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Endoskopie in der Schlafmedizin

Endoscopy in sleep medicine

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Zusammenfassung

Die endoskopische Evaluation der oberen Atemwege bei Patienten mit schlafbezogenen Atmungsstörungen (SBAS) mit starren und flexiblen Endoskopen gehört zu den Standarduntersuchungen von Hals-Nasen-Ohren-Ärzten. Von besonderem Interesse sind die Darstellung einerseits des anatomischen Substrats und andererseits des dynamischen Mechanismus, durch den die Obstruktion und das Schnarchen im Wachzustand, im natürlichen Schlaf und in Sedierung entstehen. Die Ergebnisse haben zum Verständnis der Pathophysiologie der SBAS mit Obstruktion der oberen Atemwege beigetragen. Die Videoendoskopie in Sedierung hat sich mehr und mehr etabliert zur Festlegung des therapeutischen Prozedere bei Unverträglichkeit einer Beatmungstherapie. Sie führt in einem signifikanten Ausmaß zu einer Änderung des Therapiekonzepts im Vergleich zur klinischen Untersuchung im Wachzustand und kann den Therapieerfolg von Unterkieferprotrusionsschienen hinreichend vorhersagen. Es ist jedoch bisher noch unklar, inwieweit sie zu einer Verbesserung der Erfolgsrate operativer Therapien beiträgt. Die vielversprechenden Ansätze bedürfen weiterer, intensiver Forschung, um zu wertvollen Hilfsmitteln in der diagnostischen Abklärung von Schlafapnoikern werden zu können.

Abstract

Endoscopic evaluation of the upper airway in patients with sleep disordered breathing (SDB) using rigid and flexible endoscopes is a typical investigation in otorhinolaryngology. Visualizing the anatomic structure as well as the dynamic mechanism of snoring and pharyngeal obstruction during wakefulness, natural sleep, and under sedation are of special interest. The results obtained have increased our understanding of SDB with obstruction of the upper airway. Videoendoscopy under sedation (ViSe) has become increasingly established as a tool to identify the therapeutic concept in cases of CPAP failure, leading to changes compared to the concept derived from basic awake endoscopy. The success of mandibular advancement devices can be adequately predicted. However, it remains unclear to what extent the success rate of surgery can be improved by ViSe. Further research into these approaches is needed in order to become valuable tools in the diagnostic work-up of patients with sleep apnea.

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  1. Schlafmedizinisches Zentrum,Universitäts-Hals-Nasen-Ohren-Klinik Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, 68135, Mannheim, Deutschland

    J.T. Maurer & K. Hörmann

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  2. K. Hörmann
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Correspondence to J.T. Maurer.

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Maurer, J., Hörmann, K. Endoskopie in der Schlafmedizin. HNO 58, 341–347 (2010). https://doi.org/10.1007/s00106-010-2096-8

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