Skip to main content
SpringerLink
Log in

Funktionelle Topodiagnostik der oberen Atemwege bei schlafbezogenen Atmungsstörungen

Functional evaluation of the upper respiratory tract in sleep-related breathing disorders

  • Schwerpunkt
  • Published:
Somnologie - Schlafforschung und Schlafmedizin Aims and scope Submit manuscript

Zusammenfassung

Die chirurgischen Alternativen zur CPAP-Therapie werden bei der obstruktiven Schlafapnoe im interdisziplinären Kontext kontrovers diskutiert. Neuere Arbeiten evaluieren prädiktive Parameter für eine Verbesserung des Operationserfolgs. Im Rahmen dieser Anstrengung gewinnen 2 funktionelle Untersuchungsmethoden der oberen Atemwege zunehmend an Bedeutung. Gegenstand der folgenden Übersichtsarbeit ist es, die Möglichkeiten und Grenzen der medikamentös induzierten Schlafendoskopie und der Mehrkanaldrucksondenmessung aufzuzeigen und deren derzeitige und zukünftige Bedeutung für die Therapieindikationsstellung darzustellen. Weitere multizentrische Studien müssen den Stellenwert dieser funktionellen Untersuchungsmethoden untermauern.

Abstract

In the interdisciplinary approach to obstructive sleep apnea, surgical alternatives to continuous positive airway pressure are still being controversially discussed. In this context, the functional evaluation of the upper respiratory tract gains additional importance. Recent studies have analyzed predictive parameters to improve surgical success. The present review addresses the current techniques that assess the functional anatomy of the upper respiratory tract (e.g., endoscopy under sedation and multichannel pressure recordings). Methodological aspects associated with these techniques and the impact on the indications for specific surgical interventions are discussed. More multicenter studies are needed to improve the evidence of these techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Agrawal S, Stone P, Mcguinness K et al (2002) Sound frequency analysis and the site of snoring in natural and induced sleep. Clin Otolaryngol Allied Sci 27:162–166

    Article  PubMed  CAS  Google Scholar 

  2. Arens R, Mcdonough JM, Costarino AT et al (2001) Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 164:698–703

    PubMed  CAS  Google Scholar 

  3. Baisch A, Hein G, Gossler U et al (2005) Finding the appropriate therapy with the help of sleep endoscopy. Laryngorhinootologie 84:833–837

    Article  PubMed  CAS  Google Scholar 

  4. Battagel JM, Johal A, Kotecha BT (2005) Sleep nasendoscopy as a predictor of treatment success in snorers using mandibular advancement splints. J Laryngol Otol 119:106–112

    Article  PubMed  CAS  Google Scholar 

  5. Berry S, Roblin G, Williams A et al (2005) Validity of sleep nasendoscopy in the investigation of sleep related breathing disorders. Laryngoscope 115:538–540

    Article  PubMed  CAS  Google Scholar 

  6. Camilleri AE, Ramamurthy L, Jones PH (1995) Sleep nasendoscopy: what benefit to the management of snorers? J Laryngol Otol 109:1163–1165

    Article  PubMed  CAS  Google Scholar 

  7. Counter P, Wilson JA (2004) The management of simple snoring. Sleep Med Rev 8:433–441

    PubMed  Google Scholar 

  8. Croft CB, Thomson HG, Samuels MP et al (1990) Endoscopic evaluation and treatment of sleep-associated upper airway obstruction in infants and young children. Clin Otolaryngol Allied Sci 15:209–216

    Article  PubMed  CAS  Google Scholar 

  9. Do KL, Ferreyra H, Healy JF et al (2000) Does tongue size differ between patients with and without sleep-disordered breathing? Laryngoscope 110:1552–1555

    Article  PubMed  CAS  Google Scholar 

  10. Eastwood PR, Platt PR, Shepherd K et al (2005) Collapsibility of the upper airway at different concentrations of propofol anesthesia. Anesthesiology 103:470–477

    Article  PubMed  CAS  Google Scholar 

  11. El Badawey MR, Mckee G, Heggie N et al (2003) Predictive value of sleep nasendoscopy in the management of habitual snorers. Ann Otol Rhinol Laryngol 112:40–44

    Google Scholar 

  12. Friedman M, Ibrahim H, Bass L (2002) Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg 127:13–21

    Article  PubMed  Google Scholar 

  13. Golz A, Goldenberg D, Westerman ST et al (2000) Laser partial epiglottidectomy as a treatment for obstructive sleep apnea and laryngomalacia. Ann Otol Rhinol Laryngol 109:1140–1145

    PubMed  CAS  Google Scholar 

  14. Guilleminault C, Hill MH, Simmons FB et al (1997) Passive constriction of the upper airway during central apneas: fiberoptic and EMG investigations. Respir Physiol 108:11–22

    Article  PubMed  CAS  Google Scholar 

  15. Hessel NS, De Vries N (2002) Diagnostic work-up of socially unacceptable snoring. II. Sleep endoscopy. Eur Arch Otorhinolaryngol 259:158–161

