Diagnostik schlafbezogener Atmungsstörungen mittels portabler Verfahren

Zusammenfassung

Das portable Monitoring von schlafbezogenen Atmungsstörungen ist mittlerweile die Diagnostik der ersten Wahl nicht nur in Deutschland, sondern auch in anderen Ländern. Die anamnestischen und apparativen Voraussetzungen für eine verlässliche portable Diagnostik sind jetzt gut definiert. Die Grenzen und Limitationen dieser Diagnostik in Bezug auf Patientengruppen und differenzialdiagnostische Möglichkeiten sind spezifiziert. Die zur Polygrafie eingesetzten Geräte werden in vier Klassen eingeteilt, die sich an der Zahl und Art der aufgezeichneten Signale orientieren.

Neue Entwicklungen auf dem Gebiet des portablen Monitoring nutzen indirekte Möglichkeiten der Atmungsaufzeichnung, um schlafbezogene Atmungsstörungen zu erkennen. Die EKG-basierte Atmungserkennung, die plethysmografisch abgeleitete Pulswellenanalyse, die mit Magneten gemessene Kieferbewegung und Atmungsgeräuschanalysen zählen dazu. Für die neuen Verfahren liegen bis jetzt nur wenige Studien vor. Es kann sich erst mittelfristig zeigen, welche dieser Verfahren sich in der Diagnostik bewähren und welche Rolle den Systemen dann zugewiesen wird.

Abstract

Portable monitoring of sleep disordered breathing is the first diagnostic method not only in Germany but today in other countries as well. The conditions under which portable monitoring can be done with reliable results are now well defined. The limitations for the use of portable monitoring are specified as well. The devices used for portable monitoring are classified in four categories according to the number and the kind of signals recorded.

New technical developments in the field of portable monitoring (polygraphy) use an indirect assessment of sleep disordered breathing based on signals not directly recording respiration. The recording of ECG and deriving respiration, the analysis of the plethysmographically recorded pulse wave, the recording of jaw movements using magnets, and advanced analysis of respiratory sounds are recent approaches. These new methods are presented with few studies until now. More and larger clinical studies are needed in order to show which of these systems is useful in the diagnosis of sleep disordered breathing and which are the specific strengths and weaknesses.

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