Schlafapnoe-Syndrome: Alternative Therapieverfahren

Zusammenfassung

Die Basis der Behandlung obstruktiver schlafbezogener Atmungsstörungen ist eine Gewichtsreduktion sowie das Vermeiden von Hypnotika und Alkohol. Das Verhindern der Rückenlage durch z.B. spezielle Westen ist nur bei leichtgradigen Erkrankungsstadien bei Patienten ohne Beschwerden und ohne cardiovaskuläre Risikofaktoren ausreichend. In diesem Krankheitsstadium können auch Unterkieferprotrusionsschienen oder operative Maßnahmen helfen. Eine medikamentöse Therapie ist bei obstruktiven schlafbezogenen Atmungsstörungen obsolet. Die weiteren aufgeführten Verfahren (interne und externe Nasendilatatoren, nasale und orale Öle, Diäten, Magnetkopfkissen bzw. -matrazen) sind ineffektiv und nicht zu empfehlen. Die Therapie der Wahl ist die nächtliche Atmung mit kontinuierlichem Überdruck.

Abstract

Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome. However, further steps are often necessary. If there is a postural component in mild cases sleeping on the side can help. Recent developments are a range of operations that increase the size of the pharynx. There is a good relief in snoring but the reduction in apnea rate is less successful. Oral appliances are are indicated for primary snoring or mild obstructive sleep apnea. The are no data that support the use of drugs as a therapy for obstructive sleep apnea. Different nonprescription therapies are available (internal and external nasal dilators, nasal and oral lubricants, dietary supplements, magnetic pillows and matresses) but their usefulness for the treatment has not been demonstrated. The treatment of choice for sleep-related obstructive breathing disorders is nCPAP.

