What Are the Causes of Sleep Apnea?

Often underdiagnosed, sleep apnea is a respiratory disorder affecting between 2.5 and 6.4 million French people, according to an RNPC study.

This syndrome is mainly characterized by repeated interruptions in breathing during the night. It frequently causes frequent awakenings, leading to daytime sleepiness and fatigue.

To better understand the causes of this disorder and explore treatment options, here’s a detailed guide.

Sleep Apnea: Possible Causes

Sleep apnea affects between 5 and 7% of the adult population. Among seniors (70 years and older), this percentage rises to about 15%. Unfortunately, 80% of those affected are undiagnosed!

At this stage, it's important to know that sleep apnea has various causes, which are outlined below:

Anatomical Factors

Obstructive sleep apnea is typically caused by a narrowing of the upper airways during sleep. Several anatomical factors contribute to this condition:

• Excess fat tissue in the neck: In overweight individuals, fat accumulation reduces the diameter of the airways, hindering airflow.
• Enlarged tonsils or adenoids: This is especially common in children or adults with excessively large tonsils.
• Palate or jaw structure: A narrow palate or receding jaw can restrict airflow and increase the risk of apnea.

The Role of Age and Gender

Age is a key factor in the onset of obstructive sleep apnea-hypopnea syndrome (OSAHS). With age, particularly after 50, the tone of the airway muscles decreases, increasing the risk of tissue collapse during sleep.

This phenomenon primarily affects men due to their narrower airway structure compared to women.

Alcohol and Sedative Consumption

Certain substances, such as alcohol and sedatives, exacerbate sleep apnea symptoms. Why? They promote relaxation of the airway muscles.

For instance, alcoholic beverages relax the pharyngeal muscles, encouraging airway obstruction during sleep and reducing the brain's responsiveness to oxygen drops. The result? Delayed awakening reflexes.

Sedatives have similar effects, as they decrease muscle tone and increase the risk of airway closure, intensifying apnea episodes.

Smoking

Smoking is another aggravating factor for sleep apnea. Smokers are more at risk due to airway irritation and inflammation caused by smoke.

Tobacco also causes swelling in the upper airways, heightening the risk of obstruction. Studies show that smokers are up to three times more likely to develop sleep apnea than non-smokers.

Hormonal Causes

In women, hormonal changes increase the risk of sleep apnea. Menopause is particularly risky because the decrease in estrogen and progesterone levels reduces airway muscle tone.

Before menopause, female hormones seem to protect against apnea, but after this period, the risk becomes nearly as high as in men.

What Are the Treatment Options?

The gold standard for treating sleep apnea is continuous positive airway pressure (CPAP) therapy. This device keeps the airways open by delivering pressurized air through a mask worn over the nose. The goal? To improve sleep quality and prevent daytime sleepiness for those with this syndrome.

CPAP is recommended for patients with an apnea-hypopnea index (AHI) of 30 or higher. It’s also advised for those with an AHI between 15 and 30 if they experience severe symptoms such as significant sleepiness or cardiovascular issues. Furthermore, CPAP is indicated if at least three of these signs are present: daytime sleepiness, loud snoring, a choking sensation at night, constant fatigue, frequent nighttime awakenings, or morning headaches.

Good news: this treatment is covered by health insurance, provided the device is used for at least two hours per night and its effectiveness is demonstrated. To ensure proper follow-up, treatment must be renewed after four months and then annually.

Other Sleep Apnea Treatments

When sleep apnea is caused by anatomical defects, surgical intervention may be considered. Options include tonsil or uvula removal, modifications to pharyngeal anatomy, or nasal and jaw surgery.

However, these interventions are less effective than CPAP therapy, with relief rates ranging from 30% to 80%. Additionally, they carry risks and are only proposed when other treatments have failed.

Another option is a mandibular advancement device, a custom-fitted appliance worn at night. This device keeps the lower jaw in a forward position, facilitating airflow through the pharynx. While effective at reducing snoring, its impact on apnea is limited. It’s generally recommended when CPAP is ineffective or poorly tolerated.

For individuals experiencing daytime sleepiness due to apnea that resists treatment, solriamfetol (SUNOSI) may be prescribed. This medication aims to improve wakefulness but is contraindicated in certain cardiovascular conditions.

Nasal Prosthesis: An Innovative Solution

If you still struggle with sleep apnea despite trying these methods, innovative products like a nasal prosthesis or anti-snoring kits can help.

The nasal prosthesis is designed to enhance breathing by facilitating airflow through the nasal passages. It is particularly useful for those with respiratory issues such as sleep apnea, snoring, or nasal obstructions. Its purpose is to widen the nostrils, allowing better ventilation.

Made from silicone or soft plastic, the prosthesis offers optimal comfort. Positioned at the entrance of the nostrils, it gently expands the nasal walls, reducing airflow resistance and improving breathing quality, especially during sleep.