Hypoglossusnervstimulation bei CPAP-Versagen

Evolution einer Alternativbehandlung für Patienten mit obstruktiver Schlafapnoe

Hypoglossal nerve stimulation in patients with CPAP failure

Evolution of an alternative treatment for patients with obstructive sleep apnea

Zusammenfassung

Die obstruktive Schlafapnoe (OSA) ist eine der häufigsten Erkrankungen mit steigender Prävalenz in den westlichen Industrieländern. Goldstandard der Therapie ist die nächtliche Überdruckbeatmung mittels „continuous positive airway pressure“ (CPAP), welche jedoch aufgrund von Komplikationen und Nebenwirkungen nicht oder nicht ausreichend von allen Patienten genutzt werden kann. Seit ein paar Jahren besteht nun die Hypoglossusnervstimulation als Alternative in der chirurgischen Therapie zur Verfügung. Ziel dieser Arbeit ist es, eine Übersicht über die Geschichte und den aktuellen wissenschaftlichen Stand dieser Therapie in der Behandlung der OSA zu geben. Aktuell gibt es 2 verfügbare Systeme auf dem Markt: die atmungsgesteuerte Stimulation des N. hypoglossus (Fa. Inspire Medical Systems) und die atmungsunabhängige Stimulation des N. hypoglossus (Fa. ImThera Medical). Die atmungsgesteuerte Stimulation weist ein hohes Evidenzniveau auf und wurde in zahlreichen multizentrischen klinischen Studien auf ihre Effektivität hin untersucht. Die Evidenzlage für die atmungsunabhängige Stimulation hingegen ist bislang limitiert. Ende des letzten Jahrhunderts wurden die ersten Patienten mit einem Stimulationssystem behandelt und erste erfolgversprechende klinische Ergebnisse dokumentiert. Aufgrund einer konsequenten technischen und wissenschaftlichen Weiterentwicklung konnten die Therapien in die heutige klinische Routine eingeführt werden. Damit kann das Spektrum in der Behandlung der OSA, insbesondere für Patienten mit CPAP-Intoleranz, deutlich erweitert werden.

Abstract

Obstructive sleep apnea (OSA) is a common disease in western industrialized countries with increasing prevalence. Gold standard of therapy is nocturnal positive pressure ventilation by continuous positive airway pressure (CPAP). Due to complications and side effects of ventilation, therapy adherence is limited. Recently an alternative surgical treatment has become available for these patients, which uses established techniques to stimulate the hypoglossus nerve to open the upper airway during sleep. The aim of this work is to provide an overview of the history and current state of scientific knowledge of this therapy in the treatment of OSA. Currently, two systems are available on the market: respiratory-driven hypoglossal nerve stimulation (Inspire Medical Systems) and continuous hypoglossal nerve stimulation (ImThera Medical). For respiratory-driven hypoglossal nerve stimulation, a solid body of evidence is available and the therapy has been investigated in numerous multicenter clinical studies with regard to safety and efficacy. Only a small number of publications is available for continuous hypoglossal nerve stimulation. At the end of the last century, promising clinical results were shown in the first patients treated with hypoglossal nerve stimulation. Consequent technological and scientific development of respiratory-driven hypoglossal nerve stimulation in recent years led to its implementation in today’s clinical routine. This therapy significantly broadens the spectrum of therapies in the treatment of OSA, especially for patients with CPAP intolerance.

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Correspondence to Priv. Doz.-Dr. med. C. Heiser.

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Interessenkonflikt

C. Heiser und B. Hofauer haben von Fa. Inspire Medical Systems Vortragshonorare und finanzielle Unterstützung bei Forschungsprojekten erhalten.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Dieser Übersichtsartikel ist Herrn Prof. Wolfgang Pirsig gewidmet, für all seine wissenschaftliche Unterstützung in den letzten Jahren!

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Heiser, C., Hofauer, B. Hypoglossusnervstimulation bei CPAP-Versagen. HNO 65, 99–106 (2017). https://doi.org/10.1007/s00106-016-0247-2

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Schlüsselwörter

  • Schlafbezogene Atmungstörungen
  • Selektive Stimulation der oberen Atemwege
  • Chirurgische Therapieverfahren
  • Implantierbarer Neurostimulator
  • Nervus hypoglossus

Keywords

  • Sleep disordered breathing
  • Selective upper airway stimulation
  • Surgical treatment
  • Implantable neurostimulator
  • Hypoglossal nerve