CARDIAC PATHOLOGIES
SLEEP APNEA
Sleep apnea, also known as SAS (sleep apnea syndrome), includes both obstructive and central apneas.
Obstructive sleep apnea-hypopnea syndrome (OSAHS), formerly known as obstructive sleep apnea syndrome (OSAS), is characterized by the occurrence of abnormally frequent episodes of interrupted (apnea) or reduced (hypopnea) breathing during sleep. Breathing pauses can range from 10 seconds to 1 minute, and their quantity helps define the severity of OSA.
If they occur between 5 and 15 times an hour, SAS is mild.
If they occur between 15 and 30 times an hour, SAS is moderate.
If they occur more than 30 times an hour, SAS is severe.
Obstructive SAS (OSAHS) is due to repeated complete or partial obstructions of the respiratory ducts in the back of the throat (upper airways) during sleep.
Central SAS (SACS) is due to instability of respiratory control.
This reduction or interruption of ventilation during sleep causes a lack of oxygen. The brain reacts, and the body wakes up to resume breathing. These awakenings are short-lived: they are called “micro-awakenings” and the person is unaware of them.
This syndrome is often associated with nocturnal snoring and daytime drowsiness, the result of very disturbed, jerky, poor-quality sleep.
Other common symptoms include nocturnal polyuria (getting up several times to urinate at night), mood and memory disorders or a depressive syndrome, daytime fatigue, morning headaches, a feeling of unrefreshing sleep, and a feeling of suffocation or choking during sleep.
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Factors favouring SAS are :
- age (very common over 65), predominantly male
- overweight and obesity
- upper airway obstruction (e.g. deviated nasal septum, tonsil obstruction, jaw positioning problems, etc.)
- consumption of alcohol, tobacco, sedatives or sleeping pills
- heart failure (particularly in SACS).
The long-term consequences of sleep apnea are significant in terms of both cardiovascular and metabolic health.
The main pathologies associated with SAS are
HYPERTENSION
Coronary pathology, heart failure and stroke
Heart rhythm disorders (extrasystoles, fibrillation, etc.) or cardiac conduction disorders (cardiac pauses)
Metabolic disorders such as insulin resistance (leading to diabetes) and metabolic dyslipidemia.
Treatments include improving lifestyle habits:
- weight loss
- avoiding alcohol, tobacco and medication (benzodiazepines, muscle relaxants, morphine, sleeping pills)
- sleep hygiene
An ENT check-up may be indicated in cases of severe snoring.
Depending on the severity of SAS and the patient's history, treatment with CPAP (continuous positive airway pressure) or OAM (mandibular advancement orthosis) may be suggested.
