Chirurgische Therapieoptionen bei obstruktiven schlafbezogenen Atmungsstörungen und Schnarchen

Zusammenfassung

Entsprechend der ICSD-3 wird eine obstruktive Schlafapnoe (OSA) dann diagnostiziert, wenn die Atmungsstörung durch keine andere Schlafstörung oder medizinische Erkrankung oder durch Medikamente oder andere Substanzen erklärbar ist und entweder ein AHI (Apnoe-Hypopnoe-Index-Anzahl der Apnoen und Hypopnoen pro Stunde Schlaf) > 15/h (Ereignis ≥ 10 s) Schlafzeit oder ein AHI ≥ 5/h Schlafzeit in Kombination mit einer typischen klinischen Symptomatik oder relevanten Komorbidität vorliegt [1].

Abstract

The prevalence of mild obstructive sleep apnea (OSA) in adults is 20 %, of moderate to severe OSA about 6–7 %. The current gold standard for the treatment of moderate to severe OSA is the continuous positive airway pressure (CPAP) therapy. It is the most effective treatment modality, if there is good compliance and therapy adherence. Poor adherence still remains a problem for OSA treatment. In contrast to CPAP therapy, surgical therapy offers 100 % therapy adherence. Various surgical procedures are available for the treatment of primary snoring and mild to moderate OSA.

Surgical therapy requires adequate preoperative diagnostics including a good clinical basic ENT examination after detailed sleep medicine anamnesis. Additionally, the drug-induced sleep endoscopy to determine collapse location, collapse pattern and degree of collapse could be performed. According to Sher et al, the surgical success of a therapy in OSA is defined as a reduction of the apnea-hypopnea-index (AHI) by at least half and below a value of 20/h. In contrast, successful CPAP therapy is defined with an AHI below < 5/h but the acceptance, adherence and compliance to CPAP therapy should be always considered too.

In severe OSA, surgical approaches should only be performed to optimize ventilation therapy or in cases of intolerance or lack of adherence.

Schlüsselwörter

Obstruktive Schlafapnoe - Adhärenz - Überdruckbeatmung - chirurgische Therapie - Apnoe-Hypopnoe-Index

Key words

obstructive sleep apnea - adherence - continuous positive airway pressure - surgical therapy - apnea-hypopnea-index

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