Die Nicht-CPAP-Therapie des obstruktiven Schlafapnoe-Syndroms: ein Überblick

Zusammenfassung

Die optimale Therapie des obstruktiven Schlafapnoe-Syndroms erfordert ein individuell und interdisziplinär ausgerichtetes Konzept. Als Standardtherapie wird die nächtliche Überdruckatmung (CPAP = continuous positive airway pressure) angesehen. Darüber hinaus existiert ein umfangreiches Repertoire an Nicht-CPAP-Therapien, die insbesondere bei Versagen oder Ablehnung der nächtlichen Überdruckatmung zum Einsatz kommen. Limitierend in der Bewertung der Nicht-CPAP-Therapie ist jedoch die vorwiegend unzureichende Evidenz der Nicht-CPAP-Therapien. Als konservative Maßnahme kann die Unterkieferprotrusionsschiene bei leichtem bis moderatem OSAS zum Einsatz kommen. Die bisher präklinisch eingesetzte Neurostimulation der Muskulatur der oberen Atemwege stellt einen attraktiven Ansatz zur Behandlung des OSAS dar, der sich jedoch in klinischen Studien noch beweisen muss. Isolierte chirurgische Maßnahmen der Nase, des Oropharynx oder des Hypopharynx können aufgrund der geringen Erfolgsrate im Allgemeinen nicht empfohlen werden. Ausnahmen stellen die Tonsillektomie bei Vergrößerung der Tonsillen und die aufwendige maxillomandibuläre Umstellungsosteotomie dar. Ein potenzieller Ansatz der chirurgischen Therapie des OSAS für die Zukunft stellt die Multi-Level-Chirurgie dar.

Abstract

Optimal treatment of the obstructive sleep apnoea syndrome (OSAS) requires an individually designed and interdisciplinary approach. Continu ous positive airway pressure (CPAP) is accepted as the first line therapy for patients with OSAS. However, non-CPAP therapies may be indicated as supportive therapeutical approach in CPAP failure or as an alternative approach in CPAP intolerance. Overall, the level of evidence for the majority of non-CPAP therapies is low. Mandibular advancement devices as a medical non-CPAP treatment have proven to reduce respiratory disturbances to a level which may be sufficient in mild to moderate sleep apnoea. Apnoea triggered neurostimulation of upper airway muscles is an innovative approach that has shown promising results in preclinical studies. Surgical treatment has previously been performed as single level surgery of the nasal, the oropharyngeal or hypopharyngeal level. However, only tonsillectomy in the presence of tonsillar hypertrophy and maxillomandibular advancement are recommended in carefully selected cases. Due to low success rates for single level surgery, multilevel surgery has been proposed as the surgical approach for the future.

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