Bedeutung der Schlafendoskopie bei obstruktiv-schlafbezogener Atmungsstörung im Kindes- und Jugendalter

Zusammenfassung

Hintergrund: Studien zur gezielten operativen OSAS-Therapie nach Medikamenten-induzierter Schlafendoskopie (MISE) konnten bei Erwachsenen ein verbessertes Outcome erzielen. Im Kindesalter liegen zu diesem Verfahren nur wenige Erfahrungen vor. Diese Studie evaluiert den differenzialdiagnostischen Stellenwert der MISE bei obstruktiven schlafbezogenen Atmungserkrankungen im Kindes- und Jugendalter. Es wird untersucht, ob initiale Therapie-Entscheidungen beeinflusst werden.

Material und Methoden: Es wurden retrospektiv die Krankenakten von 25 Kindern mit obstruktiver schlafbezogener Erkrankung analysiert, die im Zeitraum von 05/2012 bis 12/2013 eine Polysomnografie und Schlafendoskopie erhalten hatten. Anhand des Grades der obstruktiven schlafbezogenen Erkrankung wurden 2 Gruppen gebildet (Upper airway resistence syndrome (UARS) und mildes OSAS: AHI<5, n=10; moderates und schweres OSAS: AHI≥5, n=15).

Ergebnisse: Häufigster Ort einer Obstruktion war die Oropharynx-Ebene. Ein moderates oder schweres OSAS war signifikant mit einer vollständigen Obstruktion auf Oropharynx-Ebene assoziiert (p=0,02). Zudem fand sich ein signifikanter Zusammenhang zwischen der Adenoidgröße und dem Obstruktionsmuster auf Velopharynx­Ebene (p=0,02). Eine vollständige Obstruktion auf Oropharynx-Ebene konnte bei 71% der Kinder mit Tonsillengröße IV gefunden werden. Es bestand keine Assoziation zwischen der Adenoid- und Tonsillengröße und dem Ausprägungsgrad der schlafbezogenen Atmungsstörung. Bei 5 Kindern (20%) ergab sich ein Erkenntniszugewinn mit Anpassung der initial geplanten Therapien.

Schlussfolgerung: Die Medikamenten-induzierte Schlafendoskopie erscheint ein vielversprechendes Verfahren mit therapeutischer Konsequenz, um Obstruktionen beim kindlichen OSAS topografisch zu beurteilen. Weitere Studien sind jedoch notwendig, um verlässliche Vorhersageparameter für potenzielle Therapieversager nach operativer Therapie zu etablieren.

Abstract

Objective: Studies on the surgical treatment of OSAS in adults have shown an improved outcome after targeted therapy by drug-induced sleep endoscopy (DISE). So far, only a few studies have focused on this method in children. The aim of this study is to evaluate the impact of DISE for children with obstructive sleep-disordered breathing and to determine the influence of DISE on treatment recommendations.

Subjects and Methods: The medical records of children (n=25) who underwent polysomnography and DISE between 05/2012 and 12/2013 were retrospectively reviewed. The subjects were divided into an UARS (upper airway resistance syndrome)/mild OSAS group (AHI<5; n=10) and a moderate/severe OSAS group (AHI≥5; n=15).

Results: The oropharynx was the most common site of obstruction. Prevalence of complete obstruction at the oropharynx was significantly higher in moderate or severe OSAS (p=0.02). The obstruction pattern of the velopharynx was significantly associated with the size of the adenoids (p=0.02), but tonsil and adenoid size were not related to the severity of OSAS. 71% of children with grade IV tonsils showed complete obstruction of the oropharynx. After DISE, the initial management plan changed in 5 patients (20%).

Conclusion: DISE is a promising technique to identify sites of obstruction in children with OSAS and to guide treatment decisions. Further studies are needed to predict persistent OSAS based on this tool.

Schlüsselwörter

schlafbezogene Atmungsstörungen - OSAS - Schnarchen - medikamenteninduzierte Schlafendoskopie - Polysomnografie - Kinder

Key words

Sleep-disordered breathing - obstructive sleep apnea syndrome - snoring - drug-induced sleep endoscopy - polysomnography - children

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