Abstract
Over the past few years, the diagnostic tools and therapeutic approaches for obstructive sleep apnea (OSA) have evolved further. Based on a review of the current literature and the personal experiences of the authors, the most relevant developments are summarized in this article and discussed with regard to their impact on the clinical management of the disease. In the third edition of the International Classification of Sleep Disorders, the classification of sleep-disordered breathing was modified. Notably, additional clinical criteria for the diagnosis of OSA were established and out-of-center sleep testing was introduced as an alternative to polysomnography. Recent technical advancements in diagnostic tools (e. g., peripheral arterial tonometry and pulse wave analysis) have further expanded the diagnostic possibilities. Drug-induced sleep endoscopy allows for a reliable assessment of the level and degree of upper airway obstruction. Whether this gain in diagnostic information leads to an improvement in surgical outcome is, however, still being discussed. The relevance of positional OSA has received increasing attention – the subgroup of patients in whom sleeping position significantly impacts their disease is reported to be above 50 %. For these patients, the introduction of the sleep position trainer offers a new therapeutic option. Further, hypoglossal nerve stimulation (upper airway stimulation) has substantially expanded the surgical spectrum for the treatment of OSA. In regard to the established surgical treatment options, randomized trials with superior methodology have been published, especially for bimaxillary advancement and tonsillectomy with uvulopalatopharyngoplasty. These developments are of particular interest for the otolaryngologist and will influence daily practice.
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B.A. Stuck has received financial support for research projects as well as consultancy fees from the following companies: Aspire Medical, Fisher&Paykel Healthcare, Celon AG Medical Instruments, Olympus, Sutter Medizintechnik, Fachlabor Dr. W. Klee, Neuwirth Medical Products, Philips Healthcare, Heinen&Löwenstein, Alaxo GmbH, Tomed Dr. Toussaint GmbH, MEDA Pharma Gmbh, Inspire Medical, 3NT Medical, and PCI Biotech. J.T. Maurer has received financial support for research projects as well as consultancy fees from the following companies: Compumedics, Weinmann, Olympus, Celon AG, Sutter Medizintechnik, Neuwirth Medical Products, Resmed, Fisher & Paykl, Glaxo SmithKline, Inspire Medical, Heinen und Löwenstein, Philipps, Revent Medical, Medel, and Sissel Novacare.
The accompanying manuscript does not include studies on humans or animals.
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P.K. Plinkert, Heidelberg
B. Wollenberg, Lübeck
This work has been presented in part at the 49th Annual Meeting of Otorhinolaryngologists on 30 October 2015, in Mannheim, Germany
The German version of this article is available at: DOI: 10.1007/s00106-015-0092-8
The authors greatly appreciate the editorial help of Timon Hussain, MD, Essen, Germany.
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Stuck, B.A., Maurer, J.T. Recent developments in the diagnosis and treatment of obstructive sleep apnea. HNO 65 (Suppl 1), 13–18 (2017). https://doi.org/10.1007/s00106-016-0176-0
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DOI: https://doi.org/10.1007/s00106-016-0176-0