Gestörte Funktion der oberen AtemwegePharyngeale Atmung/Schnarchen

T. Verse

doi:10.1055/s-2005-861130

Laryngo-Rhino-Otologie, Table of Contents

Laryngorhinootologie 2005; 84: 118-135
DOI: 10.1055/s-2005-861130

Gestörte Funktion der oberen Atemwege

Gestörte Funktion der oberen Atemwege
Pharyngeale Atmung/Schnarchen

T. Verse¹

¹Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde der Universitätskliniken des Saarlandes (kommissarischer Direktor: Priv.-Doz. Dr. med. Thomas Verse)

Abstract

Zusammenfassung

Die vorliegende Übersicht befasst sich mit Atmungsstörungen, deren pathophysiologische Ursache im Pharynx liegt. Derartige Atmungsstörungen manifestieren sich überwiegend im Schlaf. Diese so genannten obstruktiven schlafbezogenen Atmungsstörungen umfassen drei unterschiedliche Diagnosen, das primäre Schnarchen, das Upper Airway Resistance Syndrom (UARS) und die obstruktive Schlafapnoe (OSA). Jede dieser Störungen wird unterschiedlich behandelt.

Das primäre Schnarchen ist eine Befindlichkeitsstörung und besitzt keinen eigenen Krankheitswert für den Patienten selbst, wenngleich häufig sekundär soziale Probleme durch die störenden Atmungsgeräusche entstehen. Adäquate konservative Behandlungsmöglichkeiten stellen Bissschienen dar. Auch die transkutane Elektrostimulationstherapie mit Oberflächenelektroden hat sich als nützlich erwiesen. Operative Verfahren bestehen bei Kindern in der Adenototomie, der Tonsillektomie oder der Tonsillotomie. Bei Erwachsenen hat sich die Radiofrequenztherapie der Tonsillen, des Weichgaumens und des Zungengrundes etabliert. Des Weiteren kommen die Uvulopalatopharyngoplastik (UPPP), laser-assistierte Verfahren am Weichgaumen (LAUP) und Weichgaumenimplantate erfolgreich zur Anwendung.

Das UARS und die milde OSA können sehr gut mit Bissschienen behandelt werden. Die nasale Überdruckbeatmung (nasal continuos positive airway pressure, nCPAP) ist eine sehr erfolgreiche Behandlungsoption, erreicht aber bei dieser Indikationsgruppe nur mäßige Therapieakzeptanz, da insbesondere bei der milden OSA die Tagessymptomatik oft nur gering ausgeprägt ist. An chirurgischen wiederherstellenden Verfahren kommen die UPPP, die Radiofrequenzchirurgie des Zungengrundes, die Hyoidsuspension, die Unterkieferosteotomie mit Vorverlagerung des M. genioglossus entweder isoliert oder in unterschiedlichen Kombinationen als sog. Multi-Level-Chirurgie-Konzepte erfolgreich zur Anwendung.

Goldstandard in der Behandlung der mittelschweren und der schweren OSA ist die nCPAP-Therapie. Alle Patienten mit einer mittelschweren oder schweren OSA sollten zumindest einen nCPAP-Therapieversuch unterlaufen. Chirurgische Verfahren sollten hier nur sekundär im Falle eines nCPAP-Therapieversagens eingesetzt werden, welches in gut 30 % der Fälle zu beobachten ist. Erfolgreiche Verfahren sind die Adenotomie, Tonsillektomie oder Tonsillotomie bei Kindern und bei Erwachsenen darüber hinaus die Hyoidsuspension, die Unterkieferosteotomie mit Vorverlagerung des M. genioglossus, verschiedene Multi-Level-Chirurgie-Konzepte oder Umstellungsosteotomien des Ober- und Unterkiefers. Letztere können bei entsprechenden kraniofazialen Fehlstellungen auch primär indiziert sein.

Schlüsselwörter

Primäres Schnarchen - Upper Airway Resistance Syndrome - obstruktive Schlafapnoe - Schlafatmungsstörungen

