Diagnostik und Therapie des obstruktiven Schlafapnoesyndroms

Zusammenfassung

Die Adipositas gehört neben dem männlichen Geschlecht und dem höheren Lebensalter zu den wichtigsten Risikofaktoren des obstruktiven Schlafapnoesyndroms (OSAS). Dabei handelt es sich um ein Krankheitsbild, das aufgrund des individuellen gesundheitlichen Risikos, der Gefährdung durch Unfälle und kardiovaskuläre Folgeerkrankungen und durch die hohe Prävalenz eine erhebliche sozioökonomische Bedeutung hat. Typische Leitsymptome sind das laute und unregelmäßige Schnarchen, Atempausen, die von Bettpartnern beobachtet werden, sowie die vermehrte Tagesschläfrigkeit. Angesichts der hohen Zahl unerkannter Patienten kommt der Anamnese hohe Bedeutung zu. In der weiteren Diagnostik kommt die Erfassung des Atemflusses, der Atemanstrengung und der Sauerstoffsättigung zum Einsatz. Die genaue Erfassung der Schlafstadien und Weckreaktionen erlaubt nur die Polysomnografie. In der Therapie des OSAS stellt die Positivdruck-Therapie (Continuous Positive Airway Pressure, CPAP) den Standard dar, der sehr effektiv die Symptomatik, aber auch das Unfallrisiko und die kardiovaskuläre Belastung beseitigen kann. Bei Patienten mit leichtem OSAS können alternativ auch Unterkieferprotrusionsschienen oder Hals-Nasen-Ohren-ärztliche Operationen eingesetzt werden.

Summary

Obesity is one of the most important risk factors of the obstructive sleep apnoea syndrome (OSAS). OSAS represents a serious problem of individual health and a huge socioeconomic challenge due to its high prevalence, the risk of occupational and traffic accidents and the cardiovascular consequences. Loud and irregular snoring, witnessed apneas during sleep and excessive daytime sleepiness are the most typical symptoms. However, a huge number of patients remain undiagnosed. Diagnosis is built up by the history, questionnaires on daytime symptoms and polygraphical measurement of cardio-pulmonary parameters such as airflow through mouth and nose, breathing effort or oxygen saturation. The polysomnography represents the gold standard of diagnosis and measures additionally sleep stages and arousals from sleep. Continuous positive airway pressure treatment (CPAP) has proven to be the most effective treatment of OSAS. It normalizes symptoms, the risk of accidents and cardiovascular diseases. Intraoral appliances, ENT operations can alternatively be used in a number of patients with mild OSAS.

Schlüsselwörter

Obstruktives Schlafapnoesyndrom - Positivdrucktherapie - CPAP - Adipositas

Keywords

Obstructive sleep apnoea syndrome - continuous positive airway pressure - CPAP - obesity

