Leitlinie: Therapie der obstruktiven Schlafapnoe des Erwachsenen

T. Verse; R. de la Chaux; A. Dreher; Y. Fischer; T. Grundmann; K. Hecksteden; K. Hörmann; W. Hohenhorst; F. Ilgen; T. Kühnel; N. Mahl; J. T. Maurer; W. Pirsig; B. Roth; R. Siegert; B. A. Stuck; ArGe Schlafmedizin der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde Kopf- und Hals-Chirurg

doi:10.1055/s-2007-966213

Laryngo-Rhino-Otologie, Inhaltsverzeichnis

Laryngorhinootologie 2008; 87(3): 192-204
DOI: 10.1055/s-2007-966213

Leitlinie

Leitlinie: Therapie der obstruktiven Schlafapnoe des Erwachsenen

Guideline: Treatment of Adult Obstructive Sleep ApneaT. Verse¹ , R. de la Chaux² , A. Dreher² , Y. Fischer³ , T. Grundmann⁴ , K. Hecksteden⁵ , K. Hörmann⁶ , W. Hohenhorst⁷ , F. Ilgen⁸ , T. Kühnel⁹ , N. Mahl¹⁰ , J. T. Maurer⁶ , W. Pirsig³ , B. Roth¹¹ , R. Siegert¹⁰ , B. A. Stuck⁶ , ArGe Schlafmedizin der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (Vorsitzender: Prof. Dr. med. Thomas Verse)

¹Klinik für HNO-Heilkunde, Asklepios Klinik Harburg, Hamburg
²Universitäts-Klinik für HNO-Heilkunde, Klinikum Großhadern, München
³Universitätsklinik und Poliklinik für HNO-Heilkunde, Ulm
⁴Klinik für HNO-Heilkunde, Asklepios Klinik Altona, Hamburg
⁵Universitäts-HNO-Klinik Freiburg
⁶Universitäts-HNO-Klinik Mannheim
⁷Klinik für HNO-Heilkunde, Alfried-Krupp-Krankenhaus, Essen
⁸HNO-Praxis, Biberach
⁹HNO-Klinik und Poliklinik der Universität Regensburg
¹⁰Klinik für HNO-Heilkunde, Prosper Hospital, Recklinghausen
¹¹Universitäts-HNO-Klinik Hamburg