Full Text

References

Literatur

1 Moore K. Site specific versus diffuse treatment/presenting severity of obstructive sleep apnea. Sleep Breath. 2000; 4 145-146
2 Remmers J E, de Groot W J, Sauerland E K, Anch A M. Pathogenesis of the upper airway occlusion during sleep. J Appl Physiol. 1978; 44 931-938
3 Phillipson E A. Control of breathing during sleep. Am Rev Respir Dis. 1978; 118 909-939
4 Guilleminault C, Stoohs R, Clerk J, Simmons J, Labanowski M. A cause of excessive daytime sleepiness: the upper airway resistance syndrome. Chest. 1993; 104 781-787
5 Guilleminault C, van den Hoed J, Mitler M M. Clinical overview of sleep apnea syndromes. In: Guilleminault C, Dement WC Sleep apnea syndromes. New York; Alan R. Liss Inc 1978: 1-12
6 Jennum P, Hein H O, Suadicani P, Gyntelberg F. Cardiovascular risk factors in snorers. A cross sectional study of 3323 men aged 54 to 74 years: the Copenhagen Mal Study. Chest. 1992; 102 1371-1376
7 Young T, Palat M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993; 328 1230-1235
8 Hung J, Whitford E G, Parsons R W, Hillman D R. Association of sleep apnoea with myocardial infarction in men. Lancet. 1990; 336 261-264
9 Dyken M E, Sommers V K, Yamada T, Ren Z Y, Zimmerman M B. Investigating the relationship between stroke and obstructive sleep apnea. Stroke. 1996; 27 401-407
10 Peppard P, Young T, Palta M, Skatrud J. Prospective study of the association between sleep disordered breathing and hypertension. N Engl J Med. 2000; 342 1378-1384
11 Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med. 1999; 340 847-851
12 American Sleep Disorders Association. Practice parameters for the indications for polysomnography and related procedures. Sleep. 1997; 20 406-422
13 Fischer J, Mayer G, Hermann J, Riemann D, Sitter H. Untersuchungsstandards im medizinischen Zentrum. Somnologie. 2001; 5 (Suppl 3) 41-59
14 American Sleep Disorders Association. Practice parameters for the treatment of obstructive sleep apnea in adults: the efficacy of surgical modifications of the upper airway. Sleep. 1996; 19 152-155
15 Lugaresi E, Cirignotta F, Gerardi R, Montagna P. Snoring and sleep apnea: Natural history of heavy snorers disease. In: Guilleminault C, Partinen M (eds) Obstructive sleep apnea syndrome: Clinical research and treatment. New York; Raven Press 1990: 25-36
16 Mortimore I L, Bradley P A, Murray J A, Douglas N J. Uvulopalatopharyngoplasty may compromise nasal CPAP therapy in sleep apnea syndrome. Am J Respir Crit Care Med. 1996; 154 1759-1762
17 He J, Kryger M H, Zorick F J, Conway W, Roth T. Mortality and apnea index in obstructive sleep apnea: Experience in 385-male patients. Chest. 1988; 94 9-14
18 Pirsig W, Hörmann K, Siegert R, Maurer J, Verse T. Leitlinie der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie „Obstruktive Schlafapnoe”. HNO. 1998; 46 730
19 Fujita S. Pharyngeal surgery for obstructive sleep apnea and snoring. In: Fairbanks DNF (ed) Snoring and obstructive sleep apnea. New York; Raven Press 1987: 101-128
20 Canadian Task Force on the Periodic Health Examination. The periodic health examination: 2. 1987 update. Can Med Assoc J. 1988; 138 618-626
21 Canadian Task Force on the Periodic Health Examination. The Canadian guide to clinical preventive health care. Ottawa: Minister of Supply and Services, Canada. 1994
22 Browman C P, Sampson M G, Yolles F S, Gujavarti K S, Weiler S J, Walsleben J A, Hahn P M, Mitler M M. Obstructive sleep apnea and body weight. Chest. 1984; 85 435-438
23 Sampol G, Munoz X, Sagalés M T, Marti S, Roca A, Dolors d e, Lloberes P, Morell F. Long-term efficacy of dietary weight loss in sleep apnoea/hypopnoea syndrome. Eur Respir J. 1998; 12 1156-1159
24 Maurer J T, Hein G, Stuck B A, Verse T, Hörmann K. Schlafapnoetherapie mit einer neuartigen Rückenlage-Verhinderungs-Weste. DMW. 2003; 128 71-75
25 Hein H, Magnussen H. Wie steht es um die medikamentöse Therapie bei schlafbezogenen Atmungsstörungen?. Somnologie. 1998; 2 77-88
26 Sullivan C E, Issa F G, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981; 1 862-865
27 Dobrowski J M, Ahmed M. Positive airway pressure for obstructive sleep apnea. In: Fairbanks DNF, Mickelson SA, Woodson BT Snoring and obstructive sleep apnea. 3rd edition. Philadelphia; Lippincott Williams & Wilkins 2002: 95-106
28 Jenkinson C, Davies R JO, Stradling J R. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnea: a randomised prospective parallel trial. Lancet. 1999; 353 2100-2105
29 Ballester E, Badia J R, Hernandez L, Carrasco E, de Pablo J, Fornas C, Rodriguez-Roisin R, Montserrat J M. Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999; 159 495-501
30 McArdle N, Dervereux G, Heidarnejad H, Engleman H M, Mackay T W, Douglas N J. Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999; 159 1108-1114
31 Janson C, Nöges E, Svedberg-Brandt S, Lindberg E. What characterizes patients who are unable to tolerate continuous positive airway pressure (CPAP) treatment?. Resp Med. 2000; 94 145-149
32 Souter M A, Stevenson S, Sparks B, Drennan C. Upper airway surgery benefits patients with obstructive sleep apnoea who cannot tolerate nasal continuous positive airway pressure. J Laryngol Otol. 2004; 118 270-274
33 Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep. 1995; 18 501-510
34 Menn S J, Loube D I, Morgan T D, Mitler M M, Berger J S, Erman M K. The mandibula repositioning device: role in the treatment of obstructive sleep apnea. Sleep. 1996; 19 794-800
35 Clark G T, Blumenfeld I, Yoffe N, Peled E, Lavie P. A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibular positioning devices on patients with obstructive sleep apnea. Chest. 1996; 109 1477-1483
36 Ferguson K A, Ono T, Lowe A A, Keenan S P, Fleetham J A. A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest. 1996; 109 1269-1275
37 Pantin C C, Hillman D R, Tennant M. Dental side effects of an oral device to treat snoring and obstructive sleep apnea. Sleep. 1999; 22 237-240
38 Randerath W J, Galetke W, Domanski U, Weitkunat R, Ruhle K H. Tongue-muscle training by intraoral electrical neurostimulation in patients with obstructive sleep apnea. Sleep. 2004; 27 254-259
39 Verse T, Schwalb J, Hörmann K, Stuck B A, Maurer J T. Transkutane, submentale Elektrostimulationstherapie zur Behandlung der obstruktiven Schlafapnoe. HNO. 2003; 51 966-970
