The SAS (Sleep Apnea Syndrome) is a condition defined by an excessive number of stops (apnea) or reduction (hypopnoea) of breathing during sleep for more than 10 seconds and repeating more than 10 per hour of sleep, partnering with a daytime hyper somnolence (periods of extreme fatigue occurring frequently during the day).
The phenomenon of sleep apnea is associated, among other things, with changes in the rate of oxygen in the blood (arterial oxygen saturation, or SpO2), heart rate and blood pressure. Sleep apnea affects 1-5% of the adult population and has a frequent incidence in men.
The SAS is associated with repetitive obstruction of the upper airway due to anatomical narrowing of the pharyngeal region (back of the throat). This narrowing is either innate, but most often related to a defect in the nervous control or, in the vast majority of cases, acquired in life, most often in connection with excess fat associated with obesity.
With each breath, the flow of air goes through the upper airways, which are real elastic conduits through dilator muscles of the pharynx. But during sleep, especially if an excess of fat is present, the activity of these muscles is slowed, the airways become less rigid and they close easily during inhalation. A clear disruption sleep quality follows, since the phases of sleep become shorter or nonexistent.
These results in a significant decrease in the quality of life due to multiple periods of drowsiness during the day and other complications that may be more or less serious on short or medium term.
The main risk factors for this syndrome are: male gender, obesity, age between 40 and 65, being a woman after menopause. The sleep apnea syndrome is aggravated by the intake of sleeping pills, alcohol, abuse of stimulants (caffeine) and an unhealthy lifestyle with late or variable bedtime hours.
The diagnosis of sleep apnea syndrome is essentially clinical and it is based initially on a thorough examination in search of the main symptoms: intense and irregular snoring, diurnal sleepiness which becomes a social and professional handicap, headaches, dry mouth, impaired concentration, low libido, chronic nasal congestion, nightmares, or even sleepwalking, irritability and muscle fatigue during exercising.
There are other clinical signs that may suggest the existence of the Sleep Apnea Syndrome, such as obesity, high blood pressure resistant to anti-hypertensive medication, hypertrophy of pharyngeal structures (soft palate, base of tongue, tonsils). These signs are associated relatively frequent with sleep apnea, but not mandatory for diagnosis.
The aim of sleep apnea treatment is to suppress the symptoms and avoid the risk of complications. The success of the treatment is primarily based on lifestyle and dietary essential rules, such as reducing weight through a healthy diet, reducing or stopping the consumption of alcohol and stimulants as well as going to bed at regular hours. Sleeping pills are not indicated because of respiratory depression that can result.
The main treatment of sleep apnea syndrome is so far based on the use of nocturnal ventilator support devices (CPAP: Continuous Positive Airway Pressure), which keeps open the upper airways through the insufflations of a continuous positive airway pressure through a mask connected to a compressor. Thus, apnea disappears and the quality of sleep is significantly improved.
This treatment is quite effective, well tolerated, but binding, requiring a special education of the patient and a minimal use of 5 to 6 hours per night of the machine.
Surgery generally has little place in the treatment of sleep apnea syndrome, except in cases of obvious anatomical abnormality. The operations are usually complex and they involve the soft tissue, palate, tongue, pharynx, tonsils and bony structures (maxilla and mandible).