Obstructive Sleep Apnea: what’s that we really risk?

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) syndrome, or more commonly known as sleep apnea, does not only affect the quality of life, in the long-term it can lead to severe conditions.

While many people think that snoring is normal and the sounds associated with it can even be fun, there is nothing funny about sleep apnea!

This common and often misdiagnosed respiratory disorder affects 49% of men and 23% of women. And although it usually affects people over the age of 40, young adults, children and even babies can suffer from obstructive sleep apnea. Impacting as much the nights as the days of the affected person, this chronic condition can cause serious health consequences. Hence the need to be screened and treated.

Obstructive Sleep Apnea : A purely nocturne disorder

According to the CDC, sleep deprivation is a major public health problem as it has many physical and psychological repercussions on overall health and even life expectancy. And among the many causes of sleep dysfunction, obstructive sleep apnea is clearly the most serious!

OSA is a purely nocturnal disorder, often characterized by intense and persistent snoring, which is the consequence of a complete or partial closure of the upper airways (Pharynx, Larynx), in the form of short, repeated and reversible episodes. The result is a decrease (hypopnea) or interruption (apnea) of respiration for at least 10 seconds.

Obstructive Sleep Apnea : Identify the symptoms

Concretely, it is a loosening of the tongue and throat muscles. As they are not – or no longer – toned enough, these muscles block the passage of air during respiration. When it is complete and prolonged, this obstruction leads to respiratory efforts that can lead to micro-awakenings that will affect the quality of sleep.  And if this phenomenon can occur hundreds of times during the night, it is easy to imagine how exhausting it becomes for the person. Especially as this fragmentation prevents the sleeper from reaching the deep stages of sleep, which of course makes it less restorative. The person may also experience difficulty in breathing, choking, night sweats, nocturia and even have libido problems, especially erectile dysfunction.

Obstructive Sleep Apnea : Assessing the severity of the condition

As one might expect, the consequences of obstructive sleep apnea are even more important as the disorder is severe. The severity of OSA is evaluated by the apnea – hypopnea index, which corresponds to the ratio of the number of apneas and hypopneas to total sleep time. There are three levels of severity: mild if the AHI is between 5 and 15 per hour; moderate if it is between 16 and 30; and severe if it is greater than 30.

Obstructive Sleep Apnea : Impact on the daily life

Even so, the person affected is not always aware of his problems. It is therefore up to those around him to report frequent and noisy snoring, respiratory breaks or very restless sleep. The consequences of sleep apnea also have repercussions during the day, initially through waking headaches, joint or muscle pain, great fatigue, a feeling of lassitude while one feels like they have had a full night’s sleep and a restful restorative sleep. At work, one may struggle to remain attentive and focused, and be subject to memory problems. This can evidently affect his performance.

Obstructive Sleep Apnea : Dangerous somnolence

Obstructive sleep apnea syndrome can also cause an increase in a person’s bad mood, irritability and even aggressiveness towards family and friends. In addition, lack of sleep leads to an alteration in the inflammatory response which can lead, in some cases, to a state of depression.

But above all, apneic patients may tend to be drowsy or even sleepy during monotonous or routine activities. This somnolence is especially dangerous as it can occur at any time of the day: at work, in transport and at the wheel. in fact, it is estimated that the rate of car accidents is 6 times higher in people suffering from untreated sleep apnea. To the point where a vigilance test is required for professional drivers.

Obstructive Sleep Apnea : A link with the obesity

Overweight and obesity (leading to an accumulation of fat in the neck which weighs on the airways) multiply by 7 the risk of being affected by sleep apnea. Moreover, the prevalence of obstructive sleep apnea syndrome is proportional to BMI: 58% of obese people have OSA and at least 50% of patients with SOA are obese.  Alcohol consumption, smoking, family antecedents, the use of medication or sedatives and even morphology, also affect the outbreak and development of AOS.

In any case, it is important not to disregard this syndrome these repeated respiratory breaks cause at once a decrease in brain oxygenation and a significant stress, which puts the heart on an increasing strain. In the long term, sleep apnea leads to a number of serious health consequences, particularly on cardiovascular level.

Obstructive Sleep Apnea : Serious consequences

Sleep Apnea is associated with an elevated cardiovascular risk (high blood pressure, heart failure, heart rhythm disorder, coronary heart disease, stroke and myocardial infarction). It is also associated with dysfunction of the endothelial cells lining the vascular walls, resulting in increased blood pressure and risk of atherosclerosis.

On the other hand, according to a study published in the Journal of Clinical Endocrinology & Metabolism, apnea leads, inter alia, to an alteration of lipid and carbohydrate metabolism – even in the absence of obesity – which results in an increased frequency of glucose intolerance and type 2 diabetes.

Obstructive Sleep Apnea : Common sense advices

If an OSA is suspected, the patient may be subjected to respiratory polygraphy or even polysomnography. These are painless, nocturnal examinations that analyze the quality of sleep, quantify apneas and hypopneas and make a possible diagnosis of OSA. Today, there is no definitive solution to apnea, but several effective treatments allow the patient to regain restful sleep.

Depending on the severity of the syndrome, the doctor may already recommend some dietary and lifestyle measures that may be sufficient, namely: losing weight, adopting a balanced diet by avoiding fatty and copious meals, avoiding alcohol and sleeping pills before going to bed, stopping smoking, lying on the side and not on the back, treating respiratory allergies and practicing physical activity.

Obstructive Sleep Apnea : Therapy options

As a first-line treatment, the physician may prescribe a mandibular advancement orthosis (MAO). This is a removable, custom-made dental prosthesis that allows the lower jaw to be advanced, which frees the airway in the pharynx. In general, this orthosis is recommended for people with moderate apnea. If this solution does not succeed, continuous positive airway pressure treatment can be used.

The latter is considered the reference therapy for moderate to severe apnea. If properly used and supported by the patient, CPAP therapy is clinically immediately effective. It is a ventilation device equipped with a turbine that keeps the upper airway opened by sending a continuous airflow through a nasal or oral mask.

Lingual rehabilitation, which is a specialty of physiotherapy, can now be combined with classical treatments. Developed by a physiotherapist, Maryvonne Fournier, lingual rehabilitation is increasingly interesting pneumologists and otorhinolaryngologist to treat moderate sleep apnea. The aim is to strengthen the throat and to tone the 17 muscles of the tongue through exercises focusing on posture, swallowing, ventilation… and therefore to train the patient to properly position his tongue during sleep and allow him to respire efficiently.