40 Nieminen P, Tolonen U, Löppönen H. Snoring and obstructive sleep apnea in children. A 6-month follow-up study. Arch Otolaryngol Head Neck Surg. 2000; 126 481-486
41 Jain A, Sahni J K. Polysomnographic studies in children undergoing adenoidectomy and/or tonsillectomy. J Laryngol Otol. 2002; 116 711-715
42 Brooks L J, Stephens B M, Bacevice A M. Adenoid size is related to severity but not the number of episodes of obstructive apnea in children. J Pediatr. 1998; 132 682-686
43 Hibbert J, Stell P. Adenoidectomy. An evaluation of the indications. Arch Dis Child. 1978; 53 910-911
44 Chen J M, Schloss M D, Azouz M E. Antro-choanal polyp: a 10-year retrospective study in the pediatric population with a review of the literature. J Otolaryngol. 1989; 18 168-172
45 Orvidas L J, Beatty C W, Weaver A L. Antrochoanal polyps in children. Am J Rhinol. 2001; 15 321-325
46 Rodgers G K, Chan K H, Dahl R E. Antral choanal polyp presenting as obstructive sleep apnea syndrome. Arch Otolaryngol Head Neck Surg. 1991; 117 914-916
47 Salib R J, Sadek S A, Dutt S N, Pearman K. Antrochoanal polyp presenting with obstructive sleep apnoea and cachexia. Int J Pediatr Otorhinolaryngol. 2000; 54 163-166
48 Brausewetter F, Hecht M, Pirsig W. Antrochoanal polyp and obstructive sleep apnoea in children. J Laryngol Otol. 2004; 118 453-458
49 Crampette L, Mondain M, Rombaux P. Sphenochoanal polyp in children. Diagnosis and treatment. Rhinology. 1995; 33 43-45
50 Donnelly L F, Surdulescu V, Chini B A, Casper K A, Poe S A, Amin R S. Upper airway motion depicted at cine MR imaging performed during sleep: comparison between young patients with and those without obstructive sleep apnea. Radiology. 2003; 227 239-245
51 Khalifa M S, Kamel R H, Abu Zikry M, Kandil T M. Effect of enlarged adenoids on arterial blood gases in children. J Laryngol Otol. 1991; 105 436-438
52 Paditz E, Knauth H, Baerthold W. Effect of adenotomy on mental performance of children with adenoid vegetations [in German]. Wien Med Wochenschr. 1996; 146 327-328
53 Guilleminault C, Eldridge F L, Simmons F B, Dement W C. Sleep apnea in eight children. Pedriatrics. 1976; 58 23-30
54 Konno A, Hoshino T, Togawa K. Influence of upper airway obstruction by enlarged tonsils and adenoids upon recurrent infection of the lower airway in childhood. Laryngoscope. 1980; 90 1709-1716
55 Hultcrantz E, Linder A, Markström A. Tonsillectomy or tonsillotomy? - a randomized study comparing postoperative pain and long-term effects. Int J Pediatr Otorhinolaryngol. 1999; 51 171-176
56 Nelson L M. Radiofrequency treatment for obstructive tonsillar hypertrophy. Arch Otolaryngol Head Neck Surg. 2000; 126 736-740
57 Agren K, Nordlander B, Linder-Aronsson S, Zettergren-Wijk L, Svanborg E. Children with nocturnal upper airway obstruction: postoperative orthodontic and respiratory improvement. Acta Otolaryngol. 1998; 118 581-587
58 Ahlquist-Rastad J, Hultcrantz E, Svanholm H. Children with tonsillar obstruction: indications for and efficacy of tonsillectomy. Acta Pediatr Scand. 1988; 77 831-835
59 Helling K, Abrams J, Bertram W K, Hohner S, Scherer H. Laser tonsillotomy - a method for treating tonsillar hyperplasia in early childhood [in German]. HNO. 2002; 50 410-414
60 Swift A C. Upper airway obstruction, sleep disturbance and adenotonsillectomy in children. J Laryngol Otol. 1988; 102 419-422
61 Stradling J R, Thomas G, Earley A RH, Williams P, Freeland A. Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children. Lancet. 1990; 335 249-253
62 Urschitz M S, Guenther A, Eggebrecht E, Wolf J, Urschitz-Duprat P M, Schlaud M, Poets C F. Snoring, intermittent hypoxia and academic performance in primary school children. Am J Respir Crit Care Med. 2003; 168 464-468
63 Blunden S, Lushington K, Kennedy D, Martin J, Dawson D. Behavior and neurocognitive performance in children aged 5 - 10 years who snore compared to normal controls. J Clin Exp Neuropsych. 2000; 22 554-568
64 Friedman B C, Hendeles-Amitai A, Kozminsky E, Leiberman A, Friger M, Tarasiuk A, Tal A. Adenotonsillectomy improves neurocognitive function in children with obstructive sleep apnea syndrome. Sleep. 2003; 26 999-1005
65 Frank Y, Krevath R E, Pollak C P, Weitzman E D. Obstructive sleep apnea and its therapy: clinical and polysomnographic manifestations. Pediatrics. 1983; 71 737-742
66 Bar A, Tarasiuk A, Segev Y, Phillip M, Tal A. The effect of adenotonsillectomy on serum insulin-like growth factor-I and growth in children with obstructive sleep apnea syndrome. J Pediatr. 1999; 135 76-80
67 Helfaer M A, McColley S A, Pyzik P L, Tunkel D E, Nichols D G, Baroody F M, April M M, Maxwell L G, Loughlin G M. Polysomnography after adenotonsillectomy in mild pediatric obstructive sleep apnea. Am J Resp Crit Care Med.. 1996; 24 1232-1327
68 Shintani T, Asakura K, Kataura A. The effect of adenotonsillectomy in children with OSA. Int J Pediatr Otorhinolaryngol. 1998; 44 51-58
69 Suen J S, Arnold J E, Brooks L J. Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg. 1995; 121 525-530
70 Wiet G J, Bower C, Seibert R, Griebel M. Surgical correction of obstructive sleep apnea in the complicated pediatric patient documented by polysomnography. Int J Pediatr Otorhinolaryngol. 1997; 41 133-143
71 Zucconi M, Strambi L F, Pestalozza G, Tessitore E, Smire S. Habitual snoring and obstructive sleep apnea syndrome in children: effect of early tonsil surgery. Int J Pediatr Otorhinolaryngol. 1993; 26 235-243
72 Nandapalan V, McCormick M S, Jones T M, Gibson H. Does adenotonsillectomy cure hypoxaemia in children with sleep apnoea and congenital cardiac pathology?. Int J Pediatr Otorhinolaryng. 1999; 50 55-62
73 Kudoh F, Sanai A. Effect of tonsillectomy and adenoidectomy on obese children with sleep-associated breathing disorders. Acta Otolaryngol. 1996; Suppl 523 216-218
74 Guilleminault C, Partinen M, Praud J P, Quera-Salva M A, Powell N, Riley R. Morphometric facial changes and obstructive sleep apnea in adolescents. J Pediatr. 1989; 114 997-999
75 Guilleminault C, Korobkin R, Winkle R. A review of 50 children with obstructive sleep apnea syndrome. Lung. 1981; 159 275-287
