What is sleep apnoea?
What are the characteristics of sleep apnoea syndrome?
Sleep apnoea is characterised by repeated involuntary respiratory arrest while sleeping. An apnoea occurs if air flow is stopped for a minimum of 10 seconds but this can go on for more than one minute. Doctors also refer to hypopnoea, which is a reduction in air flow to the lungs of at least 30%, resulting in a drop of at least 4% in the oxygen level in the blood.
There are two types of sleep apnoea:
- Obstructive sleep apnoea syndrome (OSAS) is the most common case. This type of apnoea is due to a relaxation of the tongue and the throat muscles which relax and collapse on the airways. The air passage is thus completely blocked.
- Central sleep apnoea is caused by a dysfunction in the brain that no longer sends the command to breathe.
Apnoea is considered pathological if you stop breathing more than 5 times per hour. Beyond 15 times per hour we speak of moderate apnoea and beyond 30 times per hour is called severe apnoea.
Who is affected by sleep apnoea?
Sleep apnoea can affect anyone, whether you are a child, an adult, overweight or underweight. There are different estimates of the number of people affected by sleep apnoea. According to the most recent and large epidemiological study published on this pathology 1, sleep apnoea affects 49% of men and 23% of middle-aged to elderly women.
Who is affected by sleep apnoea?
During sleep, apnoea does not occur evenly but preferably in certain positions (on the back). Thus it is estimated that apnoea occur only in the dorsal position in 27% of apnoeic patients. Apnoea also occurs preferably in certain stages of sleep (REM).This is probably due to the fact that during this phase of sleep the muscles of the pharynx become more relaxed, which leads to airway obstruction, causing snoring and apnoea.
Being male, your age and obesity are the most important risk factors leading to nocturnal respiratory disorders. For example, the frequency of moderate apnoea (AHI>15/h) increases from 28% in 40–60-year-olds to 48% in 60–80-year-olds. This increase seems to be due to age-related loss of muscle tone and is particularly significant in women due to the menopause, which causes the pharyngeal tissues to sag. Obesity also has a significant impact with a frequency of sleep apnoea that is 2.8 times higher in overweight people (BMI > 30). Indeed, in the event of being overweight, the fatty tissues infiltrate the pharyngeal muscles more, which leads to a loss of tonicity causing them to sag and thus obstructing the airways.
Certain anatomical features also play an important role in the development of obstructive sleep apnoea. For example, retrognathia (recessed lower jaw) causes the tongue to move towards the pharynx. Also a bulky tongue (macroglossia), enlarged tonsils or a very long soft palate favour airway obstruction and the appearance of obstructive events that cause sleep apnoea and snoring.
Upper airway abnormality described in patients with obstructive sleep apnoea syndrome. Modified based on Lévy and al. Nat Rev Dis Primers 2015 [1]
1: long and enlarged uvula; 2: reduced retropharyngeal space; 3: lowering of the hyoid bone; 4: verticalization of the mandible; 5: retro-position of the mandible; 6: loss of dental occlusion; 7: enlarged tonsils; 8: enlarged adenoids; 9: macroglossia.
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What are the consequences of this sleep disorder?
Obstructive sleep apnoea syndrome is a pathology that can have serious consequences. Repeated episodes of apnoea-hypopnoea lead to a drop in oxygen levels and sleep fragmentation, which activate numerous mechanisms (oxidative stress, tissue inflammation) causing serious cardiovascular and metabolic consequences.
OSAS (obstructive sleep apnoea syndrome): pathophysiology of cardio-metabolic consequences. Modified based on Pépin and al. Thorax 2012 [24]
In adults, sleep apnoea is associated with several significant pathologies:
- Risk of high blood pressure multiplied by 5, and 40% of people with high blood pressure suffer from apnoea.
- Risk of coronary heart disease multiplied by 5.
- Risk of atrial fibrillation multiplied by 4.
- Risk of ventricular tachycardia multiplied by 3.
- Risk of stroke increased by 60%, and 60% of those affected suffer from sleep apnoea.
- Risk of Cancer multiplied by 4.8 in severe cases.
- Risk of type 2 diabetes, twice as frequent in snorers and 4 times more frequent in people with sleep apnoea.
- Risk of Alzheimer’s disease, which appears 10 years earlier in people who snore and suffer from sleep apnoea.
- Risk of depression multiplied by 1.6 to 2.6 depending on the severity of the apnoea.
- Risk of road and work accidents multiplied by 5 in the case of apnoea due to a drop in alertness linked to lack of sleep.
Beyond these consequences that can lead to premature death, there are also many disabling symptoms that affect the quality of physical, social and mental life:
- Fatigue and drowsiness
- Mood swings, depression
- Difficulty concentrating
- Memory problems
- Libido disorders
Sleep apnoea in children is also associated with learning and growth disorders.
All of this results in a high cost to the health of the untreated person suffering from sleep apnoea. In fact, the cost will be twice as high, as they have more hospitalisations, medical consultations and drug treatments.
This cost is also important because of the decline in productivity levels at work and the increase in accidents at work. For example, the American Academy of Sleep Medicine has estimated the cost of lost productivity in the US due to untreated sleep apnoea at $87 billion.
Despite its harmful impact, this sleep apnoea syndrome is too often overlooked, its symptoms appear mild or harmless and 75% of cases of sleep respiratory disorders go undiagnosed.
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