Metaanalyse zur laserassistierten Uvulopalatopharyngoplastik

Zusammenfassung

Hintergrund: Der Einsatz der laserassistierten Uvulopalatoplastik (LAUP) zur Therapie der obstruktiven Schlafapnoe (OSA) und des primären Schnarchens wurde in einer Stellungnahme der American Sleep Disorders Association 1994 wegen fehlender objektiver Daten abgelehnt. Seither sind zahlreiche neuere Arbeiten zum Thema erschienen, die eine neue Evaluation der Situation fordern. Methode: In einer weltweiten Literaturrecherche bis März 1999 wurden über 70 Arbeiten zum Thema zusammengetragen. Die Arbeiten wurden unter den Aspekten Methodik, Operationstechniken, LAUP und OSA, LAUP und primäres Schnarchen, Schmerzen, Komplikationen, Indikationen und Kontraindikationen sowie Kriterien zur Vorhersage des Operationserfolges analysiert. Ergebnisse: Während die Methodik, die Operationstechniken, die Erfolge der LAUP beim primären Schnarchen und die Komplikationen der LAUP heute gut überblickt werden können, liegen zum Thema LAUP und OSA noch keine objektiven Langzeitdaten vor. Schlussfolgerung: Somit muss an der strengen Indikationsempfehlung zur LAUP seitens der Deutschen Gesellschaft für Hals-, Nasen-, Ohren-Heilkunde, Kopf- und Halschirurgie vorerst festgehalten werden. Kurzzeitergebnisse scheinen den Einsatz der Verfahren allerdings auch bei der OSA bedingt zu rechtfertigen.

Background: Laser-assisted uvulopalatoplasty (LAUP) was not recommended by the American Sleep Disorders Association for the treatment of snoring and obstructive sleep apnea (OSA) because of data lacking in 1994. In the meantime numerous new papers concerning this subject have been published in peer reviewed journals. A new evaluation of the value of LAUP is presented. Methods: In a world-wide literature search (Medline®) from 1980 until March 1999, seventy articles were identified. The papers were analyzed concerning the subtopics „operative techniques”, „LAUP and OSA”, „LAUP and snoring”, „pain”, „side-effects”, „indications” and „predictive criteria”. Results: On the basis of the collected data, it is possible to put definitive values on the subtopics „operative techniques”, „LAUP and snoring” and „side-effects”. In contrast, objective long-term results concerning „LAUP and OSA” are still missing. Short-term results are promising. Conclusion: Nevertheless, LAUP and its related procedures presently should not be recommended for the treatment of any severity of OSA.

Schlüsselwörter:

LAUP - Schlafbezogene Atmungsstörungen - Primäres Schnarchen - Literaturübersicht

Key words:

LAUP - Sleep related breathing disorders - Habitual snoring - Metaanalysis

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