76 Aubert-Tulkens G, Hamoir M, van den Eeckhaut J, Rodenstein D O. Failure of tonsil and nose surgery in adults with long-standing severe sleep apnea syndrome. Arch Intern Med. 1989; 149 2118-2121
77 Houghton D J, Camilleri A E, Stone P. Adult obstructive sleep apnoea syndrome and tonsillectomy. J Laryngol Otol. 1997; 111 829-832
78 Moser R J, Rajagopal K R. Obstructive sleep apnea in adults with tonsillar hypertrophy. Arch Intern Med.. 1987; 147 1265-1267
79 Orr W C, Martin R J. Obstructive sleep apnea associated with tonsillar hypertrophy in adults. Arch Intern Med. 1981; 141 990-992
80 Rubin A H, Eliaschar I, Joachim Z, Alroy G, Lavie P. Effects of nasal surgery and tonsillectomy on sleep apnea. Bull Eur Physiopathol Respir. 1983; 19 612-615
81 Verse T, Kroker B, Pirsig W, Brosch S. Tonsillectomy for treatment of obstructive sleep apnea in adults with tonsillar hypertrophy. Laryngoscope. 2000; 110 1556-1559
82 Sher A E, Schechtman K B, Piccirillo J F. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep. 1996; 19 156-177
83 Li K K, Powell N B, Riley R W, Troell R J, Guilleminault C. Radiofrequency volumetric tissue reduction for treatment of turbinate hypertrophy: a pilot study. Otolaryngol Head Neck Surg. 1998; 119 569-573
84 Powell N B, Riley R W, Troell R J, Li K, Blumen M B, Guilleminault C. Radiofrequency volumetric tissue reduction of the palate in subjects with sleep disordered breathing. Chest. 1998; 113 1163-1174
85 Powell N B, Riley R W, Guilleminault C. Radiofrequency tongue base reducution in sleep-disordered breathing: a pilot study. Otolaryngol Head Neck Surg. 1999; 120 656-664
86 Friedman M, Lo Savio P, Ibrahim H, Ramakrishnan V. Radiofrequency tonsil reduction: safety, morbidity, and efficacy. Laryngoscope. 2003; 113 882-887
87 Nelson L M. Temperature-controlled radiofrequency tonsil reduction in children. Arch Otolaryngol Head Neck Surg. 2003; 129 533-537
88 Nelson L M. Temperature-controlled radiofrequency tonsil reduction: extended follow-up. Otolaryngol Head Neck Surg. 2001; 125 456-461
89 Fischer Y, Khan M, Mann W J. Multilevel temperature-controlled radiofrequency therapy of soft palate, base of tongue, and tonsils in adults with obstructive sleep apnea. Laryngoscope. 2003; 113 1786-1791
90 Verse T, Pirsig W. Laser-assistierte Uvulopalatoplastik in der Behandlung der obstruktiven Schlafapnoe. HNO aktuell. 2000; 8 195-202
91 Haavisto L, Suonpaa J. Complications of uvulopalatoplasty. Clin Otolaryngol. 1994; 19 243-247
92 Katsantonis G P, Friedman W H, Krebs F J, Walsh J K. Nasopharyngeal complications following uvulopalatopharyngoplasty. Laryngoscope. 1987; 97 309-314
93 Pirsig W, Schäfer J, Yildiz F, Nagel J. Uvulopalatopharyngoplastik ohne Komplikationen. Eine Modifikation nach Fujita. Laryngo-Rhino-Otol. 1989; 68 585-590
94 Fujita S, Conway W, Zorick F. Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: Uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg. 1981; 89 923-934
95 Macnab T, Blokmanis A, Dickson R I. Long-term results of uvulopalatopharyngoplasty for snoring. J Otolaryngol. 1992; 21 350-354
96 Levin B C, Becker G D. Uvulopalatopharyngoplasty for snoring: long-term results. Laryngoscope. 1994; 104 1150-1152
97 Chabolle F, de Dieuleveult T, Cabanes J, Séquert C, Dahan S, Drweski P, Engalenc D. Résultats a long terme de la pharyngotomie chirurgicale classique (uvulo-palato-pahryngoplastie) versus Laser (LAUP) CO₂ en ambulatoire dans le traitement de la ronchopathie simple. Ann Otolaryngol Chir Cervicofac. 1998; 115 196-201
98 Hultcrantz E, Johansson K, Bengtson H. The effect of uvulopalatopharyngoplasty without tonsillectomy using local anaesthesia: a prospective long-term follow-up. J Laryngol Otol. 1999; 113 542-547
99 Hagert B, Wahren L K, Wikblad K, Ödkvist L. Patients' and cohabitants' reports on snoring and daytime sleepiness, 1 - 8 years after surgical treatment of snoring. ORL J Otolaryngol Relat Spec. 1999; 61 19-24
100 Pasche P, Pellanda A, Jaques B. Obstructive sleep apnea syndrome and snoring: what is the role of surgery?. Otorhinolaryngol Nova. 2000; 10 127-137
101 Hicklin L A, Tostevin P, Dasan S. Retrospective survey of long-term results and patient satisfaction with uvulopalatopharyngoplasty for snoring. J Laryngol Otol. 2000; 114 675-681
102 Hassid S, Afrapoli A H, Decaaestecker C, Choufani G. UPPP for snoring: long-term results and patient satisfaction. Acta Otorhinolaryngol Belg. 2002; 56 157-162
103 Boudewyns A, de Cock W, Willemen M, Wagemans M, de Backer W, van de Heyning P H. Influence of uvulopalatopharyngoplasty on alpha-EEG arousals in nonapneic snorers. Eur Respir J. 1997; 10 129-132
104 Janson C, Hillerdal G, Larsson L, Hultcrantz E, Lindholm C E, Bengtsson H, Hetta J. Excessive daytime sleepiness and fatigue in nonapnoeic snorers: improvement after UPPP. Eur Respir J. 1994; 7 845-849
105 Osman E Z, Osborne J E, Hill P D, Lee B WV, Hammad Z. Uvulopalatopharyngoplasty versus laser assisted uvulopalatoplasty for the treatment of snoring: an objective randomized clinical trial. Clin Otolaryngol. 2000; 25 305-310
106 Osman E Z, Abo-Khatwa M M, Hill P D, Lee B WV, Osborne J. Palatal surgery for snoring: objective long-term evaluation. Clin Otolaryngol. 2003; 28 257-261
107 Lysdahl M, Haraldson P O. Uvulopalatopharyngoplasty versus laser uvulopalatoplasty: prospective long-term follow-up of self-reported symptoms. Acta Otolaryngol. 2002; 122 752-757
108 Perello-Scherdel E, Quesada P, Lorente J, Lao J, Prades J. Long-term follow-up of partial resection of the palate as a surgical treatment for obstructive sleep apnea syndrome. In: Tos M, Thomsen J, Balle V (eds) Rhinology - a state of the art. Amsterdam, New York; Kugler 1995: 261-262
109 Lu S J, Chang S Y, Shiao G M. Comparison between short-term and long-term post-operative evaluation of sleep apnea after uvulopalatopharyngoplasty. J Laryngol Otol. 1995; 109 308-312
110 Larsson L H, Carlsson-Nordlander B, Svanborg E. Four-year follow-up after uvulopalatopharyngoplasty in 50 unselected patients with obstructive sleep apnea syndrome. Laryngoscope. 1994; 104 1362-1368
111 Janson C, Gislason T, Bengtsson H, Eriksson G, Lindberg E, Lindholm C E, Hultcrantz E, Hetta J, Boman G. Long-term follow-up of patients with obstructive sleep apnea treated with uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg. 1997; 123 257-262