Abstract

Volltext

Referenzen

Literatur

1 Pirsig W, Hörmann K, Siegert R, Maurer J, Verse T. Leitlinie der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie „Obstruktive Schlafapnoe”. HNO. 1998; 46 730
2 Pirsig W, Hörmann K, Siegert R, Maurer J, Verse T. Leitlinie der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie „Primäres Schnarchen”. HNO. 1998; 46 729
3 Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM) . S2-Leitlinie: Der nicht-erholsame Schlaf. Somnologie. 2001; Suppl 3 1-258
4 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) .Erarbeitung von Leitlinien für Diagnostik und Therapie. Methodische Empfehlungen. http://www.uni-duesseldorf.de/WWW/AWMF/ll/ll_metho.html
5 Oxford Centre for Evidence-based Medicine (OCEMB) .Appendix 3. http://www.gradeworkinggroup.org/publications/APPENDIX_3_OCEBM-system.pdf
6 Browman C P, Sampson M G, Yolles F S, Gujavarti K S, Weiler S J, Walsleben J A, Hahn P M, Mitler M M. Obstructive sleep apnea and body weight. Chest. 1984; 85 435-438
7 Barvaux V A, Aubert G, Rodenstein D O. Weight loss as a treatment for obstructive sleep apnoea. Sleep Med Rev. 2000; 4 435-452
8 Sampol G, Munoz X, Sagalés M T, Marti S, Roca A, Dolors de la Calzada M, Lloberes P, Morell F. Long-term efficacy of dietary weight loss in sleep apnoea/hypopnoea syndrome. Eur Respir J. 1998; 12 1156-1159
9 Jokic R, Klimaszewski A, Crossley M, Sridhar G, Fitzpatrick M F. Positional treatment vs continuous positive airway pressure in patients with positional obstructive sleep apnea syndrome. Chest. 1999; 115 771-781
10 Cartwright R D, Lloyd S, Lilie J, Kravitz H. Sleep position training as treatment for sleep apnea syndrome: a preliminary study. Sleep. 1985; 8 87-94
11 Kavey N B, Blitzer A, Gidro-Frank S, Korstanje K. Sleeping position and sleep apnea syndrome. Am J Otolaryngol. 1985; 6 373-377
12 Cartwright R, Ristanovic R, Diaz F, Caldarelli D, Alder G. A comparative study of treatments for positional sleep apnea. Sleep. 1991; 14 546-552
13 Maurer J T, Stuck B A, Hein G, Verse T, Hörmann K. Schlafapnoetherapie mit einer neuartigen Rückenlage-Verhinderungsweste. Dtsch Med Wochenschr. 2003; 128 71-75
14 Maurer J T, Hirth K, Mattinger C, Hörmann K. Combined surgical and prosthetic therapy of severe obstructive sleep apnea - a case report. Laryngorhinootol. 2001; 80 278-281
15 Hein H, Magnussen H. Wie steht es um die medikamentöse Therapie bei schlafbezogenen Atmungsstörungen?. Somnologie. 1998; 2 77-88
16 Smith I, Lasserson T, Wright J. Drug treatments for obstructive sleep apnoea (Cochrane Review). The Cochrane Library, Issue 2. Oxford; 2002
17 Sullivan C E, Issa F G, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981; 1 862-865
18 Dobrowski J M, Ahmed M. Positive airway pressure for obstructive sleep apnea. In: Fairbanks DNF, Mickelson SA, Woodson BT. Snoring and obstructive sleep apnea, 3rd edition. Philadelphia; Lippincott Williams & Wilkins 2002: 95-106
19 Jenkinson C, Davies R JO, Stradling J R. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apneoea: a randomised prospective parallel trial. Lancet. 1999; 353 2100-2105
20 Ballester E, Badia J R, Hernandez L, Carrasco E, de Pablo J, Fornas C, Rodriguez-Roisin R, Montserrat J M. Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999; 159 495-501
21 White J, Cates C, Wright J. Continuous positive airway pressure for obstructive sleep apnoea (Cochrane Review). The Cochrane Library, Issue 2. Oxford; 2002
22 McArdle N, Dervereux G, Heidarnejad H, Engleman H M, Mackay T W, Douglas N J. Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999; 159 1108-1114
23 Janson C, Nöges E, Svedberg-Brandt S, Lindberg E. What characterizes patients who are unable to tolerate continuous positive airway pressure (CPAP) treatment?. Resp Med. 2000; 94 145-149
24 Souter M A, Stevenson S, Sparks B, Drennan C. Upper airway surgery benefits patients with obstructive sleep apnoea who cannot tolerate nasal continuous positive airway pressure. J Laryngol Otol. 2004; 118 270-274
25 Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep. 1995; 18 501-510
26 Menn S J, Loube D I, Morgan T D, Mitler M M, Berger J S, Erman M K. The mandibula repositioning device: role in the treatment of obstructive sleep apnea. Sleep. 1996; 19 794-800
27 Clark G T, Blumenfeld I, Yoffe N, Peled E, Lavie P. A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibular positioning devices on patients with obstructive sleep apnea. Chest. 1996; 109 1477-1483
28 Ferguson K A, Ono T, Lowe A A, Keenan S P, Fleetham J A. A randomized crossover study of an oral appliance vs. nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest. 1996; 109 1269-1275
29 Pantin C C, Hillman D R, Tennant M. Dental side effects of an oral device to treat snoring and obstructive sleep apnea. Sleep. 1999; 22 237-240
