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Update: Therapie des Schlafapnoe-Syndroms mit positivem Atemwegsdruck

Update on therapy with positive airway pressure in sleep-related breathing disorders

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Zusammenfassung

Die Anwendung von positivem Atemwegsdruck („positive airway pressure“, PAP) ist heute Standardtherapie der meisten schlafbezogenen Atmungsstörungen (SBAS). Aufgrund der unterschiedlichen Gerätetypen mit PAP ist eine differenzierte Indikationsstellung unverzichtbar. Die Darstellung aus der Sicht eines HNO-ärztlich geführten schlafmedizinischen Zentrums soll dem HNO-Arzt auch ohne fundierte schlafmedizinische Erfahrungen die Möglichkeit geben, seine Patienten mit SBAS vor und nach Einleitung einer Therapie mit PAP beraten und betreuen zu können. Durch eine differenzierte Indikationsstellung lässt sich die Compliance erhöhen. Die Therapie mit PAP ist zwar äußerst wirksam bezüglich der Beseitigung der zugrunde liegenden Obstruktionen und der damit verbundenen Symptome und Folgeerkrankungen. Da sie aber lebenslang angewendet werden muss, ist eine sorgfältige differenzierte Indikationsstellung für die unterschiedlichen Gerätetypen von entscheidender Bedeutung für die Nebenwirkungsraten und die sich daraus ableitende Compliance.

Abstract

Positive airway pressure (PAP) is the therapy of choice for most sleep-related breathing disorders. A variety of PAP devices exist (continuous PAP, bilevel PAP, automatic PAP, adaptive servo-ventilation) and must be carefully considered before application. The data presented are from an ENT sleep laboratory perspective and are designed to help the inexperienced ENT practitioner support patients before and after PAP therapy has begun. Patient compliance can be increased with individualized therapy. PAP treatment is very effective in eliminating obstruction-related sleep diseases and symptoms. However, because it generally has to be used throughout the patient’s life, the optimal PAP device must be carefully selected, taking into account side effects that influence compliance.

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Literatur

  1. Giles TL, Lasserson TJ, Smith BJ et al. (2006) Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 2006(3): CD001106

    Google Scholar 

  2. Guilleminault C, Dement WC (1978) Sleep apnea syndromes and related sleep disorders. In: Williams R, Karacan J (eds) Sleep disorders: diagnosis and treatment. Wiley, New York, pp 9–28

  3. Gemeinsamer Bundesausschuss (2004) Beschluss über eine Änderung der Richtlinien zur Bewertung medizinischer Untersuchungs- und Behandlungsmethoden gemäß § 135 Abs. 1 des Fünften Buches Sozialgesetzbuch (BUB-Richtlinien) in Anlage A „Anerkannte Untersuchungs- und Behandlungsmethoden“ vom 15. Juni 2004/21. Dtsch Ärztebl 101: 3370–3371

    Google Scholar 

  4. Becker H, Peter JH, von Wichert P (1992) Nasal continuous positive airway pressure. Eur Respir J 2: 400–408

    Google Scholar 

  5. Rapoport DM, Garay SM, Goldring RM (1983) Nasal CPAP in obstructive sleep apnea: mechanisms of action. Bull Eur Physiopathol Respir 19: 616–620

    PubMed  CAS  Google Scholar 

  6. Becker H, Brandenburg U, Peter JH et al. (1993) Indikation und Applikation der BiPAP-Therapie. Pneumol 47: 184–188

    Google Scholar 

  7. Sanders MH, Kern N (1990) Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask. Physiologic and clinical implications. Chest 98: 317–324

    Article  PubMed  CAS  Google Scholar 

  8. Reeves-Hoche MK, Meck R, Zwillich CW (1994) Nasal CPAP: an objective evaluation of patient compliance. Am J Respir Crit Care Med 149: 149–154

    PubMed  CAS  Google Scholar 

  9. Loube DI, Gay PC, Strohl KP et al. (1999) Indications for positive airway pressure treatment of adult obstructive sleep apnea patients: a consensus statement. Chest 115: 863–866