112 Boot H, van Wegen R, Poublon R ML, Bogaard J M, Schmitz P IM, van der Meche F GA. Long-term results of uvulopalatopharyngoplasty for obstructive sleep apnea syndrome. Laryngoscope. 2000; 110 469-475
113 Lysdahl M, Haraldson P O. Long-term survival after uvulopalatopharyngoplasty in nonobese heavy snorers: a 5- to 9-year follow-up of 400 consecutive patients. Arch Otolaryngol Head Neck Surg. 2000; 126 1136-1140
114 Keenan S P, Burt H, Ryan C F, Fleetham J A. Long-term survival of patients with obstructive sleep apnea treated by uvulopalatopharyngoplasty or nasal CPAP. Chest. 1994; 105 155-159
115 Haraldson P O, Carenfelt C, Persson H E, Sachs C, Tornros J. Simulated long-term driving performance before and after uvulopalatopharyngoplasty. ORL J Otorhinolaryngol Relat Spec. 1991; 53 106-110
116 Haraldsson P O, Carenfelt C, Lysdahl M, Tingvall C. Does uvulopalatopharyngoplasty inhibit automobile accidents?. Laryngoscope. 1995; 105 657-661
117 Verse T, Pirsig W. Laser-assisted uvulopalatoplasty. A metanalysis. In: Fabiani M, Saponara M (eds) Surgery for snoring and obstructive sleep apnea syndrome. Amsterdam; Kugler Publications 2003: 463-474
118 Carenfelt C. Laser uvulopalatopharyngoplasty in treatment of habitual snoring. Ann Otol Rhinol Laryngol. 1991; 100 451-454
119 Kamami Y V. Laser CO₂ for snoring: preliminary results. Acta Otorhinolaryngol Belg. 1990; 44 451-456
120 Coleman J A. Laser-assisted uvulopalatoplasty: Long-term results with a treatment for snoring. Ear, Nose & Throat J. 1998; 77 22-34
121 Ellis P DM. Laser palatoplasty for snoring due to palatal flutter: a further report. Clin Otolaryngol. 1994; 19 350-351
122 Albu S, de Min G, Forti A, Babighian G. Nd:YAG laser-assisted uvulopalatoplasty for snoring. Acta Otolaryngol Belg. 1998; 52 69-73
123 Wennmo C, Olsson P, Flisberg K, Paulsson B, Luttrup S. Treatment of snoring - with and without carbon dioxide laser. Acta Otolaryngol (Stockh). 1992; 492 Suppl 152-155
124 Shehab Z P, Robin P E. Comparison of the effectiveness of uvulopalatopharyngoplasty and laser palatoplasty for snoring. Clin Otolaryngol. 1997; 22 158-161
125 Morar P, Nandapalan V, Lesser T HJ, Swift A C. Mucosal-strip/uvulectomy by the CO₂ laser as a method of treating simple snoring. Clin Otolaryngol. 1995; 20 308-311
126 Hanada T, Furuta S, Tateyama T, Uchizono A, Seki D, Ohyama M. Laser-assisted uvulopalatoplasty with Nd:YAG laser for sleep disorders. Laryngoscope. 1996; 106 1531-1533
127 Vukovic L, Hutchings J. Patient evaluation of Laser-assisted uvulopalatoplasty. J Otolaryngol (Toronto). 1996; 25 404-407
128 Walker R P, Grigg-Damberger M M, Gopalsami C, Totten M C. Laser-assisted uvulopalatoplasty for snoring and obstructive sleep apnea: Results in 170 patients. Laryngoscope. 1995; 105 938-943
129 Astor F C, Hanft K L, Benson C, Amaranath A. Analysis of short-term outcome after office-based laser-assisted uvulopalatoplasty. Otolaryngol Head Neck Surg. 1998; 118 478-480
130 Schlieper J, Brinkmann B, Karmeier A, Pakusa T. Erfolgsrate und Komplikationen der primären, laserassistierten Uvilopalatoplastik (LAUP) bei Patienten mit Rhonchopathie. Mund Kiefer Gesichts Chir. 2002; 6 146-152
131 Sharp H R, Mitchell D B. Long-term results of laser-assisted uvulopalatoplasty for snoring. J Laryngol Otol. 2001; 115 897-900
132 Neruntarat C. Laser-assisted uvulopalatoplasty: short-term and long-term results. Otolaryngol Head Neck Surg. 2001; 124 90-93
133 Berger G, Finkelstein Y, Stein G, Ophir D. Laser-assisted uvulopalatoplasty for snoring: medium- to long-term subjective and objective analysis. Arch Otolaryngol Head Neck Surg. 2001; 127 412-417
134 Kyrmizakis D E, Chimona T S, Papadakis C E, Bizakis J G, Velegrakis G A, Schiza S, Siafakas N M, Helidonis E S. Laser-assisted uvulopalatoplasty for the treatment of snoring and mild obstructive sleep apnea syndrome. J Otolaryngol. 2003; 32 174-179
135 Uppal S, Nadig S, Jones C, Nicolaides A R, Coatesworth A P. A prospective single-blinded randomized-controlled trial comparing two surgical techniques for the treatment of snoring: laser palatoplasty versus uvulectomy with punctate palatal diathermy. Clin Otolaryngol. 2004; 29 254-263
136 Troell R J, Powell N B, Riley R W, Li K K, Guilleminault C. Comparison of postoperative pain between laser-assisted uvulopalatoplasty, uvulopalatopharyngoplasty, and radiofrequency volumetric tissue reduction of the palate. Otolaryngol Head Neck Surg. 2000; 122 402-409
137 Blumen M B, Dahan S, Wagner I, de Dieuleveult T, Chabolle F. Radiofrequency versus LAUP for the treatment of snoring. Otolaryngol Head Neck Surg. 2002; 126 67-73
138 Rombaux P, Hamoir M, Bertrand B, Aubert G, Liistro G, Rodenstein D. Postoperative pain and side effects after uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty, and radiofrequency tissue volume reduction in primary snoring. Laryngoscope. 2003; 113 2169-2173
139 Verse T, Pirsig W. Metaanalyse zur laserassistierten Uvulopalatopharyngoplastik. Was ist bisher klinisch relevant?. Laryngo-Rhino-Otol. 2000; 79 273-284
140 Utley D S, Shin E J, Clerk A A, Terris D J. A cost-effective and rational surgical approach to patients with snoring, upper airway resistance syndrome, or obstructive sleep apnea syndrome. Laryngoscope. 1997; 107 726-734
141 Mickelson S A, Ahuja A. Short-term objective and long-term subjective results of laser-assisted uvulopalatoplasty for obstructive sleep apnea. Laryngoscope. 1999; 109 362-367
142 Walker R P, Grigg-Damberger M M, Gopalsami C. Laser-assisted uvulopalatopharyngoplasty for the treatment of mild, moderate, and severe obstructive sleep apnea. Laryngoscope. 1999; 109 79-85
143 Ryan C F, Love L L. Unpredictable results of laser assisted uvulopalatoplasty in the treatment of obstructive sleep apnoea. Thorax. 2000; 55 399-404
144 Seemann R P, Di Toppa J C, Holm M A, Hanson J. Does laser-assisted uvulopalatoplasty work? An objective analysis using pre- and postoperative polysomnographic studies. J Otolaryngol. 2001; 30 212-215
145 Finkelstein Y, Stein G, Ophir D, Berger R, Berger G. Laser-assisted uvulopalatoplasty for the management of obstructive sleep apnea. Myths and facts. Arch Otolaryngol Head Neck Surg. 2002; 128 429-434
