Sleep apnea: definition, mechanism and treatment

Sleep apnoea, or obstructive sleep apnoea-hypopnoea syndrome (OSAHS), is a respiratory disorder characterised by repeated pauses in breathing during sleep.

These interruptions, which last between 10 and 30 seconds, can occur several times an hour, disrupting sleep and reducing quality of life.

The main causes include:

💊 relaxing the muscles of the throat and tongue,

💊 obesity,

💊 anatomical anomalies.

Common symptoms include:

💊 snoring,

💊 daytime sleepiness,

💊 morning headaches.

Treatment ranges from weight loss to the use of medical devices such as continuous positive airway pressure(CPAP) and intranasal intranasal orthoses.

Important points	Summary
Definition of sleep apnoea	A respiratory disorder characterized by repeated pauses in breathing during sleep.
Symptoms of sleep apnoea	Loud snoring, respiratory pauses observed, frequent awakenings, excessive daytime sleepiness, morning headaches.
Causes of sleep apnoea	Obesity, anatomical anomalies, family history, high blood pressure, other medical conditions.
Diagnosis of sleep apnoea	Clinical assessment and medical history, sleep tests such as polysomnography and ventilatory polygraphy.
Treatments for sleep apnoea	Lifestyle changes, continuous positive airway pressure (CPAP) therapy, mandibular advancement orthosis (MAO), Back2Sleep intranasal orthosis, surgical procedures, other treatments.

 

What are the symptoms of sleep apnoea?

Loud snoring

Snoring is one of the most common and recognisable signs of sleep apnoea.

It is caused by a partial obstruction of the upper airways, which causes the tissues of the pharynx to vibrate during breathing.

Breathing pauses observed

Breathing pauses, or apnoeas, are complete pauses in breathing during sleep, often observed by the bed partner.

These interruptions can last from a few seconds to more than a minute and are generally followed by a sudden awakening with a sniff or choking.

Frequent awakenings

People suffering from sleep apnoea may experience frequent awakenings or micro-awakenings during the night, often without remembering them the next day.

These sleep interruptions can lead to sleep fragmentation and poor-quality restorative sleep.

Excessive daytime sleepiness

Excessive daytime sleepiness is a frequent symptom in people with sleep apnoea, resulting from unrefreshing night-time sleep.

It is characterised by an irresistible urge to sleep during the day, even after a seemingly full night's sleep.

Morning headaches

Headaches on waking are common among sleep apnoea sufferers.

They can be caused by reduced levels of oxygen in the blood during apnoea episodes, leading to vasodilation and, consequently, headaches.

What are the causes of sleep apnoea?

Obesity

Obesity is considered to be one of the main risk factors for sleep apnoea, particularly obstructive sleep apnoea.

Excess weight leads to an accumulation of fatty tissue around the neck and throat, which can narrow the airways and cause them to become obstructed during sleep.

Anatomical anomalies

Certain anatomical features can predispose to sleep apnoea.

🔎 For example, a recessed lower jaw (retrognathia), a narrow palate or a large tongue can reduce the space available for air to pass through and cause obstructions.

Family history

Studies have shown that sleep apnoea can have a genetic component.

⚠ If members of your family suffer from this disorder, you may be more likely to have it too.

Hypertension

There is a close link between sleep apnoea and high blood pressure.

▶ On the one hand, hypertension can favour the development of apnoea due to the anatomical changes it brings about.

▶  Untreated sleep apnoea can also contribute to an increase in blood pressure.

Other medical conditions

Certain medical conditions can also increase the risk of sleep apnoea by affecting the airways or the control of breathing, such as:

💊 hypothyroidism,

💊 acromegaly,

💊 neuromuscular diseases.

How is sleep apnoea diagnosed?

Clinical assessment and medical history

During your consultation, your doctor will ask you about:

💊 your sleeping habits,

💊 your snoring,

💊 your daytime sleepiness,

💊 any breathing pauses observed by your partner,

💊 other potential symptoms.

It will also examine:

💊 your weight,

💊 your neck size,

💊 any anatomical abnormalities that may contribute to sleep apnoea.

Your full medical history will also be taken into account.

Sleep tests

A polysomnography or complete sleep recording, is considered to be the reference test for diagnosing sleep apnoea.

Carried out in a sleep laboratory, this study makes it possible to record a number of parameters such as:

💊 brain activity,

💊 eye movements,

💊 breathing,

💊 oxygen saturation and cardiac activity while you sleep.

A simpler alternative is ventilatory polygraphy, which can be carried out at home.

Although less complete than polysomnography, it allows respiratory parameters to be recorded and apnoeas and hypopnoeas to be detected.

Interpretation of results

After analysing the data collected, your doctor will be able to determine whether you suffer from sleep apnoea and, if so, assess its severity.

This is generally measured by the apnoea-hypopnoea index (AHI), which corresponds to the number of respiratory events per hour of sleep.

The higher the AHI, the more severe the apnoea.

What are the treatments for sleep apnoea?

Lifestyle changes

Adopting a healthy lifestyle is often the first step in managing sleep apnoea.

This includes:

💊 weight loss,

💊 stopping smoking,

💊 reducing alcohol consumption,

💊 increasing physical activity.

These changes can reduce symptoms and improve sleep quality.

🔎 For example, losing weight can reduce pressure on the airways, making it easier to breathe while you sleep.

Continuous Positive Airway Pressure (CPAP) therapy

CPAP (Continuous Positive Airway Pressure) is the standard treatment for obstructive sleep apnoea.

This involves wearing a mask connected to a machine that delivers a continuous flow of air to keep the airways open while you sleep.

This treatment is highly effective in reducing apnoea and improving sleep quality.

Mandibular Advancement Orthosis (MAO)

The mandibular advancement orthosis is an oral device that holds the lower jaw in an advanced position, helping to keep the airway open.

This treatment is particularly useful for patients suffering from mild to moderate sleep apnoea and can be an alternative or a complement to CPAP.

Back2Sleep Intranasal Orthosis

The Back2Sleep intranasal orthosis is designed to treat snoring and sleep apnoea by keeping the airway open.

This device reaches the soft palate and prevents obstruction of the airways, improving breathing during sleep.

It is made from flexible materials and is easy to use, providing a practical solution for many patients.

Surgical procedures

In some cases, surgery may be necessary, especially if other treatments have not been effective.

Surgical options include correcting anatomical abnormalities, such as removing the tonsils or modifying the structure of the pharynx.

These procedures aim to widen the airways to make breathing easier during sleep.

Other treatments

Other treatment options may include:

💊 from behavioural therapies,

💊  medication to treat the underlying conditions,

💊  alternative ventilation devices such as APAP (Auto-Adjusting Positive Airway Pressure) or BiPAP (Bilevel Positive Airway Pressure).

These treatments are tailored to the specific needs of each patient and the severity of their sleep apnoea.