Diagnosis and screening of sleep apnoea
How do you know if you suffer from sleep apnoea syndrome?
Although common, it is quite difficult to diagnose sleep apnoea syndrome. It is generally accepted that 80% of people with sleep apnoea are undiagnosed for several reasons:
- Lack of knowledge about the problem of sleep apnoea and its consequences.
- Symptoms that insidiously develop over time, such as fatigue that is mistakenly attributed to other reasons (work, going out, etc.).
- A rejection of the most well-known treatments such as surgery or positive pressure ventilation.
- A lack of time or means.
- Appointment times for diagnosis can be long and restrictive.
What are the signs of sleep apnoea?
You should be concerned if you experience several of the following signs:
- severe snoring,
- significant daytime sleepiness,
- constant fatigue,
- headaches in the morning,
- respiratory arrest described by your entourage,
- getting up several times to go to the toilet (nocturia),
- disturbed attention and difficulty concentrating,
- memory problems,
- depression,
- impotence, etc.
A combination of several of these signs should be a warning as they can be a direct consequence of a sleep apnoea problem. And in this case an effective treatment will be able to make them disappear.
Certain factors also predispose to the occurrence of sleep apnoea. Being overweight, having a very recessed lower jaw, alcohol intake and age all contribute to the onset of sleep apnoea.
Special attention should also be paid to men suffering from these symptoms, as men are more prone to sleep apnoea syndrome.
However, women are not protected and after the menopause they are just as prone to sleep apnoea as men.
Screening questionnaires can also help to identify a risk of sleep apnoea. Perhaps the most recognised by the medical community is the Berlin questionnaire and the STOP BANG test.
Finally, sleep apnoea has many adverse health consequences and can lead to serious pathologies which are all signs, for the person suffering from it, of a potential risk of sleep apnoea. Among these pathologies linked to sleep apnoea are high blood pressure, cardiac arrhythmia, type 2 diabetes, cerebrovascular accidents, heart attacks and cancer.
What to do when these symptoms are detected?
If sleep apnoea is suspected, you should consult a specialist doctor with special training in sleep disorders. They may be ENT doctors, Respirologists, Cardiologists, General Practitioners, etc. The patient’s sleep will then be recorded in the laboratory or at home.
These doctors can use 2 techniques:
- Nocturnal respiratory polygraphy
This technique consists of recording respiratory movements, the flow of air in and out through the nasal passages and the level of oxygen in the blood.
The polygraphy takes place at home and requires at least 6 hours of sleep to be effective. The result will make it possible to specify how many sleep apnoea were detected during the recording and thus to know the severity of the sleep apnoea syndrome.
However, this technique does not detect sleep stages, which leads to inaccuracy. For example, if the polygraph measured 100 sleep apnoea during 10 hours of recording the result will give an apnoea rate of 10 per hour (100/10h).
But if in reality the person has only slept 5 hours during the 10 hours of recording, the real rate of apnoea is 20 per hour (100/5h).
This technique therefore tends to underestimate the actual rate of apnoea and the severity of the problem.
- Polysomnography
This technique is more complete than the polygraphy because it provides information on the patient’s brain activity. It thus makes it possible to detect the exact duration of sleep and to measure the rate of apnoea per hour of sleep (IAH) more precisely.
The polysomnography requires spending a whole night in a laboratory or specialised service. The polysomnography will record brain activity (via an electroencephalogram), naso-oral airflow, thoracic and abdominal movements (to determine respiratory efforts) as well as movements of the extraocular muscles in order to identify the REM sleep phase. It is generally recommended if the results of the polygraph have left the doctor doubtful about the nature and severity of the sleep problem.
These techniques make it possible to detect and determine the severity of sleep apnoea by detecting, among other things, the number and duration of sleep apnoea during the night and the drop in oxygen in the blood. The longer a sleep apnoea lasts, the more oxygen the body will lack and the greater the health consequences.
If you are diagnosed as suffering from sleep apnoea syndrome, you will be referred to a solution adapted to your severity.
Here are the treatments recommended today by the Health Authorities according to severity.
| Severity of OSAS | Treatment recommended first | Treatment recommended second in case of failure of the first treatment |
|---|---|---|
| Simple snoring or less than 15 apnoea/hour | MAD | Surgery* |
| From 15 to 30 apnoea/hour without cardiovascular complications | MAD | Surgery* |
| From 15 to 30 apnoea/hour with cardiovascular complications | CPAP | MAD |
| More than 30 apnoea/hour | CPAP | MAD |
|
OSAS: Sleep apnoea syndrome; MAD: Custom-made mandibular advancement device; CPAP: Continuous Positive Airway Pressure; Surgery: different types of operation are envisaged according to the morphological specificities of the patient (e.g. tonsil hypertrophy = tonsillectomy; hypertrophy of the soft palate = uvulopalatoplasty). Note: The European Respiratory Society (ERS) advises against radio frequency and nasal surgery to treat OSAS. | ||
ONIRIS – Class I medical device manufactured by ONIRIS SAS and indicated in the treatment of snoring and sleep apnoea – Read the leaflet carefully before use – Ask your doctor or pharmacist for advice. This medical device is a regulated health product which, under these regulations, bears the CE mark.
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A complete range of oral devices to meet your needs
| ONIRIS | ONIRIS Pro | Tali | |
|---|---|---|---|
| Freedom of movement | |||
| Millimetre-adjustment of the advancement | |||
| Custom-made impression | |||
| Clinically approved for snoring | |||
| Clinically approved for sleep apnoea | |||
| Approved by the French National Authority for Health | |||
| Developed by a trained dentist | |||
| Custom-made | |||
| Waiting time | 24-48 hours | 30 days | 3 to 9 months |
| Average lifespan | 12 to 24 months | 12 to 24 months | 5 years |