2023-07-08 04:38:48
Pr Ari Chaouat, sleep apnea, disease or syndrome?
“If you take the WHO definition, it’s a disease. It impacts the quality of life. It will hinder the subject in his professional and social life. Many epidemiological studies also show that sleep apnea increases the risk of cardiovascular disease. The more the number of apneas increases, the greater the cardiovascular risk in the long term. »
What is its mechanism?
“Air no longer passes through the upper airways during sleep. Breathing during sleep is ensured by the contraction of the two muscles that make up the diaphragm. As for the heart, we have an automatic and regular contraction controlled by the brainstem. Lying down will cause a mess. We are in less good mechanical conditions. Can also play an accumulation of fat around the oropharynx. A drop in tone means that the airways at the level of the oropharynx will be narrowed. They will first vibrate, this is snoring, then, sometimes, close partially (hypopnea) or completely, this is apnea. We speak of sleep apnea when the air does not pass for ten seconds. »
“Overweight is a risk factor”
This phenomenon is not felt?
“The deprivation of air will cause an awakening that is not necessarily conscious. It is called an autonomic awakening which will re-increase muscle tone often following several “unrewarded” inspiratory maneuvers. That is, the diaphragms contract, but the airways remain closed. They will reopen following one, two, three or even four contractions. The patient will not necessarily notice it. These events will recur all or part of the night. Above five events per hour, we have an apnea syndrome. Above fifteen, we have a moderate syndrome, beyond that, it’s a severe syndrome. »
It mainly affects heavy snorers?
“It’s often the first step. There is no sleep apnea without heavy snoring. Being overweight is also a risk factor. The proportion of apneics in the morbidly obese is high. However, there are also non-overweight subjects who present with an apnea syndrome. »
How do we know that we are apneic?
“Often, the entourage alerts. There are snoring, breathing pauses noted by the spouse. We hear the person who stops breathing. Above all, the recovery is often noisy. Then there are the consequences that the subject will feel: headaches in the morning, morning fatigue, difficulty waking up… The most annoying thing is daytime sleepiness and vigilance disorders. In extreme cases, we have sleepiness. And then, there are other repercussions such as hypertension that cannot be treated in large apneic patients. There is also the fact of getting up frequently to urinate in the night. »
“We can’t suffocate in the night”
For regarding ten seconds, we are no longer oxygenated. Can we die from it?
” No. You can’t choke in the night. But, the immediate consequence is indeed a drop in oxygen saturation. »
Can this apnea be treated?
“It requires multidisciplinary care. Hygieno-dietetic measures are put in place. Drinking alcohol in the evening, for example, decreases muscle tone. So we’re going to try to fix that. Sleep debt and phase shifts also promote apnea and weight gain. Otherwise, one of the most common prescriptions remains “continuous positive pressure”. This treatment has an interest in people who have significant cardiovascular pathologies and vigilance problems. This is a device that is worn at night. It creates a constant pressure which will prevent the airways from collapsing. This treatment transforms patients’ lives. »
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