146 Ferguson K A, Heighway H, Ruby R RF. A randomized trial of laser-assisted uvulopalatoplasty in the treatment of mild obstructive sleep apnea. Am J Respir Crit Care Med. 2003; 167 15-19
147 Berger G, Stein G, Ophir D, Finkelstein Y. Is there a better way to do laser-assisted uvulopalatoplasty?. Arch Otolaryngol Head Neck Surg. 2003; 129 447-453
148 Kern R C, Kutler D I, Reid K J, Conley D B, Herzon G D, Zee P. Laser-assisted uvulopalatoplasty and tonsillectomy for the management of obstructive sleep apnea syndrome. Laryngoscope. 2003; 113 1175-1181
149 Berger G, Finkelstein Y, Ophir D. Histopathologic changes in the soft palate after laser-assisted uvulopalatoplasty. Arch Otolaryngol Head Neck Surg. 1999; 125 786-790
150 Littner M, Kushida C A, Hartse K, McDowell Anderson W, Davila D, Johnson S F, Wise M S, Hirshkowitz M, Woodson B T (Standards of Practice Committee American Academy of Sleep Medicine). Practice parameters for the use of laser-assisted uvulopalatoplasty: an update for 2000. Sleep. 2001; 24 603-619
151 Stuck B A, Maurer J T, Hein G, Hörmann K, Verse T. Radiofrequency surgery of the soft palate in the treatment of snoring - a review of the literature. Sleep. 2004; 27 551-555
152 Boudewyns A, Van De Heyning P. Temperature-controlled radiofrequency tissue volumetric reduction of the soft palate (Somnoplasty®) in the treatment of habitual snoring: Results of an European multicenter trial. Acta Otolaryngol. 2000; 120 981-985
153 Cartwright R, Venkatesan T K, Caldarelli D, Diaz F. Treatments for snoring: A comparison of somnoplasty and an oral appliance. Laryngoscope. 2000; 110 1680-1683
154 Coleman S C, Smith T L. Midline radiofrequency tissue reduction of the palate for bothersome snoring and sleep disordered breathing: A clinical trial. Otolaryngol Head Neck Surg. 2000; 122 387-394
155 Emery B E, Flexon P B. Radiofrequency volumetric tissue reduction of the soft palate: A new treatment for snoring. Laryngoscope. 2000; 110 1092-1098
156 Fischer Y, Hafner B, Mann W J. Die Radiofrequenzablation des weichen Gaumens (Somnoplastik). Ein neues Verfahren der Gewebevolumenreduktion bei primärer und obstruktiver Rhonchopathie. HNO. 2000; 48 33-40
157 Hukins C A, Mitchell I C, Hillman D R. Radiofrequency tissue volume reduction of the soft palate in simple snoring. Arch Otolaryngol Head Neck Surg. 2000; 126 602-606
158 Li K K, Powell N B, Riley R W, Troell R J, Guilleminault C. Radiofrequency volumetric tissue reduction of the palate: An extended follow-up study. Otolaryngol Head Neck Surg. 2000; 122 410-414
159 Taliaferro C. Submucosal radiosurgical uvulopalatoplasty for the treatment of snoring: is the monitoring of tissue impedance and temperature necessary?. Otolaryngol Head Neck Surg. 2000; 124 46-50
160 Back L, Palomaki M, Piilonen A, Ylikoski J. Sleep-disordered breathing: Radiofrequency thermal ablation is a promising new treatment possibility. Laryngoscope. 2001; 111 464-471
161 Ferguson M, Smith T L, Zanation A M, Yarbrough W G. Radiofrequency tissue volume reduction. Multilesion vs single-lesion treatments for snoring. Arch Otolaryngol Head Neck Surg. 2001; 127 312-318
162 Sher A E, Flexon P B, Hillman D, Emery B, Swieca J, Smith T L, Cartwright R, Dierks E, Nelson L. Temperature-controlled radiofrequency tissue volume reduction in the human soft palate. Otolaryngol Head Neck Surg. 2001; 125 312-318
163 Back L J, Tervahartiala P O, Piilonen A K, Partinen M M, Ylikoski J S. Bipolar radiofrequency thermal ablation of the soft palate in habitual snorers without significant desaturations assessed by magnetic resonance imaging. Am J Respir Crit Care Med. 2002; 166 865-871
164 Haraldsson P O, Karling J, Lysdahl M, Svanborg E. Voice quality after radiofrequency volumetric tissue reduction of the soft palate in habitual snorers. Laryngoscope. 2002; 112 1260-1263
165 Johnson J T, Pollack G L, Wagner R L. Transoral radiofrequency treatment of snoring. Otolaryngol Head Neck Surg. 2002; 127 235-237
166 Terris D J, Coker J F, Thomas A J, Chavoya M. Preliminary findings from a prospective, randomized trial of two palatal operations for sleep-disordered breathing. Otolaryngol Head Neck Surg. 2002; 127 315-323
167 Trotter M I, D'Souza A R, Morgan D W. Medium-term outcome of palatal surgery for snoring using the Somnus^TM unit. J Laryngol Otol. 2002; 116 116-118
168 Tatla T, Sandhu G, Croft C B, Kotecha B. Celon radiofrequency thermo-ablative palatoplasty for snoring - a pilot study. J Laryngol Otol. 2003; 117 801-806
169 Said B, Strome M. Long-term results of radiofrequency volumetric tissue reduction of the palate for snoring. Ann Otol Laryngol. 2003; 112 276-279
170 Fang T J, Li H Y, Shue C W, Lee L A, Wang P C. Efficacy of radiofrequency volumetric tissue reduction of the soft palate in the treatment of snoring. Int J Clin Pract. 2003; 57 769-772
171 Blumen M B, Dahan S, Fleury B, Hausser-Hauw C, Chabolle F. Radiofrequency ablation for the treatment of mild to moderate obstructive sleep apnea. Laryngoscope. 2002; 112 2086-2092
172 Brown D J, Kerr P, Kryger M. Radiofrequency tissue reduction of the soft palate in patients with moderate sleep-disordered breathing. J Otolaryngol. 2001; 30 193-198
173 Powell N B, Riley R, Guilleminault C, Troell R. A reversible uvulopalatal flap for snoring and sleep apnea syndrome. Sleep. 1996; 19 593-599
174 Hörmann K, Erhard T, Hirth K, Maurer J T. Der modifizierte Uvulolappen zur Therapie schlafbezogener Atmungsstörungen. HNO. 2001; 49 361-366
175 Neruntarat C. Uvulopalatal flap for snoring on an outpatient basis. Otolaryngol Head Neck Surg. 2003; 129 353-359
176 Li H Y, Chen N H, Shu Y H, Wang P C. Changes in quality of life and respiratory disturbance after extended uvulopalatal flap surgery in patients with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2004; 130 195-200
177 Maurer J T, Verse T, Stuck B A, Hörmann K, Hein G. Palatal implants for primary snoring: Short-term results of a new minimally invasive surgical technique. Otolaryngol Head Neck Surg. 2005; 132 125-131
178 Maurer J T, Hein G, Verse T, Stuck B A, Hörmann K. Anti-Snoring-Device®: short-term results of a new minimally invasive surgical technique. Abstract. Otolaryngol Head Neck Surg. 2003; 129 P201
179 Ellis P DM, Williams J E, Shneerson J M. Surgical relief of snoring due to palatal flutter: a preliminary report. Ann R Coll Surg Engl. 1993; 75 286-290