Literatur

• 1 Young T, Palta M, Dempsey J. et al . The occurence of sleep-disordered breathing among middle-aged adults.  New Engl J Med. 1993;  328 1230-1235
• 2 Guilleminault C, Hoed J van den, Mitler M M. Clinical overview of the sleep apnea syndromes. In: Guilleminault C, Dement WE (Hrsg.): Sleep apnea syndromes. New York: Alan R Viss 1978
• 3 Guilleminault C, Elridge F L, Dement W C. Insomnia with sleep apnea: a new syndrome.  Science. 1973;  181 856-858
• 4 Duchna H W, Grote L, Andreas S. et al . Sleep-Disordered breathing and cardio- and cerebrovascular diseases: 2003 update of clinical significance and future perspectives.  Somnology. 2003;  3 101-121
• 5 Shamsuzzaman A S, Gersh B J, Somers V K. Obstructive sleep apnea: implications for cardiac and vascular disease.  JAMA. 2003;  290 1906-1914
• 6 Wolk R, Kara T, Somers V K. Sleep-disordered breathing and cardiovascular disease.  Circulation. 2003;  108 9-12
• 7 Sullivan C E, Berthon-Jones M, Issa F G. et al . Reversal of obstructive sleep apnoea by continous positive airway pressure applied through the nares.  Lancet. 1981;  1 862-865
• 8 Schmidt-Nowara W, Lowe A, Wiegand L. et al . Oral appliances for the treatment of snoring and obstructive sleep apnea: a review.  Sleep. 1995;  18 501-510
• 9 Koopmann C E, Moran W B. Surgical management of obstructive sleep apnea.  Otolaryngol Clin N Amer. 1990;  23 787-808
• 10 Hein H, Magnussen H. Wie steht es um die medikamentöse Therapie bei schlafbezogenen Atmungsstörungen?.  Somnologie. 1998;  2 77-88
• 11 Hudgel D W, Thanakitcharu S. Pharmacologic treatment of sleep disordered breathing.  Am J Respir Crit Care Med. 1998;  158 691-699
• 12 Suratt P M, McTier R F, Findley L J. et al . Effect of very-low-calorie diets with weight loss on obstructive sleep apnea.  Am J Clin Nutr. 1992;  56 (1 Suppl) 182S-184S
• 13 Pedro-Botet J, Senti M, Nogues X. et al . Lipoprotein and apolipoprotein profile in men with ischemic stroke. Role of lipoprotein(a), triglyceride- rich lipoproteins, and apolipoprotein E polymorphism.  Stroke. 1992;  23 1556-1562
• 14 Suratt P M, McTier R F, Findley L J. et al . Changes in breathing and the pharynx after weight loss in obstructive sleep apnea.  Chest. 1987;  92 631-637
• 15 Aubert-Tulkens G, Culee C, Rodenstein D O. Cure of sleep apnea syndrome after long-term nasal continuous positive airway pressure therapy and weight loss.  Sleep. 1989;  12 216-222
• 16 Noseda A, Kempenaers C, Kerkhofs M. et al . Sleep apnea after 1 year domiciliary nasal-continuous positive airway pressure and attempted weight reduction. Potential for weaning from continuous positive airway pressure.  Chest. 1996;  109 138-143
• 17 Pasquali R, Colella P, Cirignotta F. et al . Treatment of obese patients with obstructive sleep apnea syndrome (OSAS): effect of weight loss and interference of otorhinolaryngoiatric pathology.  Int J Obes. 1990;  14 207-217
• 18 Herrendorf G, Hajak G, Rodenbeck A. Treatment of obstructive sleep apnea syndrome by ambulatory, comprehensive, behavior therapy oriented weight reduction (Optifast program).  Wien Med Wochenschr. 1995;  145 508-510
• 19 Charuzi I, Lavie P, Peiser J. et al . Bariatric surgery in morbidly obese sleep-apnea patients: short- and long-term follow-up.  Am J Clin Nutr. 1992;  55 (2 Suppl) 594S-596S
• 20 Pillar G, Peled R, Lavie P. Recurrence of sleep apnea without concomitant weight increase 7.5 years after weight reduction surgery.  Chest. 1994;  106 1702-1704
• 21 Peiser J, Lavie P, Ovnat A. et al . Sleep apnea syndrome in the morbidly obese as an indication for weight reduction surgery.  Ann Surg. 1984;  199 112-115
• 22 Charuzi I, Fraser D, Peiser J. et al . Sleep apnea syndrome in the morbidly obese undergoing bariatric surgery.  Gastroenterol Clin North Am. 1987;  16 517-519
• 23 Charuzi I, Ovnat A, Peiser J. et al . The effect of surgical weight reduction on sleep quality in obesity-related sleep apnea syndrome.  Surgery. 1985;  97 535-538
• 24 Peiser J, Ovnat A, Uwyyed K. et al . Cardiac arrhythmias during sleep in morbidly obese sleep-apneic patients before and after gastric bypass surgery.  Clin Cardiol. 1985;  8 519-521
• 25 Smith I, Lasserson T, Wright J. Drug treatments for obstructive sleep apnoea (Cochrane Review). In: The Cochrane Library, Issue 1. Oxford: Update Software 2003
• 26 Carley D W, Olopade C, Seink S. et al . Serotonin Antagonist improves obstructive sleep apneal.  Sleep Med. 2003;  4S1 S6
