Gibt es Alternativen zum nCPAP-Verfahren in der Behandlung des obstruktiven Schlafapnoesyndroms?

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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