30 Maurer J T, Hirth K, Mattinger C, Riedel F, Werner B, Hörmann K. Use of an intraoral snoring therapy device of thermolabile plastic. HNO. 2000; 48 302-308
31 Schönhofer B, Hochban W, Vieregge H J, Brunig H, Kohler D. Immediate intraoral adaptation of mandibular advancing appliances of thermoplastic material for the treatment of obstructive sleep apnea. Respiration. 2000; 67 83-88
32 Höijer U, Ejnell H, Hedner J, Petruson B, Eng L B. The effects of nasal dilation on snoring and obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 1992; 118 281-284
33 Metes A, Cole P, Hoffstein V, Miljeteig H. Nasal airway dilation and obstructed breathing in sleep. Laryngoscope. 1992; 102 1053-1055
34 Kerr P, Millar T, Buckle P, Kryger M. The importance of nasal resistance in obstructive sleep apnea syndrome. J Otolaryngol. 1992; 21 189-195
35 Hoffstein V, Mateika S, Metes A. Effect of nasal dilation on snoring and apneas during different stages of sleep. Sleep. 1993; 16 360-365
36 Schönhofer B, Franklin K A, Brunig H, Wehde H, Köhler D. Effect of nasal-valve dilation on obstructive sleep apnea. Chest. 2000; 118 587-590
37 Schönhofer B, Wenzel M, Barchfeld T, Siemon K, Rager H, Kohler D. Wertigkeit verschiedener intra- und extraoraler Therapieverfahren für die Behandlung der obstruktiven Schlafapnoe und des Schnarchens. Med Klin. 1997; 92 167-174
38 Todorova A, Schellenberg R, Hofmann H C, Dimpfel W. Effect of the external nasal dilator Breathe Right on snoring. Eur J Med Res. 1998; 3 367-379
39 Bahammam A S, Tate R, Manfreda J, Kryger M H. Upper airway resistance syndrome: effect of nasal dilation, sleep stage, and sleep position. Sleep. 1999; 22 592-598
40 Gosepath J, Amedee R G, Romantschuck S, Mann W J. Breathe Right nasal strips and the respiratory disturbance index in sleep related breathing disorders. Am J Rhinol. 1999; 13 385-389
41 Djupesland P G, Skatvedt O, Borgersen A K. Dichotomous physiological effects of nocturnal external nasal dilation in heavy snorers: the answer to a rhinologic controversy?. Am J Rhinaol. 2001; 15 95-103
42 Randerath W J, Galetke W, Domanski U, Weitkunat R, Ruhle K H. Tongue-muscle training by intraoral electrical neurostimulation in patients with obstructive sleep apnea. Sleep. 2004; 27 254-259
43 Verse T, Schwalb J, Hörmann K, Stuck B A, Maurer J T. Transkutane, submentale Elektrostimulationstherapie zur Behandlung der obstruktiven Schlafapnoe. HNO. 2003; 51 966-970
44 Sher A E, Schechtman K B, Piccirillo J F. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep. 1996; 19 156-177
45 Rubin A HE, Eliaschar I, Joachim Z, Alroy G, Lavie P. Effects of nasal surgery and tonsillectomy on sleep apnea. Bull Eur Physiopathol Respir. 1983; 19 612-615
46 Dayal V S, Phillipson E A. Nasal surgery in the management of sleep apnea. Ann Otol Rhinol Laryngol. 1985; 94 550-554
47 Caldarelli D D, Cartwright R, Lilie J K. Obstructive sleep apnea: variations in surgical management. Laryngoscope. 1985; 95 1070-1073
48 Aubert-Tulkens G, Hamoir M, van den Eeckhaut J, Rodenstein D O. Failure of tonsil and nose surgery in adults with long-standing severe sleep apnea syndrome. Arch Intern Med. 1989; 149 2118-2121
49 Sériès F, St Pierre S, Carrier G. Effects of surgical correction of nasal obstruction in the treatment of obstructive sleep apnea. Am Rev Respir Dis. 1992; 146 1261-1265
50 Sériès F, St Pierre S, Carrier G. Surgical correction of nasal obstruction in the treatment of mild sleep apnoea: importance of cephalometry in predicting outcome. Thorax. 1993; 48 360-363
51 Utley D S, Shin E J, Clerk A A, Terris D J. A cost-effective and rational surgical approach to patients with snoring, upper airway resistance syndrome, or obstructive sleep apnea syndrome. Laryngoscope. 1997; 107 726-734
52 Verse T, Pirsig W, Kroker B A. Obstruktive Schlafapnoe und Polyposis nasi. Laryno-Rhino-Otol. 1998; 77 150-152
53 Friedman M, Tanyeri H, Lim J W, Landsberg R, Vaidyanathan K, Caldarelli D. Effect of nasal breathing on obstructive sleep apnea. Otolaryngol Head Neck Surg. 2000; 122 71-74
54 Verse T, Maurer J T, Pirsig W. Effect of nasal surgery on sleep related breathing disorders. Laryngoscope. 2002; 112 64-68
55 Mayer-Brix J, Müller-Marschhausen U, Becker H, Peter J H. Wie häufig sind pathologische HNO-Befunde bei Patienten mit obstruktivem Schlaf-Apnoe-Syndrom?. HNO. 1989; 37 511-516
56 Dorn M, Pirsig W, Verse T. Postoperatives Management nach rhinochirurgischen Eingriffen bei Patienten mit schwerer obstruktiver Schlafapnoe: eine Pilotstudie. HNO. 2001; 49 642-645
57 Biermann E. Nasale CPAP-Therapie beim obstruktiven Schlafapnoe-Syndrom: Verbessert funktionelle Rhinochirurgie die Compliance?. Somnologie. 2001; 5 59-64