• Literatur

• 1 American Academy of Sleep Medicine. International classification of sleep disorders. 2nd ed.. Diagnostic and coding manual. Westchester, Illinois: American Academy of Sleep Medicine; 2006
• 2 Baldwin CM, Griffith KA, Nieto FJ. et al. The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. Sleep 2001; 24 (01) 96-105.
• 3 Charuzi I, Fraser D. et al. Sleep apnea syndrome in the morbidly obese undergoing bariatric surgery. Gastroenterol Clin North Am 1987; 16 (03) 517-519.
• 4 Ciscar MA, Juan G, Martinez V. et al. Magnetic resonance imaging of the pharynx in OSA patients and healthy subjects. Eur Respir J 2001; 17 (01) 79-86.
• 5 Douglas NJ. Upper airway resistance syndrome is not a distinct syndrome. Am J Respir Crit Care Med 2000; 161 (05) 1413-1416.
• 6 Findley L, Unverzagt M, Guchu R. et al. Vigilance and automobile accidents in patients with sleep apnea or narcolepsy. Chest 1995; 108 (03) 619-624.
• 7 Friberg D, Ansved T, Borg K. et al. Histological indications of a progressive snorers disease in an upper airway muscle. Am J Respir Crit Care Med 1998; 157 (02) 586-593.
• 8 Hans MG, Nelson S, Pracharktam N. et al. Subgrouping persons with snoring and/or apnea by using anthropometric and cephalometric measures. Sleep Breath 2001; 05 (02) 79-91.
• 9 Hudgel DW, Harasick T. Fluctuation in timing of upper airway and chest wall inspiratory muscle activity in obstructive sleep apnea. J Appl Physiol 1990; 69 (02) 443-450.
• 10 Iber C, Ancoli-Israel S, Chesson A, Quan SF. for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. 1st ed.. Westchester, Illinois: merican Academy of Sleep Medicine; 2007
• 11 Johns MW. Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth sleepiness scale: failure of the MSLT as a gold standard. J Sleep Res 2000; 09 (04) 399-401.
• 12 Lim J, Lasserson TJ, Fleetham J, Wright J. ral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev 2006; 01: CD004435.
• 13 Lindberg E, Carter N, Gislason T, Janson C. Role of snoring and daytime sleepiness in occupational accidents. Am J Resp Crit Care Med 2001; 164: 2031-2035.
• 14 Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365 9464 1046-1053.
• 15 McArdle N, Devereux G, Heidarnejad H. et al. Long-term use of CPAP therapy for sleep apnea/ hypopnea syndrome. Am J Respir Crit Care Med 1999; 159 (4 Pt 1): 1108-1114.
• 16 Mezzanotte WS, Tangel DJ, White DP. Influence of sleep onset on upper-airway muscle activity in apnea patients versus normal controls. Am J Respir Crit Care Med 1996; 153 (6 Pt 1): 1880-1887.
• 17 National Commission on Sleep Disorders Research. Wake Up America: A National Sleep Alert. Vol 1: Executive summary and executive report. Bethesda, MD: National Institutes of Health; 1993
• 18 Netzer NC, Hoegel JJ, Loube D. et al. Sleep in Primary Care International Study Group. Prevalence of symptoms and risk of sleep apnea in primary care. Chest 2003; 124 (04) 1406-1414.
• 19 Randerath W, Kroll B, Schwickert M. et al. Beeinträchtigungen durch das Schlafapnoe-Syndrom in der Selbsteinschätzung der Patienten. Deutsche Medizinische Wochenschrift 2000; 125: 348-351.
• 20 Randerath WJ, Schraeder O, Galetke W. et al. Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance. Am J Respir Crit Care Med 2001; 163 (3 Pt 1): 652-657.
• 21 Randerath WJ. Automatic positive airway pressure titration and treatment. In: Randerath WJ, Sanner BM, Somers VK. Hrsg. Sleep Apnea. Prog Respir Res. 2006. 35 137-144.
• 22 Randerath W, Bauer M, Blau A. et al. Task Force der Arbeitsgruppe Apnoe der DGSM. Stellenwert der Nicht-nCPAP-Verfahren in der Therapie des obstruktiven Schlafapnoe-Syndroms. Somnologie 2006; 10: 67-98.
• 23 Randerath WJ, Stieglitz S, Galetke W. et al. Pathophysiologie des Obesitas-Hypoventilationssyndroms. Pneumologie 2008; 62 (07) 398-403.
• 24 Rechtschaffen A, Kales AA. A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Los Angeles: UCLA Brain Information Service/Brain Research Institute; 1968
• 25 Sanner BM, Heise M, Knoben B. et al. MRI of the pharynx and treatment efficacy of a mandibular advancement device in obstructive sleep apnoea syndrome. Eur Respir J 2002; 20 (01) 143-150.
• 26 Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981; 01 8225 862-865.
• 27 Suratt PM, McTier RF. et al. Changes in breathing and the pharynx after weight loss in obstructive sleep apnea. Chest 1987; 92 (04) 631-637.
• 28 Svanborg E. Upper airway muscles in obstructive respiratory sleep disorders: Clinical presentation, diagnosis and treatment. In: Randerath WJ, Sanner BM, Somers VK. Hrsg. Sleep Apnea. Prog Respir Res. 2006. 35 113-117.
• 29 Verse T, Baisch A, Hormann K. Multi-level surgery for obstructive sleep apnea. Preliminary objective results. Laryngorhinootologie 2004; 83 (08) 516-522.
• 30 Yim S, Jordan A, Malhotra A. Obstructive sleep apnea: Clinical presentation, diagnosis and treatment. In: Randerath WJ, Sanner BM, Somers VK. Hrsg. Sleep Apnea. Prog Respir Res. 2006. 35 118-136.
• 31 Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002; 165 (09) 1217-1239.
• 32 Young T, Blustein J, Finn L, Palta M. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep 1997; 20 (08) 608-613.