sleep apnea.

In addition, OSA is also responsible for leukoaraiosis , a serious disease of the central nervous system characterized by "fibrohyaline thickening" in a part of the brain (white matter). Leukoaraiosis and sleep apnea therefore cause cognitive disorders that can unfortunately manifest as dementia. This harmful consequence is highlighted in a report published in 2018 ¹⁴ in the " Journal of Thoracic Disease ".

Thus, considering the various pathologies resulting from obstructive sleep apnea syndrome, it is obvious that in the event of alarming symptoms, its screening using the various available tests as well as its treatment should be taken seriously. But then, how can sleep apnea be treated?

Treatments for sleep apnea

Having noted the very negative impact of sleep apnea on our health, it is time to lighten the mood a little because, fortunately, solutions exist for living with sleep apnea. Indeed, we can first try to reduce the symptoms , as recommended by INSERM and other health organizations ¹⁵ :

• weight loss in case of obesity or overweight ¹⁶ , practice physical activity regularly
• sleep on your side and not on your back
• quit smoking, avoid sleeping pills and alcohol
• have a good intake of magnesium to promote muscle tone
• tilt your pillow ¹⁷ to 60° to give your head a more upright posture
• acupuncture ¹⁸ to improve anoxia (lack of oxygen)
• oxygen therapy ¹⁹ for automatic oxygen supply during the night (via nasal cannulas)

On the other hand, for severe obstructive sleep apnea, treatment with continuous positive airway pressure ("CPAP") is effective and widespread. A device sends air (or pure oxygen) during the night to prevent the pharynx from closing. Wearing a mask is then necessary all night (nasal mask, forehead mask, mouth mask, pediatric mask). A significant improvement in the quality of sleep can be expected thanks to a CPAP device , however some side effects related to the device used to treat sleep apnea may appear:

• nasal dryness
• throat irritation
• discomfort caused by the mask with harness
• PPC device noise

However, some types of PPC/CPAP devices incorporate humidifiers to avoid unwanted effects such as nasal dryness or throat irritation. In addition, the variety of masks available on the market is quite substantial. Several manufacturers offer headgear-free masks , and new, increasingly innovative, comfortable, and efficient devices are appearing.

Regarding the treatment of sleep apnea in children ²⁰ , it essentially consists of surgical intervention to increase the flow of the respiratory tract by removing soft tissue (adenoidectomy, tonsillectomy), orthodontic therapy (narrow jaws), and an adapted diet in case of obesity.

Thus, sleep apnea and its most common form, OSA, turns out to be a respiratory disease in its own right, responsible for sleep disorders, but with consequences that can be very serious for health. Fortunately, effective treatments exist, and the diagnosis of obstructive sleep apnea is possible thanks to symptoms that are fairly easily identifiable, as long as you pay attention to them.

We can perhaps be pleased about some snoring, which is certainly unpleasant for the spouse or family (or even the neighbors!), but beneficial because of its preventative nature by making this sleep disorder more identifiable and not to be taken lightly!

In addition and for a more "geeky" approach: discover through this video entitled " The geeky approach to sleep apnea ", published by Koichi Nakayama (TEDxFukuoka), how computer innovation, through a new device , can help manage sleep apnea!

Sources:

[1] and [2] Sleep apnea: a source of fatigue, but also of cardiovascular diseases , “INSERM” website, October 2015 [3], [10] and [20] Obstructive sleep apnea in children , “Fondation Sommeil” website, 2020 [4], [8] and [12] Obstructive sleep apnea: definitions, epidemiology & natural history , JCM Lam, SK Sharma et al, “ The Indian Journal of Medical Research ”, February 2010 [5] Sleep apnea significantly increases cardiovascular risks , “Fédération Française de Cardiologie” website, January 2015 [6] Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration , NM Al Lawati, SR Patel et al, “ Progress in Cardiovascular Diseases ”, February 2009 [7] The Epidemiology of Adult Obstructive Sleep Apnea , NM Punjabi, “ Proceedings of The American Thoracic Society ”, February 2008 [9] Risks of general anaesthesia in people with obstructive sleep apnoea , C. den Herder, J. Schmeck et al, “ The BMJ ”, October 2004 [11] Obstructive Sleep Apnea: A Growing Problem , KK Motamedi, AC McClary et al, “ The Ochsner Journal ”, 2009 [13] Obstructive Sleep Apnea and the Risk of Sudden Cardiac Death: A Longitudinal Study of 10,701 Adults , AS Gami, EJ Olson et al, “ HHS Public Access ”, August 2014 [14] Clinical physiology and sleep: highlights from the European Respiratory Society Congress 2018 presented by early career members , I. Almendros, A. Aliverti, “ Journal of Thoracic Disease ”, January 2018 [15] Sleep apnea , website « Ameli-Assurance Santé”, 2020 [16] Interactions between obesity and obstructive sleep apnea: implications for treatment , A. Romero-Corral, SM Caples et al, “ Chest ”, March 2010 [17] New and Unconventional Treatments for Obstructive Sleep Apnea , Jose Angelo A. De Dios, Steven D. Brass, “ Neurotherapeutics ”, October 2012 [18] Effect of acupuncture on blood oxygen saturation in patients of obstructive sleep apnea-hypopnea syndrome , Jia Xu, Yan-Xia Niu et al, “ Clinical Trial ”, January 2009 [19] Home Oxygen Therapy for Sleep Apnea , Dr B. Peters for the “VerywellHealth” site, June 2020