58 Donnelly L F, Surdulescu V, Chini B A, Casper K A, Poe S A, Amin R S. Upper airway motion depicted at cine MR imaging performed during sleep: comparison between young patients with and those without obstructive sleep apnea. Radiology. 2003; 227 239-245
59 Hultcrantz E, Linder A, Markström A. Tonsillectomy or tonsillotomy? - a randomized study comparing postoperative pain and long-term effects. Int J Pediatr Otorhinolaryngol. 1999; 51 171-176
60 Nelson L M. Radiofrequency treatment for obstructive tonsillar hypertrophy. Arch Otolaryngol Head Neck Surg. 2000; 126 736-740
61 Orr W C, Martin R J. Obstructive sleep apnea associated with tonsillar hypertrophy in adults. Arch Intern Med. 1981; 141 990-992
62 Moser R J, Rajagopal K R. Obstructive sleep apnea in adults with tonsillar hypertrophy. Arch Intern Med. 1987; 147 1265-1267
63 Houghton D J, Camilleri A E, Stone P. Adult obstructive sleep apnoea syndrome and tonsillectomy. J Laryngol Otol. 1997; 111 829-832
64 Verse T, Kroker B, Pirsig W, Brosch S. Tonsillectomy for treatment of obstructive sleep apnea in adults with tonsillar hypertrophy. Laryngoscope. 2000; 110 1556-1559
65 Hultcrantz E, Linder A, Markstrom A. Long-term effects of intracapsular partial tonsillectomy (tonsillotomy) compared with full tonsillectomy. Int J Pediatr Otorhinolaryngol. 2005; 69 463-469
66 Friedman M, LoSavio P, Ibrahim H, Ramakrishnan V. Radiofrequency tonsil reduction: safety, morbidity, and efficacy. Laryngoscope. 2003; 113 882-887
67 Nelson L M. Temperature-controlled radiofrequency tonsil reduction in children. Arch Otolaryngol Head Neck Surg. 2003; 129 533-537
68 Nelson L M. Temperature-controlled radiofrequency tonsil reduction: extended follow-up. Otolaryngol Head Neck Surg. 2001; 125 456-461
69 Brosch S, Matthes C, Pirsig W, Verse T. Uvulopalatopharyngoplasty changes fundamental frequency of voice - a prospective study. J Laryngol Otol. 2000; 114 113-118
70 Larsson L H, Carlsson-Nordlander B, Svanborg E. Four-year follow-up after uvulopalatopharyngoplasty in 50 unselected patients with obstructive sleep apnea syndrome. Laryngoscope. 1994; 104 1362-1368
71 Perello-Scherdel E, Quesada P, Lorente J, Lao J, Prades J. Long-term follow-up of partial resection of the palate as a surgical treatment for obstructive sleep apnea syndrome. In: Tos M, Thomsen J, Balle V (eds). Rhinology - a state of the art. Amsterdam, New York; Kugler 1995: 261-262
72 Lu S J, Chang S Y, Shiao G M. Comparison between short-term and long-term post-operative evaluation of sleep apnea after uvulopalatopharyngoplasty. J Laryngol Otol. 1995; 109 308-312
73 Janson C, Gislason T, Bengtsson H, Eriksson G, Lindberg E, Lindholm C E, Hultcrantz E, Hetta J, Boman G. Long-term follow-up of patients with obstructive sleep apnea treated with uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg. 1997; 123 257-262
74 Hultcrantz E, Johansson K, Bengtson H. The effect of uvulopalatopharyngoplasty without tonsillectomy using local anaesthesia: a prospective long-term follow-up. J Laryngol Otol. 1999; 113 542-547
75 Boot H, van Wegen R, Poublon R ML, Bogaard J M, Schmitz P IM, van der Meche F GA. Long-term results of uvulopalatopharyngoplasty for obstructive sleep apnea syndrome. Laryngoscope. 2000; 110 469-475
76 Lysdahl M, Haraldson P O. Long-term survival after uvulopalatopharyngoplasty in nonobese heavy snorers: a 5- to 9-year follow-up of 400 consecutive patients. Arch Otolaryngol Head Neck Surg. 2000; 126 1136-1140
77 Keenan S P, Burt H, Ryan C F, Fleetham J A. Long-term survival of patients with obstructive sleep apnea treated by uvulopalatopharyngoplasty or nasal CPAP. Chest. 1994; 105 155-159
78 Haraldson P O, Carenfelt C, Persson H E, Sachs C, Tornros J. Simulated long-term driving performance before and after uvulopalatopharyngoplasty. ORL J Otorhinolaryngol Relat Spec. 1991; 53 106-110
79 Haraldsson P O, Carenfelt C, Lysdahl M, Tingvall C. Does uvulopalatopharyngoplasty inhibit automobile accidents?. Laryngoscope. 1995; 105 657-661
80 Verse T, Pirsig W. Laser-assisted uvulopalatoplasty. A metanalysis. In: Fabiani M, Saponara M (eds). Surgery for snoring and obstructive sleep apnea syndrome. Amsterdam; Kugler 2003: 463-474
81 Carenfelt C. Laser uvulopalatopharyngoplasty in treatment of habitual snoring. Ann Otol Rhinol Laryngol. 1991; 100 451-454
82 Kamami Y V. Laser CO₂ for snoring: preliminary results. Acta Otorhinolaryngol Belg. 1990; 44 451-456
83 Coleman J A. Laser-assisted uvulopalatoplasty: Long-term results with a treatment for snoring. Ear, Nose & Throat J. 1998; 77 22-34
84 Ellis P DM. Laser palatoplasty for snoring due to palatal flutter: a further report. Clin Otolaryngol. 1994; 19 350-351
85 Verse T, Pirsig W. Metaanalyse zur laserasisstierten Uvulopalatopharyngoplastik. Was ist bisher klinisch relevant?. Laryngo-Rhino-Otol. 2000; 79 273-284