    Article  PubMed  CAS  Google Scholar 

  10. Reeves-Hoche MK, Hudgel DW, Meck R et al. (1995) Continuous versus bilevel positive airway pressure for obstructive sleep apnea. Am J Respir Crit Care Med 151: 443–449

    PubMed  CAS  Google Scholar 

  11. McGinley B et al. (2007) A nasal cannula can be used to treat obstructive sleep apnea. Am J Respir Crit Care Med 176: 194–200

    Article  PubMed  Google Scholar 

  12. Engelman HM, Martin SE, Deary IJ, Douglas NJ (1997) Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. Thorax 52: 114–119

    Article  Google Scholar 

  13. Jokic R, Klimaszewski A, Sridhar G, Fitzpatrick MF (1998) Continuous positive airway pressure requirement during the first month of treatment in patients with severe obstructive sleep apnea. Chest 114: 1061–1069

    Article  PubMed  CAS  Google Scholar 

  14. Redline S, Adams N, Strauss ME et al. (1998) Improvement of mild sleep-disordered breathing with CPAP compared with conservative therapy. Am J Respir Crit Care Med 157: 858–865

    PubMed  CAS  Google Scholar 

  15. McArdle N, Douglas NJ (2001) Effects of continuous positive airway pressure on sleep architecture in the sleep apnea-hypopnea syndrome. A randomized controlled trial. Am J Respir Crit Care Med 164: 1459–1463

    PubMed  CAS  Google Scholar 

  16. Jenkinson C, Stradling J, Petersen S (1997) Comparison of three measures of quality of life outcome in the evaluation of continuous positive airways pressure therapy for sleep apnoea. J Sleep Res 6: 199–204

    Article  PubMed  CAS  Google Scholar 

  17. Engleman HM, Kingshott RN, Wraith PK et al. (1999) Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome. Am J Respir Crit Care Med 159: 461–467

    PubMed  CAS  Google Scholar 

  18. Lavie P, Ben Yosef R, Rubin AE (1984) Prevalence of sleep apnea syndrome among patients with essential hypertension. Am Heart J 108: 373–376

    Article  PubMed  CAS  Google Scholar 

  19. Krieger J, Kurtz D (1987) Problems in the application of nasal continuous positive airway pressure for the treatment of obstructive sleep apnea. Hypoxemia during sleep on nasal continuous positive airway pressure treatment. In: Peter JH, Podszus T, v.Wichert P (eds) Sleep related disorders and internal diseases. Springer, Berlin Heidelberg New York Tokyo, pp 367–374

  20. Nino-Murcia G, Crowke McCann C, Bliwise DL et al. (1989) Compliance and side effects in sleep apnea patients treated with nasal continuous positive airway pressure. West J Med 150: 165–169

    PubMed  CAS  Google Scholar 

  21. Massie CA, Hart RW, Peralez K, Richards GN (1999) Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure. Chest 116: 403–408

    Article  PubMed  CAS  Google Scholar 

  22. Martins de Araúyo MT, Vieira SB, Vasquez EC, Fleury B (2000) Heated humidification or face mask to prevent upper airway dryness during continuous positive airway pressure therapy. Chest 117: 142–147

    Article  Google Scholar 

  23. Mortimore IL, Whittle AT, Douglas NJ (1998) Comparison of nose and face mask CPAP therapy for sleep apnoea. Thorax 53: 290–292

    PubMed  CAS  Google Scholar 

  24. Randerath WJ, Heise M, Hinz R, Rühle KH (2002) An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Chest 122: 569–575

    Article  PubMed  Google Scholar 

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  1. Hals-Nasen-Ohren-Klinik, Westpfalz-Klinikum Kaiserslautern GmbH, Hellmut-Hartert-Straße 1, 67655, Kaiserslautern, Deutschland

    N. Stasche

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  1. N. Stasche
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Herrn Prof. Dr. med. Karl Hörmann, Direktor der Universitäts-HNO-Klinik Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, zum 60. Geburtstag gewidmet.

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Stasche, N. Update: Therapie des Schlafapnoe-Syndroms mit positivem Atemwegsdruck. HNO 56, 1105–1111 (2008). https://doi.org/10.1007/s00106-008-1759-1

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