Mit der Schlafendoskopie zur richtigen Therapie

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 obstruktiven 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. Mithilfe 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 Atemwege. In wie weit 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 - surgrey - hyoid suspension - base of tongue

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