86 Utley D S, Shin E J, Clerk A A, Terris D J. A cost-effective and rational surgical approach to patients with snoring, upper airway resistance syndrome, or obstructive sleep apnea syndrome. Laryngoscope. 1997; 107 726-734
87 Mickelson S A, Ahuja A. Short-term objective and long-term subjective results of laser-assisted uvulopalatoplasty for obstructive sleep apnea. Laryngoscope. 1999; 109 362-367
88 Walker R P, Grigg-Damberger M M, Gopalsami C. Laser-assisted uvulopalatopharyngoplasty for the treatment of mild, moderate, and severe obstructive sleep apnea. Laryngoscope. 1999; 109 79-85
89 Ryan C F, Love L L. Unpredictable results of laser assisted uvulopalatoplasty in the treatment of obstructive sleep apnoea. Thorax. 2000; 55 399-404
90 Seemann R P, DiToppa J C, Holm M A, Hanson J. Does laser-assisted uvulopalatoplasty work? An objective analysis using pre- and postoperative polysomnographic studies. J Otolaryngol. 2001; 30 212-215
91 Finkelstein Y, Stein G, Ophir D, Berger R, Berger G. Laser-assisted uvulopalatoplasty for the management of obstructive sleep apnea. Myths and facts. Arch Otolaryngol Head Neck Surg. 2002; 128 429-434
92 Ferguson K A, Heighway H, Ruby R RF. A randomized trial of laser-assisted uvulopalatoplasty in the treatment of mild obstructive sleep apnea. Am J Respir Crit Care Med. 2003; 167 15-19
93 Berger G, Stein G, Ophir D, Finkelstein Y. Is there a better way to do laser-assisted uvulopalatoplasty?. Arch Otolaryngol Head Neck Surg. 2003; 129 447-453
94 Kern R C, Kutler D I, Reid K J, Conley D B, Herzon G D, Zee P. Laser-assisted uvulopalatoplasty and tonsillectomy for the management of obstructive sleep apnea syndrome. Laryngoscope. 2003; 113 1175-1181
95 Berger G, Finkelstein Y, Ophir D. Histopathologic changes in the soft palate after laser-assisted uvulopalatoplasty. Arch Otolaryngol Head Neck Surg. 1999; 125 786-790
96 Littner M, Kushida C A, Hartse K, McDowell Anderson W, Davila D, Johnson S F, Wise M S, Hirshkowitz M, Woodson B T. (Standards of Practice Committee . Practice parameters for the use of laser-assisted uvulopalatoplasty: an update for 2000. Sleep. 2001; 24 603-619
97 Blumen M B, Dahan S, Fleury B, Hausser-Hauw C, Chabolle F. Radiofrequency ablation for the treatment of mild to moderate obstructive sleep apnea. Laryngoscope. 2002; 112 2086-2092
98 Brown D J, Kerr P, Kryger M. Radiofrequency tissue reduction of the soft palate in patients with moderate sleep-disordered breathing. J Otolaryngol. 2001; 30 193-198
99 Powell N B, Riley R, Guilleminault C, Troell R. A reversible uvulopalatal flap for snoring and sleep apnea syndrome. Sleep. 1996; 19 593-599
100 Hörmann K, Erhard T, Hirth K, Maurer J T. Der modifizierte Uvulalappen zur Therapie schlafbezogener Atmungsstörungen. HNO. 2001; 49 361-366
101 Li H Y, Chen N H, Shu Y H, Wang P C. Changes in quality of life and respiratory distrurbance after extended uvulopalatal flap surgery in patients with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2004; 130 195-200
102 Maurer J T, Verse T, Stuck B A, Hörmann K, Hein G. Palatal implants for primary snoring: short-term results of a new minimally invasive surgical technique. Otolaryngol Head Neck Surg. 2005; 132 125-131
103 Mortimore I L, Bradley P A, Murray J A, Douglas N J. Uvulopalatopharyngoplasty may compromise nasal CPAP therapy in sleep apnea syndrome. Am J Respir Crit Care Med. 1996; 154 1759-1762
104 Mair E A, Day R H. Cautery-assisted palatal stiffening operation. Otolaryngol Head Neck Surg. 2000; 122 547-555
105 Wassmuth Z, Mair E, Loube D, Leonhard D. Cautery-assisted palatal stiffening operation for the treatment of obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2000; 122 547-555
106 Brietzke S E, Mair E A. Injection snoreplasty: How to treat snoring without all the pain and expense. Otolaryngol Head Neck Surg. 2001; 124 503-510
107 Brietzke S E, Mair E A. Injection snoreplasty: Investigation of alternative sclerotherapy agents. Otolaryngol Head Neck Surg. 2004; 130 47-50
108 Brietzke S E, Mair E A. Extended follow-up and new objective data. Otolaryngol Head Neck Surg. 2003; 128 605-615
109 Wright S, Haight J, Zamel N, Hoffstein V. Changes in pharyngeal properties after uvulopalatopharyngoplasty. Laryngoscope. 1989; 99 62-65
110 Woodson B T, Toohill R J. Transpalatal advancement pharyngoplasty for obstructive sleep apnea. Laryngoscope. 1993; 103 269-276
111 Woodson B T. Retropalatal airway characteristics in uvulopalatopharyngoplasty compared with transpalatal advancement pharyngoplasty. Laryngoscope. 1997; 107 735-740
112 Stuck B A, Maurer J T, Hörmann K. Die Zungengrundreduktion mit Radiofrequenzenergie bei schlafbezogenen Atmungsstörungen. Postoperative Morbidität und Komplikationen. HNO. 2001; 49 530-537
