Zusammenfassung
Standardtherapie der obstruktiven Schlafapnoe (OSA) ist die nasale CPAP-Beatmung (continuous
positive airway pressure). Für Patienten, die die CPAP-Maske nicht tolerieren und
für jene, bei denen trotz CPAP-Akzeptanz die Beatmungstherapie versagt, werden alternativ
verschiedene Operationskonzepte favorisiert. Im vorliegenden Fall konnten bei einem
Patienten mit obstruktivem Schlafapnoe-Syndrom (OSAS) trotz CPAP-Toleranz die Apnoe-
und Hypopnoephasen mit der nächtlichen Überdruckbeatmung nicht reduziert werden. Man
beobachtete sogar eine Verschlechterung des Krankheitsbildes unter verschiedenen Beatmungsmodi.
Mit Hilfe der Schlafvideoendoskopie konnte unter physiologischen Schlafbedingungen
der Ort der Obstruktion identifiziert und mittels einer Hyoidsuspension in Kombination
mit einer Radiofrequenztherapie des Zungengrundes erfolgreich behandelt werden. Dabei
zeigte sich die Schlafvideoendoskopie als unerlässliches Diagnoseinstrument zur Ermittlung
der Obstruktion in den oberen Atemwegen. Inwieweit die Schlafvideoendoskopie als regelmäßig
durchgeführtes Standardverfahren in der Schlafmedizin eingesetzt werden kann, muss
in weiteren Studien untersucht werden.
Abstract
Nasal continuous positive airway pressure (nCPAP) ventilation is the gold standard
in the treatment of obstructive sleep apnea (OSA). For patients with CPAP-intolerance
and for those tolerating the CPAP-mask but without success, surgical strategies are
of growing interest. There are several surgical concepts which combine different surgical
procedures on both the velopharyngeal and the retrolingual section of the upper airway.
The case presented here describes the failed CPAP-therapy in an OSAS-patient who tolerates
the CPAP-mask. The apneas and hypopnoes could not be reduced by using the CPAP-mask,
even more they increased under CPAP-ventilation. Performing a videodocumented sleependoscopy
of the upper airway (under physiological sleep patterns) the location of the obstruction
could be identified. After performing a hyoid suspension in combination with a radiofrequency
therapy of the base of tongue the apneas and hypopneas decreased. Only by using the
sleep endoscopy the reason for the failed CPAP-therapy could be indentified and therefore
the surgical protocol succeed. To what extend the sleep video endoscopy becomes a
standarized procedure in sleep labs warrants further investigations.
Schlüsselwörter
Schlafbezogene Atemstörungen - OSAS - CPAP-Versagen - Schlafvideoendoskopie - chirurgische
Therapie - Hyoidsuspension - Zungengrund
Key words
Sleep related breathing disorders - OSAS - CPAP failure - sleep video endoscopy -
surgery - hyoid suspension - base of tongue
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Dr. med. Alexander Baisch
Universitäts-HNO-Klinik
68135 Mannheim ·
Email: alexander.baisch@hno.ma.uni-heidelberg.de
