THEapnea some sleep is manifested by involuntary stops in breathing, “apneas”, occurring during sleep. Sleep apnea usually occurs in people who are overweight, elderly, or who snore heavily.

These breathing pauses last by definition more than 10 seconds (and can reach more than 30 seconds). They occur several times a night, with varying frequency. Doctors consider them to be problematic when there are more than 5 per hour. In severe cases, they occur up to more than 30 times per hour.

These apneas disrupt sleep and mainly result in fatigue when you wake up headaches or a drowsiness during the day.

Causes

In the majority of cases, the apneas are due to a relaxation of the tongue and the muscles of the throat, which are not tonic enough and block the passage of the air during the breathing. Thus, the person tries to breathe, but the air does not circulate because of the obstruction of the airways. This is why doctors speak of obstructive apnea, or obstructive sleep apnea syndrome (SAOS). This excessive relaxation mainly concerns the elderly, whose muscles are less toned. Obese people are also more prone to sleep apnea because excess neck fat decreases the caliber of the airways.

More rarely, apneas are due to a malfunction of the brain, which stops sending the “command” to breathe to the respiratory muscles. In this case, unlike obstructive apnea, the person does not make any breathing effort. We then speak ofapnea central sleep. This type of apnea occurs mainly in people with a serious condition, such as heart disease (heart failure) or neurological disease (for example, meningitis, Parkinson’s disease, etc.). They can also appear after a stroke or in severe obesity. The use of sleeping pills, narcotics or alcohol is also a risk factor.

Many people have a “mixed” sleep apnea, with an alternation of obstructive and central apneas.

Prevalence

The frequency ofapnea some sleep is very high: it is comparable to that of other chronic diseases such as asthma or type 2 diabetes. Sleep apnea can affect adults and children, but its frequency increases sharply with age.

It is 2 to 4 times more common in men than in women, before the age of 60. After this age, the frequency is the same in both sexes⁶.

The estimate of the prevalence varies according to the degree of severity taken into account (number of apneas per hour, measured by theapnea-hypopnea index or AHI). Some studies in North America estimate the frequency of obstructive sleep apnea (more than 5 apneas per hour) at 24% in men and 9% in women. About 9% of men and 4% of women have a moderate to severe form of obstructive sleep apnea syndrome^1,2.

Possible complications

In the short term, theapnea some sleep causes fatigue, headaches, irritability … It can also inconvenience the spouse, because it is often accompanied by loud snoring.

In the long term, if left untreated, sleep apnea has many health consequences:

Cardiovascular illnesses. Sleep apnea significantly increases the risk of cardiovascular disease, through mechanisms that are not fully understood. However, we know that each respiratory pause causes a deficiency in oxygenation of the brain (hypoxia), and that each sudden micro-awakening causes an increase in blood pressure and heart rate. In the long term, apneas are associated with an increased risk of cardiovascular problems, such as: hypertension, stroke, myocardial infarction (heart attack), cardiac arrhythmia (cardiac arrhythmia) and heart failure. Finally, in the event of significant apnea, the risk of dying suddenly while sleeping is increased.

Depression. Lack of sleep, fatigue, the need to take naps, and drowsiness are associated with sleep apnea. They decrease the quality of life of those affected, who often suffer from depression and isolation. A recent study even showed a link between sleep apnea and cognitive impairment in older women.⁵.

Accidents. Lack of sleep induced by apnea increases the risk of accidents, in particular accidents at work and on the road. People with obstructive sleep apnea syndrome are 2 to 7 times more likely to be in a traffic accident².

Complications in case of surgery. Sleep apnea, especially if it is not yet diagnosed, can be a risk factor for general anesthesia. Indeed, anesthetics can accentuate the relaxation of throat muscles and therefore worsen apnea. Pain medications given after surgery may also increase the risk of severe apnea.³. It is therefore important to inform your surgeon if you suffer from sleep apnea.

When to consult

Doctors believe that the vast majority of people withapnea some sleep do not know. Most often, it is the spouse who notices the presence of apneas and snoring. It is advisable to see a doctor if :

• your snoring is loud and disturbs your partner’s sleep;
• you often wake up at night feeling like you are struggling to breathe or if you go to the bathroom several times a night;
• your partner notices breathing stops while you sleep;
• you feel tired in the morning and fall asleep frequently during the day. Epworth’s sleepiness test measures how sleepy you are during the day.

Your doctor may refer you to a center specializing in the study of sleep. In this case, a test called polysomnography will be realized. This test makes it possible to study the different phases of sleep and to measure several parameters to detect sleep apnea and assess their severity. In practice, you have to spend a night in the hospital or in a specialized center. Electrodes are placed in different places on the body to observe parameters such as brain or muscle activity, the level of oxygen in the blood (to ensure that breathing is efficient) and the various sleep phases. This allows you to know if the person is entering a deep sleep phase or if apneas are preventing it.