Aktuelle Trends in der Diagnostik schlafbezogener Atmungsstörungen

Zusammenfassung

In den beiden vergangenen Jahrzehnten wurden verschiedene Methoden der differenzierten Atemwegsdiagnostik bei Patienten mit SBAS erprobt. Endoskopische Techniken und die Pharynxmanometrie sind für den Hals-Nasen-Ohrenarzt in diesem Zusammenhang von besonderem Interesse.

Während mit der klinisch-endoskopischen Basisuntersuchung eine korrekturbedürftige und korrigierbare pathologische Anatomie erkannt werden kann, scheint das Müller-Manöver hilfreich in der Ausschlussdiagnostik von Patienten vor einer geplanten Uvulopalatopharyngoplastik zu sein.

Die Videoendoskopie während des Schlafes wurde weitgehend durch die Videoendoskopie in Sedierung ersetzt. Trotz guter methodischer Vorarbeiten und der beeindruckenden Darstellbarkeit der Obstruktionen gibt es bisher keine ausreichenden Hinweise für eine Verbesserung der Erfolgsrate operativer Verfahren bei SBAS durch die Videoendoskopie in Sedierung. Zur Beurteilung der Epiglottis im Kontext der SBAS ist die Videoendoskopie jedoch alternativlos.

Mehrkanaldruckmessungen erlauben eine Analyse des gesamten Nachtschlafes und sind gut verträglich. Sie erlauben eine Bestimmung des AHI sowie eine quantitative Aussage über die Häufigkeitsverteilung von obstruktiven Ereignissen im oberen und unteren Pharynxsegment, wobei Obstruktionen im Bereich von Zungengrund und Epiglottis nicht voneinander getrennt werden können.

Der Nutzen der differenzierten Atemwegsdiagnostik ist nach der aktuellen Datenlage eher kritisch zu beurteilen. Die viel versprechenden Ansätze der Videoendoskopie in Sedierung und der Mehrkanaldruckmessungen bedürfen noch weiterer intensiver Forschung, werden jedoch nach persönlicher Einschätzung des Autors in absehbarer Zukunft zu wertvollen Hilfsmitteln in der Hand des Hals-Nasen-Ohrenarztes werden und die klinisch-endoskopische Basisuntersuchung zum Nutzen der Patienten ergänzen.

Schlüsselwörter

Schlafbezogene Atmungsstörungen - Schlafapnoesyndrom - primäres Schnarchen - Diagnostik - Müller-Manöver - Videoendoskopie - Mehrkanaldruckmessungen

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