The Sainte-Barbe clinic, in Strasbourg, joins at the start of 2025 the French structures offering a stimulator capable of treating sleep apnea. France 3 Alsace takes stock of what you need to know about this syndrome which affects 5% of the population.
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It’s a small box that allows you to move your tongue forward every time you stop breathing in the middle of the night. Its name: the “XII stimulator”. It is an alternative to the traditional ventilator for people with sleep apnea, a disorder that causes the flow of breathing to stop during the night.
This stimulator can now be implanted by the Sainte-Barbe clinic in Strasbourg. The private establishment thus joins the public structures which offer the system to their patients, such as the Bordeaux University Hospital, the first to have tested it in 2016.
If more and more specialized health establishments are getting started, it is because Health Insurance has decided to cover the device since August 2024. The surgical option is thus added to other methods of treatment of a pathology likely to cause strokes and heart attacks, in its most serious form. Sleep apnea, or more precisely, obstructive sleep apnea-hypopnea syndrome (OSAS), affects 4% of the population, or around 4 million French people of all ages.
The disease is characterized by pauses in breathing that can last 10 to 30 seconds or more, and which occur at least five times per hour of sleep, according to the Medicare website.
During the night, the patient snores a lot in 95% of cases. What’s more, it presents with restless sleep, interspersed with repeated micro-awakenings, startled awakenings accompanied by a feeling of asphyxia or suffocation.
During the day, the person with apnea suffers from excessive sleepiness, sometimes with involuntary falling asleep during meetings, meals, or while driving. All of these signs can also be considered as chronic fatigue, which partly explains the low rate of diagnosis of the disease.
“As these are symptoms that occur during the night, people are not aware of themexplains neurologist Christophe Petiau, sleep specialist at the Sainte-Barbe clinic. What can ring a bell is fatigue during the day, but other explanations can also be found. On the other hand, the medical profession and the general public are increasingly aware of this disease, which is moving things in the right direction.“
He said about half of people with sleep apnea don’t know they have it. And this proportion even reaches 90% among children, according to an American study published in 2019.
Vigilance has increased in recent years, because sleep apnea can lead to many complications, and some of them can be fatal. “There are the direct consequences which are in themselves a major cause of alteration of the quality of lifeindicates Christophe Petiau. But there are also the complications that acute apnea can cause.”
The importance of the syndrome is measured by the number of apneas we do per hour: it is mild if we do between 5 and 15, moderate between 16 and 30, severe if we do more than 30. “Sleep apnea, when severe, is considered a major risk factor for cardiovascular disease, in the same way as tobacco or cholesterol.“
The risks are that apnea promotes the occurrence of a heart attack, stroke or pronounced hypertension.
Once the disease is diagnosed, as well as its degree of severity, patients are assigned the device that suits their needs. Apnea of medium severity is treated with a mandibular advancement orthosis: it is a device which increases the space between the tongue and the larynx in order to prevent the tongue from folding back and blocking the airway.
If the treatment does not work or if the apnea is more severe, it is possible to switch to continuous positive airway pressure. This is the famous respirator, a mask that propels air into the respiratory tract at night. Although it obtains excellent results, it can be very restrictive: irritation of the face, dryness of the nose and mouth, annoying noises during the night.
The purpose of the stimulator is not to replace the mask or respirator. It is really designed for those who have not been able to adapt to it
Christophe Petiau, neurologist
“It has been shown that after three years, 50% of patients abandon the mask, indicates Christophe Petiau. In our center, this figure rises to 20%.” Some of these patients then chose to live with their illness, without any treatment. “This is the reason why Health Insurance took the decision to reimburse the stimulator. It is an innovation that could change the lives of these people.“
We therefore come to the third method: surgical treatment to implant a stimulator. It propels the tongue forward during sleep to open the airway. “Around ten centers have this possibility in France today.indicates Christophe Petiau. The technique has become widespread since the announcement of reimbursement by Social Security. But be careful, the device and the operation are only covered if patients have already tried the other two methods. “The purpose of the stimulator is not to replace the device. It is really designed for those who have not been able to adapt to it.“
85,000 patients are today treated worldwide with this stimulator.
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