by Marzia Segù – researcher at the University of Parma
Why is sleep so important? Good sleep improves memory, attention, concentration, emotional control, increases creativity, repairs DNA damage, reduces obesity, the risk of developing diabetes, improves nutrition, reduces the risk of developing dementia, cancer, cardiovascular diseases, infectious diseases, reduces anxiety and depression, makes you more attractive and increases life expectancy. Sleep can be compared to a “sweeper” which cleanses the brain of toxic metabolic waste substances.
And poor quality sleep has acute effects: reduced cognitive functions, tiredness and fatigue, irritability and depressed mood, reduced performance at work or school, and chronic: reduced life expectancy, hypertension, cardiovascular disease, obesity, infections, diabetes and poor glucose tolerance. At work the number of accidents doubles, reduces productivity and work efficiency increases absences for health reasons and increases health care costs and reduces academic performance. Increases daytime sleepiness and the risk of sleep-induced traffic accidents. 22% of serious road accidents are caused by falling asleep. Falling asleep doubles the mortality rate of accidents (11.4% against 5.6%).
One of the possible causes of reduced sleep quality is Obstructive Sleep Apnea Syndrome (OSAS) which is clinically characterized by daytime sleepiness and/or impaired daytime performance and nocturnal snoring. On the physiopathological level, OSAS is characterized by the appearance during sleep of repeated episodes of partial or complete obstruction of the upper airways associated with phasic oxemia falls and consequent oxygen desaturations.
Snoring is one of the most important symptoms.
The ratio of men to women diagnosed with OSAS is 8:1 and greater. There is a serious tendency to under-diagnosing women in clinical practice. This is because, as well as for social reasons (women tend to deny the snoring symptom above all), there are important gender differences: men with OSAS are sleepy, snore loudly, are generally aged between 45 and 65, are often heavily overweight, while women have daytime fatigue, loss of energy, mood disturbances, depression, morning headache, nightmares, and insomnia.
There are three moments in a woman’s life particularly at risk: the pregnancyil post partum and the menopause.
There are two distinct clinical phenotypes of OSAS in pregnancy: women with pre-existing OSAS that may worsen and women who develop OSAS due to weight gain.
OSAS associated with hypertension can result in a preterm birth.
Sleep disorders, anxiety and vitamin D deficiency are associated with an increased risk of postpartum depression.
In premenopausal women, OSAS is related to sexual dysfunction.
In menopause, OSAS has a higher prevalence especially in women who do not undergo replacement therapy and is associated with a early cognitive deficits (memory impairment and reduced executive function as early as age 45) and joint pain.
Finally, women with OSAS have a higher risk of developing arterial hypertension.
Hence the need to early intercept the pathology through a clinical evaluation and an instrumental examination (polysomnography or cardio-respiratory monitoring) and to manage the patient by individualizing the therapy in its various approaches: sleep hygiene, weight control, positional therapy, CPAP, mandibular advancement device (MAD), ENT and maxillofacial surgery.