    Article  PubMed  Google Scholar 

  16. Hewitt RJ, Dasgupta A, Singh A et al (2009) Is sleep nasendoscopy a valuable adjunct to clinical examination in the evaluation of upper airway obstruction? Eur Arch Otorhinolaryngol 266:691–6697

    Article  PubMed  Google Scholar 

  17. Hill PD, Osman EZ, Osborne JE et al (2000) Changes in snoring during natural sleep identified by acoustic crest factor analysis at different times of night. Clin Otolaryngol Allied Sci 25:507–510

    Article  PubMed  CAS  Google Scholar 

  18. Issa FG (1992) Effect of clonidine in obstructive sleep apnea. Am Rev Respir Dis 145:435–439

    PubMed  CAS  Google Scholar 

  19. Johnson K, Page A, Williams H et al (2002) The use of melatonin as an alternative to sedation in uncooperative children undergoing an MRI examination. Clin Radiol 57:502–506

    Article  PubMed  CAS  Google Scholar 

  20. Jones TM, Ho MS, Earis JE et al (2006) Acoustic parameters of snoring sound to compare natural snores with snores during ‚steady-state‘ propofol sedation. Clin Otolaryngol 31:46–52

    Article  PubMed  CAS  Google Scholar 

  21. Katsantonis GP, Moss K, Miyazaki S et al (1993) Determining the site of airway collapse in obstructive sleep apnea with airway pressure monitoring. Laryngoscope 103:1126–1131

    Article  PubMed  CAS  Google Scholar 

  22. Koutsourelakis I, Georgoulopoulos G, Perraki E et al (2008) Randomised trial of nasal surgery for fixed nasal obstruction in obstructive sleep apnoea. Eur Respir J 31:110–117

    Article  PubMed  CAS  Google Scholar 

  23. Launois SH, Feroah TR, Campbell WN et al (1993) Site of pharyngeal narrowing predicts outcome of surgery for obstructive sleep apnea. Am Rev Respir Dis 147:182–189

    PubMed  CAS  Google Scholar 

  24. Marais J (1998) The value of sedation nasendoscopy: a comparison between snoring and non-snoring patients. Clin Otolaryngol Allied Sci 23:74–76

    Article  PubMed  CAS  Google Scholar 

  25. Maurer JT, Stuck BA (2008) Update on upper airway evaluation in obstructive sleep apnea. HNO 56:1089–1097

    Article  PubMed  CAS  Google Scholar 

  26. Maurer JT, Stuck BA, Hein G et al (2000) Videoendoscopic assessment of uncommon sites of upper airway obstruction during sleep. Sleep Breath 4:131–136

    Article  PubMed  Google Scholar 

  27. Naguib M, Gottumukkala V, Goldstein PA (2007) Melatonin and anesthesia: a clinical perspective. J Pineal Res 42:12–21

    Article  PubMed  CAS  Google Scholar 

  28. Ng AT, Qian J, Cistulli PA (2006) Oropharyngeal collapse predicts treatment response with oral appliance therapy in obstructive sleep apnea. Sleep 29:666–671

    PubMed  Google Scholar 

  29. Osnes T, Rollheim J, Hartmann E (2002) Effect of UPPP with respect to site of pharyngeal obstruction in sleep apnoea: follow-up at 18 months by overnight recording of airway pressure and flow. Clin Otolaryngol Allied Sci 27:38–43

    Article  PubMed  Google Scholar 

  30. Overland B, Bruskeland G, Akre H et al (2005) Evaluation of a portable recording device (Reggie) with actimeter and nasopharyngeal/esophagus catheter incorporated. Respiration 72:600–605

    Article  PubMed  Google Scholar 

  31. Pawlik MT, Hansen E, Waldhauser D et al (2005) Clonidine premedication in patients with sleep apnea syndrome: a randomized, double-blind, placebo-controlled study. Anesth Analg 101:1374–1380

    Article  PubMed  CAS  Google Scholar 

  32. Petri N, Suadicani P, Wildschiodtz G et al (1994) Predictive value of Muller maneuver, cephalometry and clinical features for the outcome of uvulopalatopharyngoplasty. Evaluation of predictive factors using discriminant analysis in 30 sleep apnea patients. Acta Otolaryngol 114:565–571

    Article  PubMed  CAS  Google Scholar 

  33. Pringle MB, Croft CB (1993) A grading system for patients with obstructive sleep apnoea–based on sleep nasendoscopy. Clin Otolaryngol Allied Sci 18:480–484

    Article  PubMed  CAS  Google Scholar 

  34. Quinn SJ, Daly N, Ellis PD (1995) Observation of the mechanism of snoring using sleep nasendoscopy. Clin Otolaryngol Allied Sci 20:360–364

    Article  PubMed  CAS  Google Scholar 

  35. Randerath W, Bauer M, Blau A et al (2007) Are there alternative therapeutical options other than CPAP in the treatment of the obstructive sleep apnea syndrome. Pneumologie 61:458–466