113 Powell N B, Riley R W, Guilleminault C. Radiofrequency tongue base reducution in sleep-disordered breathing: a pilot study. Otolaryngol Head Neck Surg. 1999; 120 656-664
114 Li K K, Powell N B, Riley R W, Guilleminault C. Temperature-controlled radiofrequency tongue base reduction for sleep-disordered breathing: Long-term outcomes. Otolaryngol Head Neck Surg. 2002; 127 230-234
115 Woodson B T, Nelson L, Mickelson S, Huntley T, Sher A. A multi-institutional study of radiofrequency volumetric tissue reduction for OSAS. Otolaryngol Head Neck Surg. 2001; 125 303-311
116 Stuck B A, Maurer J T, Verse T, Hörmann K. Tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction for treatment of obstructive sleep apnea syndrome. Acta Otolaryngol. 2002; 122 531-536
117 Riley R W, Powell N B, Li K K, Weaver E M, Guilleminault C. An adjunctive method of radiofrequency volumetric tissue reduction of the tongue for OSAS. Otolaryngol Head Neck Surg. 2003; 129 37-42
118 Meyer T J, Eveloff S E, Kline L R, Millman R P. One negative polysomnogram does not exclude obstructive sleep apnea. Chest. 1993; 103 756-760
119 Mendelson W B. Use of sleep laboratory in suspected sleep apnea syndrome: Is one night enough?. Cleve Clin J Med. 1994; 61 299-303
120 Patton T J, Thawley S E, Water R C, Vandermeer P J, Ogura J H. Expansion hyoid-plasty: a potential surgical procedure designed for selected patients with obstructive sleep apnea syndrome. Experimental canine results. Laryngoscope. 1983; 93 1387-1396
121 Kaya N. Sectioning the hyoid bone as a therapeutic approach for obstructive sleep apnea. Sleep. 1984; 7 77-78
122 Riley R W, Powell N B, Guilleminault C. Obstructive sleep apnea and the hyoid: a revised surgical procedure. Otolaryngol Head Neck Surg. 1994; 111 717-721
123 Hörmann K, Hirth K, Erhardt T, Maurer J T, Verse T. Die Hyoidsuspension zur Therapie der obstruktiven Schlafapnoe. Laryngo-Rhino-Otol. 2001; 80 517-521
124 Neruntarat C. Hyoid myotomy with suspension under local anesthesia for obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol. 2003; 260 286-290
125 Stuck B A, Neff W, Hörmann K, Verse T, Bran G, Baisch A, Düber C, Maurer J T. Anatomic Changes after Hyoid Suspension for Obstructive Sleep Apnea - an MRI Study. Otolaryngol Head Neck Surg. 2005; 133 397-402
126 Chabolle F, Wagner I, Blumen M, Séquert C, Fleury B, de Dieuleveult T. Tongue base reduction with hyoepiglottoplasty: a treatment for severe obstructive sleep apnea. Laryngoscope. 1999; 109 1273-1280
127 Fujita S, Woodson B T, Clark J L, Wittig R. Laser midline glossectomy as a treatment for the obstructive sleep apnea. Laryngoscope. 1991; 101 805-809
128 Djupesland G, Schrader H, Lyberg T, Refsum H, Lilleas F, Godtlibsen O B. Palatopharyngoglossoplasty in the treatment of patients with obstructive sleep apnea syndrome. Acta Otolaryngol. 1992; Suppl 492 50-54
129 Woodson B T, Fujita S. Clinical experience with lingualplasty as part of the treatment of severe obstructive sleep apnea. Otolaryngol Head Neck Surg. 1992; 107 40-48
130 Mickelson S A, Rosenthal L. Midline glossectomy and epiglottidectomy for obstructive sleep apnea syndrome. Laryngoscope. 1997; 107 614-619
131 Faye-Lund H, Djupesland G, Lyberg T. Glossopexia - Evaluation of a new surgical method for treating obstructive sleep apnea syndrome. Acta Otolaryngol. 1992; Suppl 492 46-49
132 DeRowe A, Günther E, Fibbi A, Lehtimaki K, Vahatalo K, Maurer J, Ophir D. Tongue-base suspension with a soft tissue-to-bone anchor for obstructive sleep apnea: preliminary clinical results of a new minimally invasive technique. Otolaryngol Head Neck Surg. 2000; 122 100-103
133 Woodson B T, deRowe A, Hawke M, Wenig B, Ross E B, Katsantonis G P, Mickelson S A, Bonham R E, Benbadis S. Pharyngeal suspension suture with Repose bone screw for obstructive sleep apnea. Otolaryngol Head Neck Surg. 2000; 122 395-401
134 Woodson B T. A tongue suspension suture for obstructive sleep apnea and snorers. Otolaryngol Head Neck Surg. 2001; 124 297-303
135 Sorrenti G, Piccin O, Latini G, Scaramuzzino G, Mondini S, Rinaldi Ceroni A. Tongue suspension technique in obstructive sleep apnea: personal experience [in Italian]. Acta Otorhinolaryngol Ital. 2003; 23 274-280
136 Riley R W, Powell N B, Guilleminault C. Inferior sagittal osteotomy of the mandible with hyoid myotomy-suspension: a new procedure for obstructive sleep apnea. Otolaryngol Head Neck Surg. 1986; 94 589-593
137 Kuo P C, West R A, Bloomquist D S, McNeil R W. The effect of mandibular osteotomy in three patients with hypersomnia sleep apnea. Oral Surg Oral Med Oral Path. 1979; 48 385-392
138 Prinsell J R. Maxillomandibular advancement (MMA) in a site-specific treatment approach for obstructive sleep apnea: a surgical algorithm. Sleep Breath. 2000; 4 147-154
