Kritischer Verschlussdruck (Pcrit) und negativer (subatmosphärischer) exspiratorischer Druck (NEP) zur Diagnostik der pharyngealen Kollapsibilität bei Patienten mit obstruktiver Schlafapnoe (OSA)

Zusammenfassung

Die Bestimmung des kritischen Verschlussdrucks (Pcrit) ist der diagnostische Goldstandard hinsichtlich der Beurteilung des Schweregrads der pharyngealen Instabilität. Pcrit-Messungen werden im Regelfall im natürlichen Nachtschlaf (NREM Stadium 2) in Kombination mit der Polysomnografie durchgeführt. Die Bestimmung von Pcrit im Schlaf ist jedoch zeitintensiv und in der Routine kaum umsetzbar. Alternativ können Pcrit-Messungen auch im medikamenteninduzierten Schlaf durchgeführt werden. Nachteilig sind die unterschiedlichen Propofoldosen, die zum Induzieren des Schlafes benötigt werden und den Muskeltonus unterschiedlich beeinflussen. Alternativ zu diesen Methoden hat sich die Applikation von Negativdruck im Wachen (NEP-Test) bewährt. Bei diesem Test wird dem Patienten via Maske ein subatmosphärischer Druck von –5 oder –10 cmH₂O mit Beginn der Exspiration appliziert und die Veränderung des exspiratorischen Atemflusses im Pharynx gemessen. Der NEP-Test kann sowohl im Sitzen als auch im Liegen durchgeführt werden. Nach aktuellem Wissensstand scheint der NEP-Test ein dem kritischen Verschlussdruck Pcrit durchaus vergleichbares diagnostisches Verfahren zur Bestimmung der Kollapsibilität des oberen Atemwegs.

Abstract

The determination of critical closing pressure (Pcrit) is the diagnostic gold standard for assessing the severity of pharyngeal instability. Pcrit measurements are typically performed during natural nocturnal sleep (NREM Stage 2) in combination with polysomnography. However, determining Pcrit during sleep is time-consuming and impractical for routine use. Alternatively, Pcrit measurements can also be done during drug-induced sleep. A disadvantage of this method is the varying doses of propofol needed to induce sleep, which can affect muscle tone differently. As an alternative to these methods, the application of negative pressure during wakefulness (NEP test) has proven effective. In this test, the patient is administered a subatmospheric pressure of –5 or –10 cmH₂O via mask at the beginning of expiration, and the change in expiratory airflow in the pharynx is measured. NEP test can be performed in both sitting and lying position. According to current knowledge, the NEP test appears to be a diagnostic procedure comparable to critical closing pressure (Pcrit) for assessing upper airway collapsibility.

Schlüsselwörter

pharyngeale Obstruktion - Kollapsibilität oberer Atemweg - Pcrit - NEP - obstruktive Schlafapnoe

Keywords

pharyngeal obstruction - collapsibility upper airway - pcrit - NEP - obstructive sleep apnea

Publication History

Received: 19 April 2024

Accepted after revision: 15 July 2024

Article published online:
16 September 2024

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