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Medikamentös induzierte Schlafendoskopie – quo vadis?

Bestandsaufnahme und Ausblick

Drug-induced sedation endoscopy—quo vadis?

Review and outlook

  • Leitthema
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Zusammenfassung

Hintergrund

Die medikamentös induzierte Schlafendoskopie (MISE) stellt eine Diagnostikmethode dar, mit der die Kollapsneigung der oberen Atemwege durch medikamentös herbeigeführte Sedierung beurteilbar ist. Nach Expertenmeinung ist es dadurch möglich, Lokalisation, Ausmaß und Muster der pharyngolaryngealen Obstruktion während des Schlafs zu imitieren. Dies soll eine zielgerichtetere Therapieempfehlung als bei alleiniger klinischer Untersuchung ermöglichen.

Ziel der Arbeit

Die vorliegende Arbeit evaluiert kritisch den momentanen Stand und Indikationsmöglichkeiten der MISE.

Material und Methoden

Eine PubMed-Literaturrecherche mit den Schlagwörtern „sleep“ und „endoscopy“ oder „DISE“ wurde durchgeführt und relevante Publikationen ausgewertet.

Ergebnisse

Die vorliegende Arbeit bietet einen historischen Abriss über die Literatur und setzt diese in Bezug zu anderen Untersuchungstechniken bei obstruktiver Schlafapnoe. Die aktuelle Entwicklung der MISE in Hinblick auf Medikation, Klassifikationssysteme und Validierung wird evaluiert. Indikationsstellungen für eine MISE werden kritisch beleuchtet und anhand von Literaturdaten diskutiert.

Schlussfolgerung

Die MISE bietet einen tieferen Einblick in die Entstehung von Atemwegsobstruktionen und Schnarchen. Ihre Wertigkeit in Diagnostik und Therapie schlafbezogener Atmungsstörungen (SBAS) konnte zwar bisher nicht pauschal für Nicht-CPAP-Verfahren („continuous positive airway pressure“) nachgewiesen werden, jedoch wurden für einige Therapieverfahren prädiktive Parameter in der MISE definiert. Hierzu zählen z. B. Unterkieferprotrusionsschienen und die atmungssynchrone Stimulation des N. hypoglossus. Damit ist die MISE auch in Zukunft ein wertvolles Diagnostikinstrument bei obstruktiver Schlafapnoe und Schnarchen.

Abstract

Background

Drug-induced sedation endoscopy (DISE) is a diagnostic procedure which allows evaluation of the collapsibility of the upper airway. According to expert opinion, it is possible to imitate nocturnal collapsibility and perform a realistic investigation of the site of obstruction and vibration. This should enable sufficient and precise therapeutic advice to be given solely on the basis of clinical assessment.

Objective

The current publication critically evaluates the present state of development of DISE and its potential indications.

Materials and methods

A PubMed literature research was performed using “sleep” and “endoscopy” or “DISE” as keywords. Relevant publications were evaluated.

Results

The present publication provides a historical summary of the available publications and relates these to other methods for examining obstructive sleep apnea. The present state of DISE in terms of drugs applied, grading systems, and validity is evaluated. Indications for DISE are described and critically discussed on the basis of literature data.

Conclusion

DISE provides deep insights into the genesis of obstructions of the upper airway and snoring. Although its value for diagnosis and treatment of sleep-disordered breathing could not yet be demonstrated for all non-CPAP (continuous positive airway pressure) therapies, DISE could identify predictive parameters some methods. Further potential indications for DISE might be predictive examinations for mandibular advancement devices and respiration-synchronous neurostimulation of the hypoglossal nerve. DISE will thus remain a valuable diagnostic tool for obstructive sleep apnea and rhonchopathy.

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Authors and Affiliations

  1. Klinik für HNO-Krankheiten, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Deutschland

    M. Herzog

  2. Schlafmedizinisches Zentrum, Universitäts-HNO-Klinik Mannheim, Mannheim, Deutschland

    J. T. Maurer

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  1. M. Herzog
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Correspondence to M. Herzog.

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Interessenkonflikt

M. Herzog erhielt Unterstützung zu Implantationskursen der Firmen InspireMedical und ImTheraMedical.

J.T. Maurer erhielt Honorare für Vortragstätigkeiten von GlaxoSmithKline, Heinen & Löwenstein, Inspire Medical, Medtronic, Novartis, Olympus, Revent Medical, Resmed, Sissel Novacare und Weinmann Medizintechnik. Er bekam Reisekostenerstattung von Heinen & Löwenstein, Inspire Medical, MED-EL, Philipps, Revent Medical. Für klinische Studien wurde er unterstützt von ImThera, Inspire Medical, Neuwirth Medical, Nyxoah, Revent Medical und Sissel Novacare. Er erhielt finanzielle Unterstützung auf Drittmittelkonten von ImThera, Inspire Medical, MED-EL, Neuwirth Medical, Nyxoah, Philipps, Revent Medical und Sissel Novacare. Für Forschungsvorhaben wurde er unterstützt von MED-EL. Für die Abfassung thematisch verwandter Arbeiten wurde er unterstützt von Inspire Medical und ImThera Medical. Er erhielt Erstattung von Teilnahmegebühren für einen Kongress von Olympus.

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

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Widmung Gewidmet Prof. Dr. Wolfgang Pirsig als Pionier der deutschen HNO-ärztlichen Schlafmedizin.

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Herzog, M., Maurer, J.T. Medikamentös induzierte Schlafendoskopie – quo vadis?. HNO 65, 125–133 (2017). https://doi.org/10.1007/s00106-016-0329-1

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