Montpellier: sleep apnea, surgery as an alternative to the oxygen mask

The Montpellier Mutualist Institute, Beau Soleil Clinic, candidate for sleep apnea surgery.

Almost everyone is subject to sleep apnea, but the repetition during the night is highly dependent on medical management. An information day for ENT surgeons was recently organized at the Beau Soleil clinic. The goal, to present the possible solutions offered to patients who cannot bear the oxygen mask or the mandibular orthosis at night. In particular the possibility of surgical interventions.

“Surgery always comes as a second intention, says Doctor Vincent Trevillot, ENT at the Beau Soleil clinic and specialist in severe sleep apnea syndrome. The reference treatment remains continuous ventilation (CPAP) by mask worn at night or mandibular orthosis”. Solutions that have been proven but that some patients do not accept “depending on the movements at night which can disturb the correct wearing, mask or prosthesis”.

Detect sleep apnea

Surgical interventions are of several types: “Interventions in the palate where the tissues are tightened. Neurostimulation of the hypoglossus, a nerve that advances the tongue, is also in full development”, details the specialist. But this last development is not yet practiced in France.

To assess the propensity to sleep apnea, a reading is necessary: “We equip the patient to measure breathing, heart rate, oxygen saturation overnight.” The device records the number of apneas per hour during the sleep phase (see insert). Return the next day to the clinic to analyze the data: “We can thus interpret”. For the ENT specialist, the main risk of people suffering from sleep apnea is drowsiness. But also cardiovascular risks: “It’s a little more controversial”he points out.

The degrees of sleep apnea

Sleep apnea syndrome is calculated as the frequency of respiratory blockage per hour during a night’s sleep. Above 30, the index is severe. Between 15 and 30, it is moderate. In the last case, in case of comorbidity, the treatment can be supported. A few nocturnal apneas remain normal “up to 5 per hour”. Eight patients were operated on at Beau Soleil, as part of the research. Last month, this therapeutic principle was accepted by the high health authority. Support should follow.

Hence the interest of a precise medical follow-up, because according to the age, the protocols will not be the same: “You cannot treat someone 86 like someone 40. But we will indicate a protocol in any case”. First sound sign of a possible sleep apnea syndrome, snoring.

In children, detect the first disorders

Respiratory Health France is committed alongside Sleep of Marmotte, a fun and educational tool, to raise awareness of children’s sleep disorders, especially those due to sleep apnea.” Respiratory problems in children during their sleep are little known and largely underestimated, explains Doctor Frédéric le Guillou, President of Santé Respiraire France. The diagnostic process is often an obstacle course for parents”. According to the association, between 2 and 5% of children are affected by sleep apnea syndromes, 30% are affected by a respiratory allergy, partly responsible for certain sleep disorders. To help parents and children, the free Marmot Sleep app exists (also in book form) with games, quizzes, interactive animations, an FAQ, advice for parents, in order to support children in their illness. A tool designed by Dr. Madiha Ellaffi, pulmonologist and allergist.

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