180 Mair E A, Day R H. Cautery-assisted palatal stiffening operation. Otolaryngol Head Neck Surg. 2000; 122 547-555
181 Wassmuth Z, Mair E, Loube D, Leonhard D. Cautery-assisted palatal stiffening operation for the treatment of obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2000; 122 547-555
182 Brietzke S E, Mair E A. Injection snoreplasty: How to treat snoring without all the pain and expense. Otolaryngol Head Neck Surg. 2001; 124 503-510
183 Brietzke S E, Mair E A. Injection snoreplasty: Investigation of alternative sclerotherapy agents. Otolaryngol Head Neck Surg. 2004; 130 47-50
184 Brietzke S E, Mair E A. Extended follow-up and new objective data. Otolaryngol Head Neck Surg. 2003; 128 605-615
185 Wright S, Haight J, Zamel N, Hoffstein V. Changes in pharyngeal properties after uvulopalatopharyngoplasty. Laryngoscope. 1989; 99 62-65
186 Woodson B T, Toohill R J. Transpalatal advancement pharyngoplasty for obstructive sleep apnea. Laryngoscope. 1993; 103 269-276
187 Woodson B T. Retropalatal airway characteristics in uvulopalatopharyngoplasty compared with transpalatal advancement pharyngoplasty. Laryngoscope. 1997; 107 735-740
188 Powell N B, Riley R W, Troell R J, Blumen M B, Guilleminault C. Radiofrequency volumetric reduction of the tongue: a porcine pilot study for the treatment of obstructive sleep apnea syndrome. Chest. 1997; 111 1348-1355
189 Stuck B A, Maurer J T, Hormann K. Die Zungengrundreduktion mit Radiofrequenzenergie bei schlafbezogenen Atmungsstörungen. Postoperative Morbidität und Komplikationen. HNO. 2001; 49 530-537
190 Stuck B A, Maurer J T, Verse T, Hörmann K. Tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction for treatment of obstructive sleep apnea syndrome. Acta Otolaryngol. 2002; 122 531-536
191 Woodson B T, Nelson L, Mickelson S, Huntley T, Sher A. A multi-institutional study of radiofrequency volumetric tissue reduction for OSAS. Otolaryngol Head Neck Surg. 2001; 125 303-311
192 Li K K, Powell N B, Riley R W, Guilleminault C. Temperature-controlled radiofrequency tongue base reduction for sleep-disordered breathing: Long-term outcomes. Otolaryngol Head Neck Surg. 2002; 127 230-234
193 Riley R W, Powell N B, Li K K, Weaver E M, Guilleminault C. An adjunctive method of radiofrequency volumetric tissue reduction of the tongue for OSAS. Otolaryngol Head Neck Surg. 2003; 129 37-42
194 Mendelson W B. Use of sleep laboratory in suspected sleep apnea syndrome: Is one night enough?. Cleve Clin J Med. 1994; 61 299-303
195 Meyer T J, Eveloff S E, Kline L R, Millman R P. One negative polysomnogram does not exclude obstructive sleep apnea. Chest. 1993; 103 756-760
196 Patton T J, Thawley S E, Water R C, Vandermeer P J, Ogura J H. Expansion hyoid-plasty: a potential surgical procedure designed for selected patients with obstructive sleep apnea syndrome. Experimental canine results. Laryngoscope. 1983; 93 1387-1396
197 Kaya N. Sectioning the hyoid bone as a therapeutic approach for obstructive sleep apnea. Sleep. 1984; 7 77-78
198 Riley R W, Powell N B, Guilleminault C. Obstructive sleep apnea and the hyoid: a revised surgical procedure. Otolaryngol Head Neck Surg. 1994; 111 717-721
199 Hörmann K, Hirth K, Erhardt T, Maurer J T, Verse T. Die Hyoidsuspension zur Therapie der obstruktiven Schlafapnoe. Laryngo-Rhino-Otol. 2001; 80 517-521
200 Neruntarat C. Hyoid myotomy with suspension under local anesthesia for obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol. 2003; 260 286-290
201 Verse T, Baisch A, Hörmann K. Multi-Level-Chirurgie bei obstruktiver Schlafapnoe. Erste objektive Ergebnisse. Laryngo-Rhino-Otol. 2004; 83 516-522
202 Djupesland G, Schrader H, Lyberg T, Refsum H, Lilleas F, Godtlibsen O B. Palatopharyngoglossoplasty in the treatment of patients with obstructive sleep apnea syndrome. Acta Otolaryngol. 1992; Suppl 492 50-54
203 Fujita S, Woodson B T, Clark J L, Wittig R. Laser midline glossectomy as a treatment for the obstructive sleep apnea. Laryngoscope. 1991; 101 805-809
204 Woodson B T, Fujita S. Clinical experience with lingualplasty as part of the treatment of severe obstructive sleep apnea. Otolaryngol Head Neck Surg. 1992; 107 40-48
205 Mickelson S A, Rosenthal L. Midline glossectomy and epiglottidectomy for obstructive sleep apnea syndrome. Laryngoscope. 1997; 107 614-619
206 Chabolle F, Wagner I, Blumen M, Séquert C, Fleury B, de Dieuleveult T. Tongue base reduction with hyoepiglottoplasty: a treatment for severe obstructive sleep apnea. Laryngoscope. 1999; 109 1273-1280
207 Faye-Lund H, Djupesland G, Lyberg T. Glossopexia - Evaluation of a new surgical method for treating obstructive sleep apnea syndrome. Acta Otolaryngol. 1992; Suppl 492 46-49
208 DeRowe A, Günther E, Fibbi A, Lehtimaki K, Vahatalo K, Maurer J, Ophir D. Tongue-base suspension with a soft tissue-to-bone anchor for obstructive sleep apnea: preliminary clinical results of a new minimally invasive technique. Otolaryngol Head Neck Surg. 2000; 122 100-103
209 Woodson B T, deRowe A, Hawke M, Wenig B, Ross E B, Katsantonis G P, Mickelson S A, Bonham R E, Benbadis S. Pharyngeal suspension suture with repose bone screw for obstructive sleep apnea. Otolaryngol Head Neck Surg. 2000; 122 395-401
210 Woodson B T. A tongue suspension suture for obstructive sleep apnea and snorers. Otolaryngol Head Neck Surg. 2001; 124 297-303
211 Sorrenti G, Piccin O, Latini G, Scaramuzzino G, Mondini S, Rinaldi Ceroni A. Tongue suspension technique in obstructive sleep apnea: personal experience [in Italian]. Acta Otorhinolaryngol Ital. 2003; 23 274-280
212 Riley R W, Powell N B, Guilleminault C. Inferior sagittal osteotomy of the mandible with hyoid myotomy-suspension: a new procedure for obstructive sleep apnea. Otolaryngol Head Neck Surg. 1986; 94 589-593
213 Riley R W, Powell N B, Guilleminault C. Inferior mandibular osteotomy and hyoid myotomy suspension for obstructive sleep apnea: a review of 55 patients. J Oral Maxillofac Surg. 1989; 47 159-164
214 Fibbi A, Ameli F, Brocchetti F, Peirano M, Garaventa G, Presta A, Baricalla F. Avenzamento combinato del muscolo genioglosso (ACMG): osteotomia infero-sagittale mandibolare con avanzamento muscolo genioglosso e sua stabilizzazione con sutura in pazienti con OSAS. Risultati clinici preliminari Acta Otorhinolaryngol Ital. 2002; 22 153-157
