TREATMENT OF OBSTRUCTIVE SLEEP-APNEA SYND ROME

Obstructive sleep apnea syndrome (OSAS) is a chronic disorder in which the subject experiences an abnormally large number of episodes of mor e or less complete and prolonged ventilatory arrest due to pharyngeal obstruction leading to fragmented sleep pattern and reduced arterial o xygen saturation. OSAS produces invalidating daytime symptoms and appe ars to be associated with cardiovascular complications and overmortali ty. Diagnosis is based on an exploration of the sleeping pattern with recording of ventilation function, arterial oxygen saturation, heart r ate, and electrophysiological characteristics (polysomnography), Preva lence of a high apnea index (more than 5 per hour of sleep) associated with daytime somnolence may be as high as 3 % of the population in th e 30 to 60 year age range, Current treatment is mainly based on nasal continuous positive airway pressure given via the nasal route during s leep and pharyngeal surgery (uvulopalatopharyngoplasty). Surgery is re served for subgroups of patients with anatomic abnormalities and free of contraindications for anesthesia, Continuous positive pressure is a lways effective in case of symptomatic apnea and has a favorable effec t on several associated complications. It can be proposed for any pati ent with OSAS but its use is limited due to incomplete compliance (app roximately 70 %). It appears that patients with particularly severe di sease benefit most. Thus the ANDEM experts recommend treatment for all symptomatic patients with 30 or more episodes of apnea or hypopnea pe r hour of sleep during night-time exploration, Below this threshold, e lectrophysological recordings are required to eliminate another cause of fragmented sleep which could explain the symptomatology despite a m oderately elevated apnea index. Once the treatment has been started, r egular surveillance is recommended, In addition, general health and nu tritional councelling (weight reduction, smoking cessation, interrupti on of alcohol consumption and use of sedatives) should be proposed but usually have minimal and transitory effect.