    Article  PubMed  CAS  Google Scholar 

  36. Roblin G, Williams AR, Whittet H (2001) Target-controlled infusion in sleep endoscopy. Laryngoscope 111:175–176

    Article  PubMed  CAS  Google Scholar 

  37. Rodriguez-Bruno K, Goldberg AN, Mcculloch CE et al (2009) Test-retest reliability of drug-induced sleep endoscopy. Otolaryngol Head Neck Surg 140:646–651

    Article  PubMed  Google Scholar 

  38. Rojewski TE, Schuller DE, Clark RW et al (1982) Synchronous video recording of the pharyngeal airway and polysomnograph in patients with obstructive sleep apnea. Laryngoscope 92:246–250

    Article  PubMed  CAS  Google Scholar 

  39. Rojewski TE, Schuller DE, Clark RW et al (1984) Videoendoscopic determination of the mechanism of obstruction in obstructive sleep apnea. Otolaryngol Head Neck Surg 92:127–131

    PubMed  CAS  Google Scholar 

  40. Rollheim J, Tvinnereim M, Sitek J et al (2001) Repeatability of sites of sleep-induced upper airway obstruction. A 2-night study based on recordings of airway pressure and flow. Eur Arch Otorhinolaryngol 258:259–264

    Article  PubMed  CAS  Google Scholar 

  41. Sadaoka T, Kakitsuba N, Fujiwara Y et al (1996) The value of sleep nasendoscopy in the evaluation of patients with suspected sleep-related breathing disorders. Clin Otolaryngol Allied Sci 21:485–489

    Article  PubMed  CAS  Google Scholar 

  42. Schmidt CM, Bohlender JE, Deuster D et al (2004) The use of melatonin as an alternative to sedation in children undergoing brainstem audiometry. Laryngorhinootologie 83:523–528

    Article  PubMed  Google Scholar 

  43. Schwab RJ, Pasirstein M, Pierson R et al (2003) Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 168:522–530

    Article  PubMed  Google Scholar 

  44. Sher AE, Thorpy MJ, Shprintzen RJ et al (1985) Predictive value of Muller maneuver in selection of patients for uvulopalatopharyngoplasty. Laryngoscope 95:1483–1487

    Article  PubMed  CAS  Google Scholar 

  45. Skatvedt O (1993) Localization of site of obstruction in snorers and patients with obstructive sleep apnea syndrome: a comparison of fiberoptic nasopharyngoscopy and pressure measurements. Acta Otolaryngol 113:206–209

    Article  PubMed  CAS  Google Scholar 

  46. Skatvedt O, Akre H, Godtlibsen OB (1996) Nocturnal polysomnography with and without continuous pharyngeal and esophageal pressure measurements. Sleep 19:485–490

    PubMed  CAS  Google Scholar 

  47. Steinhart H, Kuhn-Lohmann J, Gewalt K et al (2000) Upper airway collapsibility in habitual snorers and sleep apneics: evaluation with drug-induced sleep endoscopy. Acta Otolaryngol 120:990–994

    Article  PubMed  CAS  Google Scholar 

  48. Struys M, Versichelen L, Byttebier G et al (1998) Clinical usefulness of the bispectral index for titrating propofol target effect-site concentration. Anaesthesia 53:4–12

    Article  PubMed  CAS  Google Scholar 

  49. Stuck BA, Maurer JT (2008) Airway evaluation in obstructive sleep apnea. Sleep Med Rev 12:411–436

    Article  PubMed  Google Scholar 

  50. Tvinnereim M, Cole P, Haight JS et al (1995) Diagnostic airway pressure recording in sleep apnea syndrome. Acta Otolaryngol 115:449–454

    Article  PubMed  CAS  Google Scholar 

  51. Verse T, Pirsig W, Haase S (1998) Zur Aussagekraft von Pharynxdruckmeßsonden bei der Diagnostik schlafbezogener Atmungsstörungen: Radiokephalometrische Messungen. Somnologie 58–62

  52. Weinbroum AA, Ben-Abraham R (2001) Dextromethorphan and dexmedetomidine: new agents for the control of perioperative pain. Eur J Surg 167:563–569

    Article  PubMed  CAS  Google Scholar 

  53. Woodson BT, Wooten MR (1994) Manometric and endoscopic localization of airway obstruction after uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 111:38–43

    PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Hals-Nasen-Ohren-Klinik, Campus Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    M. Hölzl, B. Sedlmaier & M.D. Jumah

  2. Interdisziplinäres Schlafmedizinisches Zentrum, Charité - Universitätsmedizin Berlin, Berlin, Deutschland

    I. Fietze

  3. Klinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Mitte und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Deutschland

    J. Birnbaum

Authors
  1. M. Hölzl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Sedlmaier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Birnbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I. Fietze
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M.D. Jumah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Hölzl.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hölzl, M., Sedlmaier, B., Birnbaum, J. et al. Funktionelle Topodiagnostik der oberen Atemwege bei schlafbezogenen Atmungsstörungen. Somnologie 13, 136–143 (2009). https://doi.org/10.1007/s11818-009-0414-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11818-009-0414-8

Schlüsselwörter

Keywords

Search

Navigation