Conditions

Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is characterized by the occurrence, during sleep, of abnormally frequent episodes of interrupted breathing (apneas) or significant reductions in airflow (hypopneas). These apnea and hypopnea episodes can cause hypoxemia (a drop in hemoglobin oxygen saturation) and micro-awakenings.

OSAHS is a common condition that remains largely underdiagnosed.^¹

According to a recent study published in 2023^², the prevalence of OSAHS in France is estimated at about 20.9% of the adult population. Yet, this condition remains poorly known, and it is likely that more than 50% of people with sleep apnea are still undiagnosed.^¹

« Along with fatigue, excessive daytime sleepiness is the symptom most frequently reported by patients, with a considerable impact on daily quality of life and safety. »

Jean-Charles Schwartz, Scientific Director and Co-Founder of Bioprojet

Sleepiness, fatigue, and alertness disorders

OSAHS has a major impact on patients’ daily lives in terms of quality of life, health, and safety. It often results in excessive daytime sleepiness (EDS).

This is characterized by an irresistible tendency to fall asleep if the person is not stimulated. It can lead to attention, concentration, or alertness disorders that may affect patients’ professional and social activities.

Alertness disorders related to daytime sleepiness increase the risk of household accidents, workplace accidents, and road traffic accidents.

Drowsy driving in figures ³,⁴ :

• 32% of French people affected
• 46% of drivers covering more than 20,000 km/year
• 1/3 of fatal accidents on motorways
• Risk of accidents multiplied by 8
• Risk of collision multiplied by 3 to 4 within half an hour after a sleepiness episode
• 17 hours awake is equivalent to a blood alcohol level of 0.5g/L (the legal limit)

Osahs and road accidents: a risk up to 7 times higher

The prevalence of drowsy driving among patients with OSAHS is about 41.3%.

Primary treatment with CPAP (continuous positive airway pressure) significantly reduces EDS and therefore lowers accident risk.⁵

Persistence of sleepiness despite well-managed CPAP treatment

A certain number of patients continue to experience excessive daytime sleepiness despite primary treatment with CPAP, explains Professor Pépin, pulmonologist at Grenoble University Hospital. These patients not only report sleepiness but also fatigue, reduced quality of life, and sometimes depressive symptoms.

The prevalence of residual excessive daytime sleepiness (REDS) under CPAP varies across studies, from 10% to 55%, with an estimated average of about 20%.⁶

What is anaphylaxis ?

Anaphylaxis is a severe systemic allergic reaction that can be life-threatening. It occurs rapidly after contact with an allergen such as :

• Certain foods: tree nuts (walnuts, hazelnuts, almonds, etc.), peanuts, fish, shellfish, eggs, milk, foods containing soy or sesame, mustard, wheat, rye, barley, oats, spelt.
• Medications: anesthetic agents and muscle relaxants, analgesics (aspirin, lidocaine, morphine derivatives), injectable iodinated contrast agents, antibiotics (penicillins), etc.
• Insect stings: wasps, bees, hornets, etc.
• Latex, and more.

It is the most severe form of allergy and is a medical emergency that can be life-threatening in the short term.

What are the symptoms ?

The reaction is often characterized by :

• General discomfort and skin symptoms such as itching, widespread hives, or swelling of the face.
• Respiratory distress caused by laryngeal edema or bronchospasm.
• A drop in blood pressure accompanied by tachycardia, which can lead to loss of consciousness or even cardiac arrest.
• Digestive symptoms may also appear, such as nausea, vomiting, diarrhea, and abdominal pain.

These symptoms, especially respiratory ones, can be worsened if there is an associated respiratory condition (such as asthma).

A specific symptom : angioedema (Quincke’s edema)

Angioedema is a severe allergic reaction characterized by swelling of the face (lips, eyelids), a feeling of heat, tingling in the throat, a change in voice, and breathing difficulties. It can affect other areas and may be accompanied by hives, requiring urgent intervention to prevent severe complications.

Anaphylaxis requires rapid recognition of symptoms and immediate medical treatment, as it can endanger a person’s life within minutes. It is therefore essential to identify the clinical signs early to act quickly and prevent serious complications

Definition of diarrhea

Diarrhea is defined as the passage of at least three loose or liquid stools per day, or stools passed at an abnormally increased frequency.

It is generally a symptom of a gastrointestinal infection, which is viral in most cases.

The infection is transmitted through the consumption of contaminated water and food, or more commonly, from person to person (human-to-human transmission).

Severe diarrhea leads to a loss of fluids and salts (electrolytes), resulting in dehydration. It can be fatal, especially in young children and in malnourished or immunocompromised individuals.

Abdominal pain and vomiting often accompany diarrhea. Moderate fever may also occur.

Diarrhea is considered acute when it lasts less than two weeks. In the majority of cases, acute diarrhea starts suddenly. It usually lasts less than a week and does not recur in the short term.

Etiology

Infectious causes

In developed countries, approximately one episode of acute gastrointestinal illness (vomiting and/or diarrhea) is reported per person per year. Most cases last less than 24 hours and are often mistakenly attributed to food poisoning, although the vast majority are viral in origin

Each year in France, 5% of the population consults a general practitioner for acute diarrhea.¹ Norovirus (most commonly implicated) or Rotavirus in very young children can cause a surge in visits to medical practices and emergency services, with an epidemic peak in winter.

Iatrogenic causes (drug-induced)

Some cases of diarrhea are caused by the use of antibiotics. Indeed, 5% to 25% of patients taking antibiotics experience a change in their bowel habits.²

TYPE 1 NARCOLEPSY (NT1)²

Type 1 narcolepsy (NT1) is characterized by often irresistible sleep attacks, cataplexy (sudden loss of muscle tone while fully conscious, triggered by emotions), as well as other occasional symptoms such as hypnagogic hallucinations, sleep paralysis, and poor nighttime sleep, which may be unstable and fragmented with excessive motor activity.¹

NT1 is lifelong and affects all aspects of daily life: personal, professional, social, and family. It is often accompanied by difficulties with concentration and learning.

Age of onset

It can start at any age, from childhood to around fifty, with peaks around ages 15 and 36².

Symptoms

• Excessive daytime sleepiness (EDS) and sudden sleep episodes, even while eating, driving, or working.
• Cataplexy: sudden loss of muscle tone, which can range from slight knee buckling to complete collapse. It often occurs during strong positive emotions and lasts a few seconds to a few minutes without loss of consciousness.
• Nighttime sleep may be poor in quality with frequent awakenings.
• Auditory, visual, or tactile hallucinations at sleep onset or upon waking.
• Temporary sleep paralysis: inability to move upon waking or falling asleep.

Cause

NT1 is caused by a deficiency in orexin, a neurotransmitter that promotes wakefulness, due to the progressive destruction of orexin-producing neurons in the hypothalamus. This destruction is likely linked to an autoimmune mechanism with a genetic predisposition.

Progression

Daytime sleepiness and cataplexy may improve over time, but nighttime sleep disturbances tend to worsen.

TYPE 2 NARCOLEPSY (NT2)

Less common than NT1, NT2 presents the same symptoms except for cataplexy. Orexin levels remain normal, and there is no known genetic predisposition. The course of NT2 is variable : it may worsen, remain stable, or improve over time.