Nighttime snoring, unusual irritability and tiredness are some of the signs that suggest sleep apnea. Many other manifestations are to be linked to this pathology which is still underdiagnosed in the general population. The need for more targeted multidisciplinary care is at the origin of the opening in November of a new concept of medical center. Doctor Marc Sapène explains the ins and outs of this ambitious and necessary project.
Can you in a few words define us the syndrome of obstructive sleep apnea (OSAS)?
We could simply define OSAS simply as a succession of nocturnal respiratory pauses. In reality , we must integrate a more modern concept as our specialist stipulates . “It is a respiratory event with an effort during sleep which leads to an arousal reaction with sleep fragmentation and modification of the functioning of the cardiovascular system. All this leads to a reduction in nocturnal respiratory flow. This pathology affects 15 to 20% of the general population. In 2015, Dr. Raphaël Heinzert and his team demonstrated this with the HypnoLaus study.
If the symptoms seem identical in adults and children, do the etiologies differ?
There is no secret . To have a good night, you need correct nasal breathing and the tongue stuck to the palate. If these two conditions are not met, good quality sleep is missed with, as a bonus, an increased risk of OSAS.
In children, enlarged tonsils should be promptly corrected. If this is not the case, evolution towards OSAS is possible with its procession of symptoms.
Other abnormalities promote mouth breathing. As Doctor Sapène reminds us, “Facial dysmorphisms of genetic or anatomical origin with poor development of the facial bones should prompt the search for OSAS in adults and children”. It may be a palate deformed by sucking the thumb or too frequent use of the pacifier (the famous “tototte” supposed to calm the child in all circumstances). The lower jaw too far back (retrognathia) with a receding chin is another aspect. Do not forget the overweight with infiltration of fatty masses on the upper airways.
It goes without saying that the hypotonicity of the tongue does not help matters!
As for respiratory allergies, they are not unrelated to the development of OSAS Hypertrophy of the nasal mucosa leads to obstruction of the upper airways
Can untreated OSA have health consequences?
In children, attention, learning and growth disorders are observed during the child’s development. For this reason, OSAS should be detected as early as possible.
“OSA interests a large number of specialties: endocrinologists, pediatricians, cardiologists, pulmonologists, allergists, ENT. It gives rise to several pathologies: obesity, type 1 and 2 diabetes, high blood pressure, myocardial infarction…” The impact on quality of life is major. “Drowsiness during the day increases the risk of road accidents. At the same time, the risk of mortality is multiplied by 12”.
Depression is sometimes misdiagnosed. Polygraphy at home or, if necessary, polysomnography in hospital allows the diagnosis to be corrected and directed towards OSAS.
The loss of tonicity of the tongue and mouth breathing are factors of aggravation of this pathology, how to remedy it?
Maxillofacial rehabilitation has its place in the treatment of moderate OSA or in addition to mechanical treatments. It is absolutely necessary to fight against excessive frenectomy or frenotomy as required the academy of medicine during April 2022
Can you remind us of the basics of the treatment??
In sleep apnea, it is not a question of drug prescription (except of course for associated pathologies). The care, often multidisciplinary, adapts according to the cause and the severity of the OSAS. Broadly speaking, we have seen that maxillofacial physiotherapy (reserved for moderate forms) has its place in improving nocturnal respiratory performance. However, in some cases, it is not enough and it is necessary to go to the next step. CPAP nasal mask fitting; is, as Dr. Sapène indicates, “almost miraculous” in the case of severe obstructive sleep apnea. The mandibular advancement orthosis and orthodontist treatments make it possible to correct anatomical anomalies. At the same time, everything is done to reduce excess weight. In children, let’s not forget the life-saving tonsillectomy!
The “Blue House” opens its doors in Bordeaux in November 2022. It’s one hell of an adventure! What are the bases of this project? Will there be other identical structures in France?
The new “Maison Bleue” medical structure is an innovative concept in the detection and support of OSAS in adults and children. It completes with its “open doors” spirit the service already existing in a private establishment in the city of Bordeaux. Doctor Sapène explains “that it is about this possibility offered to use all modern means to respond to this public health problem. The patient is at the heart of the system and all the health actors concerned are present on site. It is a team work also combining possibilities of teleconsultations, therapeutic education of the patient. New technologies are made available to optimize outpatient treatment, such as the Adelsanté platform.
Doctor Marc Sapene
Doctor Sapène, pneumo-allergist has been interested for more than a decade in the issue of sleep apnea management. For many years he held the position of president of the national association “Asthma and allergies”. In 2021, he becomes its vice president. In addition, this sleep specialist is president of “Alliance apnée”. Recently he wrote the preface to a book intended to inform the general public and health professionals about this pathology.
nensuria illustration for freepik