Zusammenfassung
Patienten mit einem obstruktiven Schlafapnoesyndrom suchen häufig Behandlungsverfahren,
mit denen sie die kontinuierliche Positivdruckatmung (CPAP) vermeiden möchten. Obwohl
zahlreiche operative und konservative Methoden angeboten werden, können nur selten
wissenschaftliche Daten angegeben werden, die eine evidenzbasierte Bewertung der Verfahren
ermöglichen. Ausreichende Untersuchungen liegen lediglich für die Unterkieferprotrusionsschienen,
die beim leichten bis allenfalls mittelgradigen OSAS eine relevante Besserung der
respiratorischen Störungen bewirken können, und die maxillo-mandibuläre Osteotomie
vor. Gewichtsreduktion oder Lagetherapie können allenfalls die CPAP-Therapie ergänzen.
Unter den hals-nasen-ohrenärztlichen Eingriffen sind muskelresezierende Verfahren
am Weichgaumen abzulehnen. Aber auch die Effekte muskelschonender Operationsverfahren
am Weichgaumen sind individuell kaum vorhersehbar und lassen über die Jahre oft nach.
Die Ergebnisse nach Operationen an anderen anatomischen Regionen scheinen dagegen
stabil zu bleiben. Kombinierte Eingriffe im Sinne einer Multi-Level-Chirurgie gewinnen
sekundär nach erfolgloser oder abgebrochener Beatmungsbehandlung an Bedeutung, auch
wenn hier noch weitere Daten nötig sind. Alle übrigen Verfahren entbehren der ausreichenden
Validierung oder sind beim Schlafapnoesyndrom als nicht indiziert anzusehen.
Abstract
Many patients with the obstructive sleep apnea syndrome (OSAS) look for alternative
conservative or surgical therapies to avoid to be treated with continuous positive
airway pressure. In view of the high prevalence and the relevant impairment of the
patients lots of methods are offered which promise definitive cure or relevant improvement
of OSAS. The working group “Apnea” in the German Society of Sleep Medicine and Research
established a task force to evaluate the scientific literature on non-CPAP therapies
in the treatment of OSAS according to the standards of evidence-based medicine. This
paper summarizes the results of the task force. The data were unsatisfactorily for
most of the methods. Sufficient data were available for intraoral appliances (IOA)
and the maxillomandibular osteotomy (MMO). IOA's can reduce mild to moderate respiratory
disturbances, MMO are efficient in the short and long term but are performed only
in special situations such as craniofacial dysmorphias. Weight reduction and body
positioning cannot be recommended as a single treatment of OSAS. Most surgical procedures
still lack sufficient data according to the criteria of evidence based medicine. Resections
of muscular tissue within the soft palate have to be strictly avoided. But even success
following gentle soft palate procedures is difficult to predict and often decreases
after years. Results in other anatomical regions seem to be more stable over time.
Today combined surgeries in the sense of multi-level surgery concepts are of increasing
interest in the secondary treatment after failure of nasal ventilation therapy although
more data from prospective controlled studies are needed. There is no evidence for
any other treatment options.
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640-644
Prof. Dr. med. Winfried J. Randerath
Institut für Pneumologie an der Universität Witten/Herdecke, Krankenhaus Bethanien,
Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin
Aufderhöher Straße 169 - 175
42699 Solingen
Email: randerath@klinik-bethanien.de