Question 1

Polysomnography (PSG)

Accepted Answer

The definitive diagnosis to establish the presence of sleep apnea relies on a clinical evaluation during a sleep test and a polysomnography (PSG). This standardized test is reproducible and validated in research and clinically, and is the gold standard for diagnosing sleep apnea. Nocturnal polysomnography is the most comprehensive examination and remains the preferred choice for evaluating sleep-related breathing disorders. However, it requires a technician and must be performed in a laboratory or a sleep specialized clinic using heavy equipment. PSG consists of a night of recordings of various parameters for a duration of at least 6 hours. This comprehensive test allows for the diagnosis of several types of sleep disorders, including obstructive sleep apnea syndrome (OSAS), restless legs syndrome, and narcolepsy.

Question 2

Causes

Accepted Answer

Two main causes can explain sleep apnea: Obstruction • Apnea can be "obstructive" if it is accompanied by an obstruction or associated with metabolic syndrome. This is then referred to as obstructive sleep apnea syndrome (OSAS, or OSA). This is the most common type of sleep apnea. • Other factors that can contribute to obstructive sleep apnea include the presence of: • enlarged tonsils obstructing the airway, • excess fatty tissue in the throat in obese individuals, • an overly long soft palate, • a lower jaw that is too short or set back (mandibular retrognathia). • Obstructive apnea requires respiratory effort to overcome an obstruction in the upper airway (nose, mouth, pharynx, and larynx). • Obstruction can vary in severity and may be due to age (aging), malocclusion, hormonal imbalance, diabetes, enlarged adenoid tissues (tonsils, adenoids), or excess weight.

Question 3

Symptoms

Accepted Answer

The main symptoms of obstructive sleep apnea are: • unexplained daytime fatigue and drowsiness; • frequent and uncontrolled falling asleep; • snoring and breathing interruptions during sleep. Other signs and symptoms may include: • elevated blood pressure; • irritability; • sensation of choking or gasping at night; • extreme fatigue; • depression; • difficulty concentrating; • decline in academic performance (children); • morning headaches; • memory problems; • erectile dysfunction (impotence) • The severity of OSAHS includes 2 elements: the severity of daytime sleepiness and that of nocturnal respiratory abnormalities. (5)

Question 4

Cardiorespiratory sleep polygraphy (CRSP)

Accepted Answer

There is a simpler version of a sleep test that measures fewer signals, called cardiorespiratory polygraphy. This simplified polysomnography does not evaluate physiological parameters and is primarily used to investigate sleep-related breathing disorders. It is not a screening test but a simplified diagnostic test. • It cannot distinguish between obstructive sleep apnea and central sleep apnea. • It cannot diagnose other sleep-related disorders such as lower limb movements, central sleep apnea, REM sleep behavior disorder, etc. Furthermore, insomnia can interfere with the results. (2) Using various sensors, this test measures and records, but is not limited to: • Oxygen saturation and heart rate; • Respiratory flow; • Thoracic effort; • Abdominal effort; • Body position.

Question 5

Consequences

Accepted Answer

Not only do individuals with OSAS experience a reduced quality of life, but so does their entourage. Sleep apnea affects sleep quality, which can: • decrease deep and REM sleep and cause micro-arousals, • cause excessive daytime sleepiness, cause irritability, decreased libido, or a depressive state, • decrease the partial pressure of oxygen in the blood, causing oxygen desaturation. This leads to chronic hypoxia which can result in high blood pressure and other cardiovascular disorders. • worsen pre-existing conditions such as endocrine disorders like diabetes or cardiovascular conditions.

Question 6

Nocturnal oximetry (nocturnal saturometry)

Accepted Answer

Several diseases, such as chronic obstructive pulmonary disease, decompensated heart failure, and sleep apnea-hypopnea syndrome (SAHS), can cause nocturnal oxygen desaturations. (1) Nocturnal pulse oximetry uses a simple device placed on a fingertip that allows for the assessment of functional blood oxygen saturation through a painless optical measurement. The measurement of blood oxygen saturation indicates the percentage of oxygen-carrying hemoglobin in the blood. The device is worn for one night, and the data is recorded in the device to be subsequently interpreted by computer. This allows for easy screening which can lead, depending on the results obtained, to a more complete evaluation if necessary.

Question 7

Diagnosis

Accepted Answer

The best way to diagnose sleep apnea and other sleep problems is with a test called a "polysomnography" (PSG). This test can be performed in a "sleep lab," which is a clinic where one can spend the night. Some partial tests can be done using a portable device that the patient can use at home for home monitoring. This allows for the evaluation of oxygen levels, airflow through the nose and mouth, respiratory variations, and snoring. Diagnosis is based on the presence of an excessive number of events (apneas and hypopneas) observed during the polysomnographic recording. This test can measure the following: • brain activity • sleep stages (duration, awakenings, etc.) • eye movements • muscle tone • pulse • leg movements • respiration • airflow • chest and abdominal movements • blood oxygen level.

Question 8

Apnea-Hypopnea Index (AHI)

Accepted Answer

Polysomnography quantifies respiratory events per hour and establishes an Apnea-Hypopnea Index (AHI). • Apnea is defined as a complete cessation of breathing or naso-buccal airflow for 10 seconds or more. • Hypopnea is a partial interruption (a 30% reduction in airflow). It corresponds to a decrease in blood oxygen saturation of at least 3-4% on a polysomnography, but there is no consensus on the duration of this event. However, many accept a duration of 10 seconds as a reference for hypopnea, just as for apnea. Note: Currently, there is no consensus among sleep-disordered breathing specialists regarding the definition of hypopnea.

Aspect	CPAP	Mandibular advancement device
What it involves	A machine that delivers pressurized air through a mask during the night.	A custom oral appliance that holds the lower jaw slightly forward.
Generally considered for	Obstructive sleep apnea, including more severe forms.	Often considered for mild to moderate apnea, or when CPAP is not well tolerated.
Comfort and habits	Requires a mask, tubing and a power source; an adjustment period is common.	Worn in the mouth, with no noise or electricity; an adjustment period is also needed.
Travel	A device to carry, power supply required.	Compact and easy to travel with.
Maintenance	Regular cleaning of the mask, tubing and filters.	Daily cleaning and periodic check-ups at the clinic.
Who decides	Prescribed and monitored by a physician, following a sleep assessment.	Recommended after a medical and dental evaluation; provided by a trained dentist.

Breathe better at night, get your energy back during the day

What is Apnée Laval?

Does this sound like you?

Loud, regular snoring

Observed breathing pauses

Fatigue upon waking

Daytime sleepiness

Morning headaches

Difficulty with CPAP

What happens in your airway

Without an appliancethe jaw falls back

With the appliancethe airway stays open

Custom-made,discreet and portable

Without an appliance, the jaw falls back

With the appliance, the airway stays open

Custom-made, discreet and portable

What working with us looks like

1. First conversation

2. Sleep assessment

3. Dental examination

4. Impressions and fabrication

5. Fitting and adjustments

6. Follow-up

CPAP and mandibular advancement device

Could an oral appliance be part of the discussion?

Your questions, our answers

Let’s talk about your sleep