Gestörte Funktion der oberen Atemwege
Pharyngeale Atmung/Schnarchen

Zusammenfassung

Die vorliegende Übersicht befasst sich mit Atmungsstörungen, deren pathophysiologische Ursache im Pharynx liegt. Derartige Atmungsstörungen manifestieren sich überwiegend im Schlaf. Diese so genannten obstruktiven schlafbezogenen Atmungsstörungen umfassen drei unterschiedliche Diagnosen, das primäre Schnarchen, das Upper Airway Resistance Syndrom (UARS) und die obstruktive Schlafapnoe (OSA). Jede dieser Störungen wird unterschiedlich behandelt.

Das primäre Schnarchen ist eine Befindlichkeitsstörung und besitzt keinen eigenen Krankheitswert für den Patienten selbst, wenngleich häufig sekundär soziale Probleme durch die störenden Atmungsgeräusche entstehen. Adäquate konservative Behandlungsmöglichkeiten stellen Bissschienen dar. Auch die transkutane Elektrostimulationstherapie mit Oberflächenelektroden hat sich als nützlich erwiesen. Operative Verfahren bestehen bei Kindern in der Adenototomie, der Tonsillektomie oder der Tonsillotomie. Bei Erwachsenen hat sich die Radiofrequenztherapie der Tonsillen, des Weichgaumens und des Zungengrundes etabliert. Des Weiteren kommen die Uvulopalatopharyngoplastik (UPPP), laser-assistierte Verfahren am Weichgaumen (LAUP) und Weichgaumenimplantate erfolgreich zur Anwendung.

Das UARS und die milde OSA können sehr gut mit Bissschienen behandelt werden. Die nasale Überdruckbeatmung (nasal continuos positive airway pressure, nCPAP) ist eine sehr erfolgreiche Behandlungsoption, erreicht aber bei dieser Indikationsgruppe nur mäßige Therapieakzeptanz, da insbesondere bei der milden OSA die Tagessymptomatik oft nur gering ausgeprägt ist. An chirurgischen wiederherstellenden Verfahren kommen die UPPP, die Radiofrequenzchirurgie des Zungengrundes, die Hyoidsuspension, die Unterkieferosteotomie mit Vorverlagerung des M. genioglossus entweder isoliert oder in unterschiedlichen Kombinationen als sog. Multi-Level-Chirurgie-Konzepte erfolgreich zur Anwendung.

Goldstandard in der Behandlung der mittelschweren und der schweren OSA ist die nCPAP-Therapie. Alle Patienten mit einer mittelschweren oder schweren OSA sollten zumindest einen nCPAP-Therapieversuch unterlaufen. Chirurgische Verfahren sollten hier nur sekundär im Falle eines nCPAP-Therapieversagens eingesetzt werden, welches in gut 30 % der Fälle zu beobachten ist. Erfolgreiche Verfahren sind die Adenotomie, Tonsillektomie oder Tonsillotomie bei Kindern und bei Erwachsenen darüber hinaus die Hyoidsuspension, die Unterkieferosteotomie mit Vorverlagerung des M. genioglossus, verschiedene Multi-Level-Chirurgie-Konzepte oder Umstellungsosteotomien des Ober- und Unterkiefers. Letztere können bei entsprechenden kraniofazialen Fehlstellungen auch primär indiziert sein.

Schlüsselwörter

Primäres Schnarchen - Upper Airway Resistance Syndrome - obstruktive Schlafapnoe - Schlafatmungsstörungen

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