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Laryngorhinootologie 2008; 87(3): 192-204
DOI: 10.1055/s-2007-966213
DOI: 10.1055/s-2007-966213
Leitlinie
© Georg Thieme Verlag KG Stuttgart · New York
Leitlinie: Therapie der obstruktiven Schlafapnoe des Erwachsenen
Guideline: Treatment of Adult Obstructive Sleep ApneaFurther Information
Publication History
Publication Date:
26 April 2007 (online)
Einleitung
Die Deutsche Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie hat zuletzt 1998 zwei wissenschaftliche Leitlinien zur obstruktiven Schlafapnoe [1] und zum primären Schnarchen [2] erarbeitet und veröffentlicht. Seither hat sich das Wissen um die Therapie beider Störungen so sehr vermehrt, dass es an der Zeit ist, neue Empfehlungen aufzustellen.
In Deutschland existieren verschiedene Leitlinien unterschiedlicher Fachgesellschaften zum Thema schlafbezogene Atmungsstörungen. Die umfassendste dieser Leitlinien stellt die S2-Leitlinie „Der nicht-erholsame Schlaf” [3] der Deutschen Gesellschaft für Schlafforschung und Schlafmedizin dar, welche auch durch Mitarbeit der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie entstanden ist. Den Empfehlungen und Ausführungen in dieser S2-Leitlinie „Der nicht-erholsame Schlaf” [3] bezüglich der Diagnostik schlafbezogener Atmungsstörungen schließt sich die ArGe Schlafmedizin der Deutschen Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie in vollem Umfang an.
Im Folgenden wird zur Therapie der obstruktiven Schlafapnoe (OSA) des Erwachsenen detaillierter und spezifischer aus HNO-Sicht Stellung bezogen.
Auftraggeber dieser neuen Leitlinie ist die Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (DGHNOKC). Erstellt wurde diese Leitlinie von der Arbeitsgemeinschaft (ArGe) Schlafmedizin der DGHNOKC unter Leitung ihres Vorsitzenden, Herrn Thomas Verse. Die Autoren sind wissenschaftlich aktive Mitglieder der ArGe Schlafmedizin. Grundsätzlich war jedes Mitglied der ArGe Schlafmedizin aufgefordert, sich an der Erstellung der neuen Leitlinie zu beteiligen. Eine wie auch immer geartete finanzielle Unterstützung bei der Erstellung der Leitlinie gab es nicht. Eine Liste finanzieller Verflechtungen mit Herstellern von genannten Medizinprodukten findet sich im Anhang (Anlage A). Abhängigkeiten oder Interessenkonflikte mit genannten Medizinprodukten oder deren Herstellern bestehen nicht. Die Leitlinie wurde mittels eines formalen Konsensusverfahrens nach den Richtlinien der Leitlinien-Kommission der AWMF im Sinne einer „S2e” Leitlinie erstellt [4].
Grundlage der nachstehenden Empfehlungen ist jeweils eine Literaturrecherche der zum jeweiligen Thema vorhandenen Literatur bis einschließlich Juni 2004. Die gefundenen Arbeiten wurden gemäß den Empfehlungen des Oxford Centre for Evidence-based Medicine (OCEBM) [5], welche eine Weiterentwicklung der ursprünglichen, kanadischen EBM-Kriterien darstellen, bezüglich ihres wissenschaftlichen Wertes analysiert. Aus diesen Tabellen resultiert ein Grad der Bewertung, wobei Grad A den höchsten und Grad D den niedrigsten Wert darstellt ([Tab. 1]).
Tab. 1 Evidenzgrade und Empfehlungsgrade gemäß Vorschlag der OCEBM vom 23. 11. 1999 Grade of Recommendation Level of Evidence Therapy/Prevention, Aetiology/Harm A 1a Systematic review (with homogenity) of randomized controlled trials 1b Individual randomized controlled trial (with narrow Confidence Interval) 1c All or none B 2a Systematic review (with homogenity) of cohort studies 2b Individual cohort study (including low quality randomized controlled trials; e. g., < 80 % follow-up) 2c „Outcomes” Research 3a Systematic review (with homogenity) of case-control studies 3b Individual case-control studies C 4 Case-series (and poor quality cohort and case-control studies) D 5 Expert opinion without explicit critical appraisal, or based on physiology, bench research or „first principles”
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Prof. Dr. med. Thomas Verse
Klinik für HNO-Heilkunde
Asklepios Klinik Harburg
Eißendorfer Pferdeweg 52
21075 Hamburg
Email: thomas.verse@ak-haarburg.lbk-hh.de