215 Kuo P C, West R A, Bloomquist D S, McNeil R W. The effect of mandibular osteotomy in three patients with hypersomnia sleep apnea. Oral Surg Oral Med Oral Path. 1979; 48 385-392
216 Prinsell J R. Maxillomandibular advancement (MMA) in a site-specific treatment approach for obstructive sleep apnea: a surgical algorithm. Sleep Breath. 2000; 4 147-154
217 Waite P D, Wooten V, Lachner J H, Guyette R F. Maxillomandibular advancement surgery in 23 patients with obstructive sleep apnea syndrome. J Oral Maxillofac Surg. 1989; 47 1256-1261
218 Riley R W, Powell N B, Guilleminault C. Maxillofacial surgery and nasal CPAP. A comparison of treatment for obstructive sleep apnea syndrome. Chest. 1990; 98 1421-1425
219 Hochban W, Conradt R, Brandenburg U, Heitmann J, Peter J H. Surgical maxillofacial treatment of obstructive sleep apnea. Plast Reconstr Surg. 1997; 99 619-626
220 Prinsell J R. Maxillomandibular advancement surgery in a site-specific treatment approach for obstructive sleep apnea in 50 consecutive patients. Chest. 1999; 116 1519-1529
221 Li K K, Riley R W, Powell N B, Guilleminault C. Maxillomandibular advancement for persistent obstructive sleep apnea after phase I surgery in patients without maxillomandibular deficiency. Laryngoscope. 2000; 110 1684-1688
222 Bettega G, Pepin J L, Veale D, Deschaux C, Raphael B, Levy P. Obstructive sleep apnea syndrome. Fifty-one consecutive patients treated by maxillofacial surgery. Am J Respir Crit Care Med. 2000; 162 641-649
223 Goh Y H, Lim K A. Modified maxillomandibular advancement for the treatment of obstructive sleep apnea: a preliminary report. Laryngoscope. 2003; 113 1577-1582
224 Dattilo D J, Drooger S A. Outcome assessment of patients undergoing maxillofacial procedures for the treatment of sleep apnea: comparison of subjective and objective results. J Oral Maxillofac Surg. 2004; 62 164-168
225 Conradt R, Hochban W, Heitmann J, Brandenburg U, Cassel W, Penzel T, Peter J H. Sleep fragmentation and daytime vigilance in patients with OSA treated by surgical maxillomandibular advancement compared to CPAP therapy. J Sleep Res. 1998; 7 217-223
226 Li K K, Powell N B, Riley R W, Troell R J, Guilleminault C. Long-term results of maxillomandibular advancement surgery. Sleep Breath. 2000; 4 137-139
227 McCarthy J G, Schreiber J, Karp N, Thorne C H, Grayson B H. Lengthening the human mandible by gradual distraction. Plast Reconstr Surg. 1992; 89 1-10
228 Bell R B, Turvey T A. Skeletal advancement for the treatment of obstructive sleep apnea in children. Cleft Palate Craniofac J. 2001; 38 147-154
229 Riley R W, Powell N B, Guilleminault C. Obstructive sleep apnea syndrome: A review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg. 1993; 108 117-125
230 Burstein F D, Cohen S R, Scott P H, Teague G R, Montgomery G L, Kattos A V. Surgical therapy for severe refractory sleep apnea in infants and children: application of the airway zone concept. Plast Reconstr Surg. 1995; 96 34-41
231 Cohen S R, Lefaivre J F, Burstein F D, Simms C, Kattos A V, Scott P H, Montgomery G L, Graham L R. Surgical treatment of obstructive sleep apnea in neurologically compromised patients. Plast Reconstr Surg. 1997; 99 638-646
232 Cohen S R, Simms C, Burstein F D, Thomsen J. Alternatives to tracheostomy in infants and children with obstructive sleep apnea. J Pediatr Surg. 1999; 34 182-187
233 Stuck B A, Starzak K, Verse T, Hörmann K, Maurer J T. Morbidität und Komplikationen der kombinierten Radiofrequenz-Chirurgie des Weichgaumens und Zungengrundes. Somnologie. 2002; 6 19-25
234 Woodson B T, Steward D L, Weaver E M, Javaheri S. A randomized trial of temperature-controlled radiofrequency, continuous positive airway pressure, and placebo for obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2003; 128 848-861
235 Johnson N T, Chinn J. Uvulopalatopharyngoplasty and inferior sagittal mandibular osteotomy with genioglossus advancement for treatment of obstructive sleep apnea. Chest. 1994; 105 278-283
236 Ramirez S G, Loube D I. Inferior sagittal osteotomy with hyoid bone suspension for obese patients with sleep apnea. Arch Otolaryngol Head Neck Surg. 1996; 122 953-957
237 Elasfour A, Miyazaki S, Itasaka Y, Yamakawa K, Ishikawa K, Togawa K. Evaluation of uvulopalatopharyngoplasty in treatment of obstructive sleep apnea syndrome. Acta Otolaryngol. 1998; Suppl 537 52-56
238 Lee N R, Givens C D, Wilson J, Robins R B. Staged surgical treatment of obstructive sleep apnea syndrome: a review of 35 patients. J Oral Maxillofac Surg. 1999; 57 382-385
239 Hsu P P, Brett R H. Multiple level pharyngeal surgery for obstructive sleep apnoea. Singapore Med J. 2001; 42 160-164
240 Hendler B H, Costello B J, Silverstein K, Yen D, Goldberg A. A protocol for uvulopalatoplasty, mortised genioplasty, and maxillomandibular advancement in patients with obstructive sleep apnea: an analysis of 40 cases. J Oral Maxillofac Surg. 2001; 59 892-897
241 Nelson L M. Combined temperature-controlled radiofrequency tongue reduction and UPPP in apnea surgery. Ear Nose Throat J. 2001; 80 640-644
242 Vilaseca I, Morello A, Montserrat J M, Santamaria J, Iranzo A. Usefulness of uvulopalatopharyngoplasty with genioglossus and hyoid advancement in the treatment of obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2002; 128 435-440
243 Neruntarat C. Genioglossus advancement and hyoid myotomy: short-term and long-term results. J Laryngol Otol. 2003; 117 482-486
244 Friedman M, Ibrahim H, Lee G, Joseph N J. Combined uvulopalatopharyngolplasty and radiofrequency tongue base reduction for treatment of obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2003; 129 611-621
245 Miller F R, Watson D, Boseley M. The role of genial bone advancement trephine system in conjunction with uvulopalatopharyngoplasty in the multilevel management of obstructive sleep apnea. Otolaryngol Head Neck Surg. 2004; 130 73-79
246 Verse T, Baisch A, Maurer J T, Stuck B A, Hörmann K. Multi-level surgery for obstructive sleep apnea. Otolaryngol Head Neck Surg, manuscript submitted. ;

Priv.-Doz. Dr. med. Thomas Verse

Universitäts-HNO-Klinik Homburg

66421 Homburg ·

Email: thomas.verse@uniklinik-saarland.de