139 Riley R W, Powell N B, Guilleminault C. Maxillofacial surgery and nasal CPAP. A comparison of treatment for obstructive sleep apnea syndrome. Chest. 1990; 98 1421-1425
140 Hochban W, Conradt R, Brandenburg U, Heitmann J, Peter J H. Surgical maxillofacial treatment of obstructive sleep apnea. Plast Reconstr Surg. 1997; 99 619-626
141 Prinsell J R. Maxillomandibular advancement surgery in a site-specific treatment approach for obstructive sleep apnea in 50 consecutive patients. Chest. 1999; 116 1519-1529
142 Waite P D, Wooten V, Lachner J H, Guyette R F. Maxillomandibular advancement surgery in 23 patients with obstructive sleep apnea syndrome. J Oral Maxillofac Surg. 1989; 47 1256-1261
143 Li K K, Riley R W, Powell N B, Guilleminault C. Maxillomandibular advancement for persistent obstructive sleep apnea after phase I surgery in patients without maxillomandibular deficiency. Laryngoscope. 2000; 110 1684-1688
144 Bettega G, Pepin J L, Veale D, Deschaux C, Raphael B, Levy P. Obstructive sleep apnea syndrome. Fifty-one consecutive patients treated by maxillofacial surgery. Am J Respir Crit Care Med. 2000; 162 641-649
145 Goh Y H, Lim K A. Modified maxillomandibular advancement for the treatment of obstructive sleep apnea: a preliminary report. Laryngoscope. 2003; 113 1577-1582
146 Dattilo D J, Drooger S A. Outcome assessment of patients undergoing maxillofacial procedures for the treatment of sleep apnea: comparison of subjective and objective results. J Oral Maxillofac Surg. 2004; 62 164-168
147 Conradt R, Hochban W, Heitmann J, Brandenburg U, Cassel W, Penzel T, Peter J H. Sleep fragmentation and daytime vigilance in patients with OSA treated by surgical maxillomandibular advancement compared to CPAP therapy. J Sleep Res. 1998; 7 217-223
148 Li K K, Powell N B, Riley R W, Troell R J, Guilleminault C. Long-term results of maxillomandibular advancement surgery. Sleep Breath. 2000; 4 137-139
149 McCarthy J G, Schreiber J, Karp N, Thorne C H, Grayson B H. Lengthening the human mandible by gradual distraction. Plast Reconstr Surg. 1992; 89 1-10
150 Bell R B, Turvey T A. Skeletal advancement for the treatment of obstructive sleep apnea in children. Cleft Palate Craniofac J. 2001; 38 147-154
151 Fujita S. Pharyngeal surgery for obstructive sleep apnea and snoring. In: Fairbanks DNF (ed). Snoring and obstructive sleep apnea. New York; Raven Press 1987: 101-128
152 Riley R W, Powell N B, Guilleminault C. Obstructive sleep apnea syndrome: A review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg. 1993; 108 117-125
153 Stuck B A, Starzak K, Verse T, Hörmann K, Maurer J T. Morbidität und Komplikationen der kombinierten Radiofrequenz-Chirurgie des Weichgaumens und Zungengrundes. Somnologie. 2002; 6 19-25
154 Fischer Y, Khan M, Mann W J. Multilevel temperature-controlled radiofrequency therapy of soft palate, base of tongue, and tonsils in adults with obstructive sleep apnea. Laryngoscope. 2003; 113 1786-1791
155 Woodson B T, Steward D L, Weaver E M, Javaheri S. A randomized trial of temperature-controlled radiofrequency, continuous positive airway pressure, and placebo for obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2003; 128 848-861
156 Johnson N T, Chinn J. Uvulopalatopharyngoplasty and inferior sagittal mandibular osteotomy with genioglossus advancement for treatment of obstructive sleep apnea. Chest. 1994; 105 278-283
157 Ramirez S G, Loube D I. Inferior sagittal osteotomy with hyoid bone suspension for obese patients with sleep apnea. Arch Otolaryngol Head Neck Surg. 1996; 122 953-957
158 Elasfour A, Miyazaki S, Itasaka Y, Yamakawa K, Ishikawa K, Togawa K. Evaluation of uvulopalatopharyngoplasty in treatment of obstructive sleep apnea syndrome. Acta Otolaryngol. 1998; Suppl 537 52-56
159 Lee N R, Givens C D, Wilson J, Robins R B. Staged surgical treatment of obstrcutive sleep apnea syndrome: a review of 35 patients. J Oral Maxillofac Surg. 1999; 57 382-385
160 Hsu P P, Brett R H. Multiple level pharyngeal surgery for obstructive sleep apnoea. Singapore Med J. 2001; 42 160-164
161 Hendler B H, Costello B J, Silverstein K, Yen D, Goldberg A. A protocol for uvulopalatoplasty, mortised genioplasty, and maxillomandibular advancement in patients with obstructive sleep apnea: an analysis of 40 cases. J Oral Maxillofac Surg. 2001; 59 892-897
162 Nelson L M. Combined temperature-controlled radiofrequency tongue reduction and UPPP in apnea surgery. Ear Nose Throat J. 2001; 80 640-644
163 Vilaseca I, Morello A, Montserrat J M, Santamaria J, Iranzo A. Usefulness of uvulopalatopharyngoplasty with genioglossus and hyoid advancement in the treatment of obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2002; 128 435-440
164 Neruntarat C. Genioglossus advancement and hyoid myotomy: short-term and long-term results. J Laryngol Otol. 2003; 117 482-486
