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Anwendung eines chirurgischen Multi-Level-Konzepts bei obstruktiver Schlafapnoe

Practicability of a surgical multilevel therapy in patients with obstructive sleep apnea

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Zusammenfassung

Hintergrund

Beim obstruktivem Schlafapnoesyndrom (OSAS) handelt es sich um eine „Systemerkrankung“ der oberen Luft- und Speisewege. Die Multi-Level-Chirurgie berücksichtigt, dass eine exakte Lokalisation des zur Obstruktion führenden Kollapses häufig nicht möglich ist.

Patienten und Methode

In einer retrospektiven Studie über 4 Jahre wurden die Daten von 25 Patienten (Median 49,9 Jahre) mit moderatem bis schwerem OSAS erfasst, bei denen eine chirurgische Multi-Level-Therapie durchgeführt wurde. Die Therapie bestand in einer submukösen Conchotomie, ggf. kombiniert mit einer plastischen Septumkorrektur, einer konventionellen Uvulopalatopharyngoplastik (UPPP), ggf. kombiniert mit einer Tonsillektomie und einer Hochfrequenzdiathermie des Zungengrundes. Prä- und postoperativ wurden klinische und polysomnographische Kontrollen durchgeführt.

Ergebnisse

Der mittlere Apnoe-Hypopnoe-Index (AHI) lag vor Therapiebeginn bei 39,2/h±19,7. Postoperativ kam es zu einer hochsignifikanten Senkung des AHI auf im Mittel 16,5/h±9,9 (p<0,0001). Bei 13 Patienten (52%) bestand definitionsgemäß postoperativ kein OSAS mehr (AHI<20 und 50%ige Reduktion des AHI). Bei 23 Patienten wurde eine Verbesserung des AHI erzielt. Bei 15 Patienten betrug die AHI-Reduktion mehr als 50%.

Schlussfolgerung

Die Multi-Level-Chirurgie sollte bei Patienten mit OSAS auch im Hinblick auf die schlechte Langzeitakzeptanz oder Intoleranz einer nCPAP-Therapie in Betracht gezogen werden.

Abstract

Background

Obstructive sleep apnea syndrome is a “systemic disease” of the upper airways and the upper digestive tract. The concept of multilevel surgery takes account of the fact that the location of the obstruction frequently cannot be identified precisely.

Patients and methods

In this retrospective study over 4 years, data on 25 patients (median age 49.9 years) with moderate to severe OSAS treated with a surgical multilevel therapy were statistically evaluated. The treatment carried out consisted in reduction of the inferior turbinate, if necessary combined with septum plasty, and conventional uvulopalatopharyngoplasty (UPPP), combined with tonsillectomy and radiofrequency therapy of the base of the tongue if appropriate. Pre- and postoperative clinical and polysomnographical checks were performed.

Results

The mean apnea-hypopnea index (AHI) was 39.2±19.7/h before surgery. Postoperatively a highly significant reduction of AHI to 16.5±9.9/h (p<0.0001) was seen. In 13 out of 25 patients (52%) the disease was cured (AHI<20 and 50% reduction). In 23 patients the AHI improved. In 15 patients AHI was reduced by more than 50%.

Conclusion

Multilevel surgery should be considered as an alternative for patients suffering from OSAS, especially in view of the poor long-term results in patients who receive CPAP therapy or are intolerant to CPAP.

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Authors and Affiliations

  1. Universitäts HNO-Klinik, Langenbeckstr. 1, 55101, Mainz, Deutschland

    E. A. Stripf, M. Kühnemund, O. Selivanova & W. J. Mann

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  1. E. A. Stripf
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  2. M. Kühnemund
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  3. O. Selivanova
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  4. W. J. Mann
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Correspondence to E. A. Stripf.

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Stripf, E.A., Kühnemund, M., Selivanova, O. et al. Anwendung eines chirurgischen Multi-Level-Konzepts bei obstruktiver Schlafapnoe. HNO 55 (Suppl 1), E1–E6 (2007). https://doi.org/10.1007/s00106-006-1486-4

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  • DOI: https://doi.org/10.1007/s00106-006-1486-4

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