• 27 Hedner J, Kraiczi H, Peker Y. et al . Reduction of sleep-disordered breathing after Physostigmine.  Am J Respir Crit Care Med. 2003;  168 1246-1251
• 28 Fiz J A, Abad J, Riera M. et al . Inspiratory muscle training in patients with osbtructive sleep apnoea (OSA). A preliminary study.  Eur Respir J. 1995;  8 34S
• 29 Miki H, Hida W, Chonan T. et al . Effects of submental electrical stimulation during sleep on upper airway patency in patients with obstructive sleep apnea.  Am Rev Respir Dis. 1989 Nov;  140 (5) 1285-1289
• 30 Edmonds L C, Daniels B K, Stanson A W. et al . The effects of transcutaneous electrical stimulation during wakefulness and sleep in patients with obstructive sleep apnea.  Am Rev Respir Dis. 1992;  146 1030-1036
• 31 Guilleminault C, Powell N, Bowman B. et al . The effect of electrical stimulation on obstructive sleep apnea syndrome.  Chest. 1995;  107 67-73
• 32 Schwartz A R, Bennett M L, Smith P L. et al . Therapeutic electrical stimulation of the hypoglossal nerve in obstructive sleep apnea.  Arch Otolaryngol Head Neck Surg. 2001;  127 1216-1223
• 33 Randerath W. et al .Sleep. 2003, im Druck
• 34 Todorova A, Schellenberg R, Hofmann H C. et al . Effect of the external nasal dilator Breathe Right on snoring.  Eur J Med Res. 1998;  3 367-379
• 35 Ulfberg J, Fenton G. Effect of Breathe Right nasal strip on snoring.  Rhinology. 1997;  35 50-52
• 36 Liistro G, Rombaux P, Dury M. et al . Effects of Breathe Right on snoring: a polysomnographic study.  Respir Med. 1998;  92 1076-1078
• 37 Wenzel M, Schönhofer B, Siemon K. et al . Nasenpflaster ohne Effekt auf die obstruktive Schlafapnoe und das Schnarchen.  Pneumologie. 1997;  51 1108-1110
• 38 Gosepath J, Amedee R G, Romantschuck S. et al . Breathe Right nasal strips and the respiratory disturbance index in sleep related breathing disorders.  Am J Rhinol. 1999;  13 385-389
• 39 Bahaman A S, Tate R, Manfreda J. et al . Upper Airway Resistance Syndrome: Effect of Nasal Dilation, Sleep Stage and Sleep Position.  Sleep. 1999;  22 592-598
• 40 Lorino A M, Lofaso F, Dahan E. et al . Combined effects of a mechanical nasal dilator and a topical decongestant on nasal airflow resistance.  Chest. 1999;  115 1514-1518
• 41 Petruson B. Improvement of the nasal airflow by the nasal dilator Nozovent.  Rhinology. 1988;  26 289-292
• 42 Metes A, Cole P, Hoffstein V. et al . Nasal airway dilation and obstructed breathing in sleep.  Laryngoscope. 1992;  102 1053-1055
• 43 Shinkawa A, Sakai M. A clinical study of the nasal dilator Nozovent in Japanese subjects.  Tokai J Exp Clin Med. 1998;  23 13-17
• 44 Hoijer U, Ejnell H, Hedner J. et al . The effects of nasal dilation on snoring and obstructive sleep apnea.  Arch Otolaryngol Head Neck Surg. 1992;  118 281-284
• 45 Maurer J T, Stuck B A, Hein G. et al . Therapie der obstruktiven Schlafapnoe mit einer neuartigen Rückenlageverhinderungsweste.  Dtsch Med Wochenschr. 2003;  128 71-75
• 46 Cartwright R D. Effect of sleep position on sleep apnea severity.  Sleep. 1984;  7 110-114
• 47 Phillips B A, Okeson J, Paesani D. et al . Effect of sleep position on sleep apnea and parafunctional activity.  Chest. 1986;  90 424-429
• 48 Miki H, Hida W, Kikuchi Y. et al . Effect of sleep position on obstructive sleep apnea.  Tohoku J Exp Med. 1988;  156 (Suppl.) 143-149
• 49 Schönhofer B, Stoohs R A, Rager H. et al . A new tongue advancement technique for sleep disordered breathing.  Am J Respir Crit Care Med. 1997;  155 732-738
• 50 Hoffstein V, Mateiko S, Halko S. et al . Reduction in snoring with phosphocholinamin, a long-acting tissue-lubricating agent.  Am J Otolaryngol. 1987;  8 236-240
• 51 Jokic R, Klimaszewski A, Mink J. et al . Surface tension forces in sleep apnea: the role of a soft tissue lubricant: a randomized double-blind, placebo-controlled trial.  Am J Respir Crit Care Med. 1998;  157 1522-1525
• 52 Lipman D, Sexton G, Schlesser J. A randomized double-blind placebo-controlled evaluation of the safety and efficacy of a natural over-the counter (OTC) medication in the management of snoring.  Sleep Breath. 1999;  3 53-56
• 53 Schönhofer B, Wenzel M, Barchfeld T. et al . Wertigkeit verschiedener intra- und extraoraler Therapieverfahren für die Behandlung der obstruktiven Schlafapnoe und des Schnarchens.  Med Klinik. 1997;  92 167-174
• 54 Dexter Jr D. Magnetic therapy is ineffective for the treatment of snoring and obstructive sleep apnea syndrome.  Wis Med J. 1997;  96 35-37