What is and how to treat sleep apnea in women

Despite being a very common disorder (It is estimated that it affects two million Spaniards), the Obstructive sleep apnea It is a pathology that has been studied relatively recently. A panorama that is changing since after its scandalous snoring it hides a whole universe of respiratory pauses and micro-arousals that compromise health more than meets the eye.

The mechanism of apnea is simple. In some people, the airway collapses during sleep and does not allow air to pass through. This pause can last from 10 to 15 seconds. "Before the drop of oxygen in blood, the brain wakes us up for a couple of seconds to breathe again," explains dr. Carles Gaig, coordinator of the Sleep Study Group of the Spanish Society of Neurology.

Women have less daytime sleepiness than men.

For decades, men have been, almost exclusively, the protagonists of the studies on this disorder, a bias that has consequences for the female health, since what is true for them does not have to be true for them. An example? Until 2014, the first study that analyzed the relationship of obstructive sleep apnea in women with cardiovascular diseases was not published. It was in the American Journal of Respiratory and Critical Care Medicine and revealed that patients with untreated apnea suffer from a increased risk of cardiovascular problems serious.

"For discoveries like this one has begun to study this syndrome more in women and, thanks to this, we have noticed other important things, such as the profile of the Obstructive apnea The dream that occurs in them is not exactly the same as what men show, "warns Dr. Olga Mediano, pulmonologist and coordinator of the Sleep area of ​​the Spanish Society of Pneumology and Thoracic Surgery.

Although both men and women share the obesity as one of the major risk factors for apnea, if you analyze the way this syndrome occurs in some and others as soon as they reach the consultation, the differences begin. "The usual thing is for the male to bring his partner because he pauses in the breathing At night, he snores a lot and falls asleep during the day. But nevertheless, the profile of the woman with apnea is not this. In them, the couple usually does not realize that they take breaks during sleep and do not show so much daytime sleepiness, "explains Dr Olga Mediano.

Diagnostic error

What do women complain about with apnea in the office? Well, from fatigue. The problem is that that exhaustion It shares characteristics with that provoked by other disorders that are traditionally associated with women's health, such as insomnia or fibromyalgia.

Not resting increases the risk of depression, stroke and stroke.

"In addition, as in them the exhaustion picture is more prolonged in time than in them, in many cases when they arrive at the consultation they also suffer from certain depression and memory problems and attention. They are easier to identify, while they come with a subtle clinical profile and that means that sometimes, by mistake, they do not get the sleep study they need, "says Dr. Mediano. Apnea with insomnia, the problem worsens, as the medication to combat it relaxes the airway more, which can worsen apnea. "This does not mean that all patients with insomnia require a sleep study, but it is necessary a detailed clinical history, because thanks to it we can suspect that there is an apnea associated with this difficulty to reconcile or maintain sleep, "says the expert.

The consequences of bad sleep

To the obvious loss of quality of life that supposes not being able to rest, it is necessary to add to the list of consequences that this respiratory disorder causes the fact that it multiplies by four the probabilities of suffering a traffic accident. In fact, specialists recommend more serious patients not to drive. "In the short term, sleep broken by apneas also affects the brain and makes it difficult for us to pay attention during the day and to perform cognitively, and micro-arousers avoid the consolidation of nighttime memory," explains Dr. Carles Gaig.

The Respiratory pauses, snoring and micro-arousals they also produce alterations that increase oxidative stress and end up creating a proinflammatory state that contributes to the onset or progression of cardiovascular disorders.

21% of women suffer from apnea, compared to 32% of men.

But the most current data ensure that not only the heart suffers because of apnea. This syndrome has also been linked to the appearance of diabetes because it is capable of affecting the metabolism of glucose and producing resistance to it. In fact, according to the International Diabetes Federation, treating apnea helps reduce the necessary dose of insulin in diabetics.

"In the long term, it is being investigated whether the inability to have a restful sleep due to apnea influences the appearance of Alzheimer's, since it has been proven that during the dream we evacuate substances toxic to the brain. But if we sleep little, we do not eliminate them in equal measure. This is a possibility. What we do know with certainty is that not resting well increases the presence of other diseases They also affect the brain, such as anxiety, depression, stroke and stroke, "concludes Dr. Carles Gaig.

Infographic on respiratory disorders during sleep.

sergio arango

Several causes, several solutions

Before a patient with Sleep apnea The first thing to do is to investigate if the cause that causes it is reversible. And this is the time to remember that 60% of patients with obstructive apnea suffer from obesity, an important risk factor, although not the only one.

"We are conducting a study to distinguish the different phenotypes of patients with apnea and we believe that in the premenopausal women the obesity profile is not met. We think that other factors come into play, such as the anatomy of the upper airway and the weakness of that airway. Are patients who are thin or lightly overweight, who have sleep apneas because their airway collapses more easily. In this phenotype, genetics has a lot to do, "explains Dr Mediano.

It is a poorly diagnosed syndrome: only 9% of those affected are treated.

Whether due to anatomy or excess weight, for some patients the solution may involve a visit to the operating room. If the person has a tonsil or a large uvula, a surgery that reduces its size is valued. If you have a hypertrophic chin that detracts a lot of space from the airway, a mandibular advance can be made. If the airway is obstructed by nodules or the septum of the nose deviated, they can be corrected. Even if the problem is obesity and a patient is not able to lose weight, the operating room may be an option. "In people who need to lose 30-40 kilos and suffer severe apneas, with 60 and 70 per hour, the bariatric surgery gives good results Weight loss reduces the number of apneas and in some cases they disappear, "says Dr Olga Mediano.

Masks or prostheses

If these treatments, which are definitive and can cure the patient, can not be performed because the person is not a suitable candidate for surgery, the resource of choice is the CPAD (Continuous positive airway pressure device): a mask connected to a machine that is used during sleep and that puts pressure through the nose to open the airway while the person is asleep.

But when the patient does not tolerate CPAD, there is another type of mandibular advance prosthesis which is used during sleep and, as its name suggests, manages to advance the jaw leading in front of the jaw, which produces an increase in airway space.

"Although these devices work better in thin patients who suffer mild-moderate apnea, sometimes we also use them in severe cases that are not able to tolerate CPAD, as a second line of treatment," explains Dr. Medium.

And what will the future hold for us? Maybe in a few years, the drugs can offer a third option for those who suffer from this problem. "An article about the effectiveness of drugs in the treatment of obstructive sleep apnea has just been published, but it is still in a very early stage of research," the specialist says.

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