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Neue Methoden der nasalen Überdrucktherapie bei der Schlafapnoe

New methods for nasal positive pressure therapy for sleep apnea

  • Leitthema
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Der Pneumologe Aims and scope

Zusammenfassung

Wir sind heute in der Lage, verschiedene Formen der Schlafapnoe und der schlafbezogenen Hypoventilationssyndrome bzw. deren Kombinationen zu differenzieren, und lernen zunehmend, diese auch differenziert zu behandeln. Die Bi-Level-Ventilation im Spontanmodus kommt v. a. bei der Kombination von Schlafapnoe und Obesitashypoventilation zum Einsatz. Bei Schlafapnoe mit hohem Druckbedarf kann versucht werden, mit einem „Pressure-release-System“ die Ausatmung zu erleichtern und Mundleckagen zu vermindern. Durch den Einsatz von Auto-CPAP-Systemen gelingt es z. B. bei lageabhängiger Schlafapnoe, den durchschnittlichen Therapiedruck abzusenken. Komplexere Therapieformen wie die adaptive Servoventilation kommen z. B. bei Herzinsuffizienz und Cheyne-Stokes-Atmung bzw. „komplexer Schlafapnoe“ zum Einsatz. Voraussetzung für eine derart differenzierte Therapie ist immer auch eine differenzierte Diagnostik auf der Basis eines soliden Verständnisses der pathophysiologischen Zusammenhänge.

Abstract

Today, we can differentiate between various forms of sleep apnea and sleep-related hypoventilation syndrome. These can be treated with different modes of nasal positive pressure therapy. Bi-level systems are used for patients with a combination of obstructive sleep apnea and obesity hypoventilation syndrome. In patients with obstructive sleep apnea with high pressures, modern pressure relief systems may be employed to ease expiration and reduce mouth leakage. With auto-continuous positive airway pressure (CPAP) systems, the mean treatment pressure may be significantly reduced, especially in patients with positional sleep apnea. Special ventilation modes such as adaptive servo-ventilation are increasingly used, for instance in patients with chronic heart failure and Cheyne-Stokes respiration or “complex sleep apnea”. Such modern differential treatment requires adequate differential diagnostics based on profound pathophysiological understanding.

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Interessenkonflikt

Der Autor hat seit vielen Jahren Studien zur Diagnostik und Therapie schlafbezogener Atmungsstörungen durchgeführt, diese wurden teilweise durch Drittmittel an die Klinik des Autors unterstützt, die unter anderem von Herstellern von Geräten zur Diagnostik und Therapie schlafbezogener Atmungsstörungen stammten. Der Autor hat darüber hinaus Vortrags- und Beratungshonorare von Herstellern von Geräten zur Diagnostik und Therapie schlafbezogener Atmungsstörungen erhalten. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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  1. Medizinische Klinik 3– Pneumologie, Allergologie, Schlafmedizin –, Klinikum Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland

    Joachim H. Ficker

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Correspondence to Joachim H. Ficker.

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Ficker, J. Neue Methoden der nasalen Überdrucktherapie bei der Schlafapnoe. Pneumologe 4, 104–111 (2007). https://doi.org/10.1007/s10405-007-0139-y

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  • DOI: https://doi.org/10.1007/s10405-007-0139-y

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