Anticipate and act: sleep apnea treatment, an informed choice after a consultation!

It is now well established that severe sleep apnea syndrome (SAS) (apnea-hypopnea index (AHI) >30/hour) is a major cardiovascular risk factor, particularly for hypertension and heart rhythm disorders. Treating it effectively on a daily basis can reduce or even eliminate this cardiovascular risk factor.
The efficacy of treatments for sleep apnoea syndrome has been established with regard to nocturnal ventilation by CPAP (continuous positive airway pressure) and mandibular advancement orthosis (MOAM). Added to this is the effectiveness of sustained weight loss. Other treatments, when sleep apnea syndrome is moderate or when CPAP is poorly tolerated, are being evaluated, notably positional treatments and oro-maxillo-facial re-education.
The choice of treatment should be the subject, during a announcement consultation, of a presentation of the various therapeutic options, each of which has advantages and disadvantages. The criteria for treatment choice by the woman and her doctor will be based, on the one hand, on the severity of the diagnosed disease and the patient's comorbidities, but also on the woman's possible reluctance linked to representations of her image with the treatment, particularly CPAP
Continuous positive airway pressure (CPAP) is the reference device for treating obstructive sleep apneas when they are numerous (apnea-hypopnea index>30/hour) and/or associated with hypertension or arrhythmia. This is a nasal ventilation device that keeps the airways clear during sleep. To date, CPAP is the only treatment whose efficacy in reducing hypertension and the recurrence of cardiac rhythm disorders has been the subject of numerous studies validating its remarkable effectiveness, which is why it is proposed as a first-line treatment for patients with hypertension or who have already had an arrhythmia episode. The device is delivered by a service provider to the patient's home.
This underlines the importance, at the time of diagnosis, of an announcement and explanations. There is never any urgency in instituting treatment for sleep apnea syndrome, which is why obtaining the patient's adherence to the therapeutic project is a prerequisite to be validated before it is instituted. Accepting CPAP for a woman often requires time to overcome any reluctance. The presence of the partner when the diagnosis is announced is a lever that allows time for exchanges and explanations about the treatment; this often helps to better understand the importance of adherence to the treatment and helps to anticipate difficulties in the couple's intimacy linked to the appliance.
Next comes the time of support in the early phase of introducing CPAP, carried out jointly by the doctor and the homecare provider: this time is crucial, as it guarantees good results in terms of CPAP use and therefore effectiveness. Patients using CPAP must take ownership of their treatment, through therapeutic education delivered progressively by the provider and the doctor.



The aim of the treatment is to improve the patient's symptoms, in particular the impression of unrefreshing sleep, morning headaches and daytime sleepiness, which rapidly regress within a few days of treatment initiation. Digital tools, such as smartphone applications developed by CPAP manufacturers, enable the effectiveness of CPAP to be monitored from the very first night of use, motivating the patient and providing solutions if adjustments need to be made.
An alternative treatment, the OAM is a custom-made dental device. It holds the lower jaw in an advanced position during sleep, freeing the passage of air through the pharynx. Effective in correcting apneas and hypopneas occurring during sleep when worn daily, it is proposed when the level of sleep apneas is qualified as moderate (15 to 30/hour) and in the absence of cardiovascular comorbidities or if CPAP is not accepted or poorly supported. However, its effectiveness in preventing cardiovascular pathologies associated with sleep apnea syndrome has not been clearly demonstrated.
Positional treatments, whose aim is to reduce or eliminate the onset of apneas by discouraging the person from going into the dorsal position during sleep, have emerged in recent years. These include devices such as vibratory alarms when the person is in the dorsal position, or "mechanical" devices such as specially designed pillows or semi-rigid backpacks, which discourage the dorsal position. These treatments are proposed when obstructive sleep apnea syndrome is positional, i.e. when apneas are present mainly in the dorsal position.
The therapeutic strategy will therefore be personalized according to several factors: severity of sleep apnea syndrome, cardiovascular comorbidities, extent of overweight, clinical impact and acceptance of treatment. It will evolve over the course of follow-up. Thus, a hypertensive, overweight patient with a high AHI will initially be offered CPAP; over time, and in the event of weight loss, and if the severity of sleep apnea syndrome diminishes, she may choose to opt for a mandibular advancement orthosis or positional treatment.
Agir pour le Coeur des femmes emphasizes the importance of taking the time to properly question women in consultation, to inform them about the sometimes atypical symptoms of apnea, to play down the situation and to clearly explain the benefits of treatment when it is necessary! Because sleep apnea is a real emerging cardiovascular and metabolic risk factor that is still poorly understood and insufficiently detected in women. So talk to your friends and family, listen to what they have to say, and get tested if you have symptoms suggestive of sleep apnea.