Zusammenfassung
Die obstruktive Schlafapnoe hat für die Betroffenen erhebliche Konsequenzen hinsichtlich Morbidität und Mortalität. Mit der CPAP-Therapie können die nächtlichen Atmungsstörungen zuverlässig beseitigt und die gesundheitlichen Folgen minimiert werden. Jedoch ist die Wirksamkeit dieser Therapie im Alltag infolge einer niedrigen Adhärenz eingeschränkt. Praktische Verbesserungen zur Adhärenzsteigerung sind daher dringend gesucht. Besondere Problemgruppen von Patienten wie nach Schlaganfall oder mit einer niedrigen Schlafeffizienz in der 1. Nacht sind bekannt. Moderne Möglichkeiten der Informationstechnologie ermöglichen eine Fernabfrage der Therapiegeräte und eine zentrale Datenauswertung. Hierbei können die nächtliche Nutzung, noch vorhandende Atmungsstörungen, hohe Maskenleckagen oder ein hoher Therapiedruck in der häuslichen Umgebung sehr rasch erkannt und Problemlösungen veranlasst werden. Die wissenschaftliche Evidenz bezüglich der Auswirkungen einer telemedizinischen Versorgung von CPAP-Patienten ist gering, aber die vorliegenden Arbeiten sind vielversprechend. Viele praktische Fragen sind aber noch nicht geklärt. Dabei muss ausdrücklich auf die Gefahr hingewiesen werden, dass die neuen technischen Möglichkeiten allein unter dem Ansatz einer kurzfristigen Kostenreduktion genutzt werden könnten. Würden diese Informationen allein dazu genutzt werden, die Finanzierung einer vermeintlich unzureichenden Therapie zu beenden, wäre aus Sicht des Patienten nichts erreicht. Ziel von telemedizinischen Konzepten muss die Akzeptanzsteigerung insbesondere von Risikogruppen sein. Von Seiten der Schlafmedizin ist dabei ein Primat des Arztes zu fordern, damit eine echte Verbesserung durch die Telemedizin für den Patienten erzielt werden kann. Die bisherigen Ergebnisse sind vielversprechend.
Abstract
The obstructive sleep apnea syndrome has considerable consequences for morbidity and mortality in affected patients. The continuous positive airway pressure (CPAP) therapy can reliably prevent the nocturnal disordered breathing and minimize health implications (high efficacy). However, the effectiveness of this therapy is restricted due to reduced adherence in the daily routine. Practical methods are urgently needed to improve adherence. Special problem groups, such as post-stroke patients or those with poor sleep efficiency in the first therapy night have already been identified. Up to date information technology enables remote monitoring and control of therapy devices and a centralized evaluation of the data. Usage time, residual breathing disorders, high mask leakage or high therapy pressure in the home environment can promptly be determined to arrange remedies in a timely manner. Scientific evidence regarding the effects of telemedical care of CPAP patients is limited, but the results of available studies are promising. Many practical questions have still not been answered. Furthermore, the danger of using the new technologies only with the aim of short-term cost reduction must explicitly be emphasized. If such information would only be used to discontinue funding of an allegedly insufficient treatment, no additional benefits would be achieved from the patient point of view. The aim of telemedical concepts has to be the improvement of therapy acceptance especially in risk groups. From the perspective of sleep medicine a primacy of physicians is promoted in order to achieve a real improvement for the patient due to telemedicine. The findings obtained so far are promising.
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Einhaltung ethischer Richtlinien
Interessenkonflikt. G. Nilius erhielt Aufwendungen für Forschungszwecke von den Firmen Resmed, Fischer & Paykel, Weimann, Heinen und Löwenstein und Philips Respironics. K.-H. Rühle erhielt Aufwendungen für Forschungszwecke von den Firmen Resmed, Fischer & Paykel, Weimann, Heinen und Löwenstein, Philips Respironics und Vitaphone. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Nilius, G., Rühle, KH. Kann die Telemedizin in der Schlafmedizin die Akzeptanz der nCPAP-Therapie verbessern?. Pneumologe 11, 234–241 (2014). https://doi.org/10.1007/s10405-013-0728-x
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DOI: https://doi.org/10.1007/s10405-013-0728-x
Schlüsselwörter
- Obstruktives Schlafapnoesyndrom
- Nächtliche Atmungsstörung
- Patientencompliance
- Neue Technologien
- Risikogruppen