165 Friedman M, Ibrahim H, Lee G, Joseph N J. Combined uvulopalatopharyngolplasty and radiofrequency tongue base reduction for treatment of obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2003; 129 611-621
166 Miller F R, Watson D, Boseley M. The role of genial bone advancement trephine system in conjunction with uvulopalatopharyngoplasty in the multilevel management of obstructive sleep apnea. Otolaryngol Head Neck Surg. 2004; 130 73-79
167 Verse T, Baisch A, Maurer J T, Stuck B A, Hörmann K. Multi-level surgery for obstructive sleep apnea. Otolaryngol Head Neck Surg. 2006; 134 511-577
168 Hörmann K, Maurer J T, Baisch A. Schnarchen/Schlafapnoe - chirurgisch heilbar?. HNO. 2004; 52 807-813
169 Andersen A PD, Alving J, Lildholdt T, Wulff C H. Obstructive sleep apnea initiated by a lax epiglottis. Chest. 1987; 91 621-623
170 Woo P. Aquired laryngomalacia: epiglottis prolapse as a cause of airway obstruction. Ann Otol Rhinol Laryngol. 1992; 101 314-320
171 Catalfumo F J, Golz A, Westerman T, Gilbert L M, Joachims H Z, Goldenberg D. The epiglottis and obstructive sleep apnoea syndrome. J Laryngol Otol. 1998; 112 940-943
172 Verse T, Pirsig W. Age-related changes in the epiglottis causing failure of nasal continuous positive airway pressure therapy. J Laryngol Otol. 1999; 113 1022-1025
173 Golz A, Goldenberg D, Netzer A, Westerman S T, Joachims H Z. Epiglottic carcinoma presenting as obstructive sleep apnea. J Otolaryngol. 2001; 30 58-59
174 Rombaux P, Hamoir M, Plouin-Gaudon I, Liistro G, Aubert G, Rodenstein D. Obstructive sleep apnea syndrome after reconstructive laryngectomy for glottic carcinoma. Eur Arch Otorhinolaryngol. 2000; 257 502-506
175 Walsh P, Smith D, Coakeley D, Dunne B, Timon C. Sleep apnoea of unusual origin. J Laryngol Otol. 2002; 116 138-139
176 Herlihy J P, Whitlock W L, Dietrich R A, Shaw T. Sleep apnea syndrome after irradiation of the neck. Arch Otolaryngol Head Neck Surg. 1989; 115 1467-1469
177 Chetty K G, Kadifa F, Berry R B, Mahutte C K. Acquired laryngomalacia as a cause of obstructive sleep apnea. Chest. 1994; 106 1898-1899
178 Fuso L, Maiolo C, Tramaglino L M, Benedetto R T, Russo A R, Spadaro S, Pagliari G. Orolaryngeal sarcoidosis presenting as obstructive sleep apnoea. Sarcoidosis Vasc Diffuse Lung Dis. 2001; 18 85-90
179 Shah R N, Mills P R, George P J, Wedzicha J A. Upper airway sarcoidosis presenting as obstructive sleep apnoea. Thorax. 1998; 53 232-233
180 Anonsen C. Laryngeal obstruction and obstructive sleep apnea syndrome. Laryngoscope. 1990; 100 775-778
181 Butterfield J H, Marcoux J P, Weiler D, Harner S G. Mast cell pharyngitis as a cause of supraglottic edema. Arch Otorhinolaryngol. 1988; 245 88-91
182 Gillespie M B, Flint P W, Smith P L, Eisele D W, Schwartz A R. Diagnosis and treatment of obstructive sleep apnea of the larynx. Arch Otolaryngol Head Neck Surg. 1995; 121 335-339
183 Kavey N B, Whyte J, Blitzer A, Gidro-Frank S. Sleep-related laryngeal obstruction presenting as snoring or sleep apnea. Laryngoscope. 1989; 99 851-854
184 Hoffstein V, Taylor R. Rapid development of obstructive sleep apnea following hemidiaphragmatic and unilateral vocal cord paralysis as a complication of mediastinal surgery. Chest. 1985; 88 145-147
185 Wiest G H, Ficker J H, Lehnert G, Hahn E G. Sekundäres obstruktives Schlafapnoesyndrom bei Trachealstenose und beidseitiger Recurrensparese. Dtsch Med Wochenschr. 1998; 123 522-526
186 Verse T, Pirsig W, Zimmermann E. Obstruktive Schlafapnoe beim älteren Patienten nach Tracheostomaverschluss. DMW. 2000; 125 137-141
187 Kuhlo W, Doll E, Franck M C. Erfolgreiche Behandlung des Pickwick-Syndroms durch eine Dauertrachealkanüle. Dtsch Med Wschr. 1969; 94 1286-1290
188 Rybak L P, Maisel R H. Endoscopic findings in sleep apnea syndrome. J Otolaryngol. 1979; 8 487-493
189 Simmons F B. Tracheotomy in obstructive sleep apnea patients. Laryngoscope. 1979; 89 1702-1703
190 Guilleminault C, Simmons F B, Motta J, Cummiskey J, Rosekind M, Schroeder J S, Dement W C. Obstructive sleep apnea syndrome and tracheostomy. Long-term follow-up expertise. Arch Intern Med. 1981; 141 985-988
191 Haapaniemi J J, Laurikainen E A, Halme P, Antila J. Long-term results of tracheostomy for severe obstructive sleep apnea syndrome. ORL J Otorhinolaryngol Relat Spec. 2001; 63 131-136
192 Kim S H, Eisele D W, Smith P L, Schneider H, Schwartz A R. Evaluation of patients with sleep apnea after tracheotomy. Arch Otolaryngol Head Neck Surg. 1998; 124 996-1000
193 Thatcher G W, Maisel R H. The long-term evaluation of tracheostomy in the management of severe obstructive sleep apnea. Laryngoscope. 2003; 113 201-204

Prof. Dr. med. Thomas Verse

Klinik für HNO-Heilkunde
Asklepios Klinik Harburg

Eißendorfer Pferdeweg 52
21075 Hamburg

eMail: thomas.verse@ak-haarburg.lbk-hh.de