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Der Stellenwert bildgebender Verfahren bei der obstruktiven Schlafapnoe

The value of imaging studies in obstructive sleep apnea

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Zusammenfassung

Von den schlafbezogenen Atmungsstörungen ist die obstruktive Schlafapnoe (OSA) besonders häufig. Zur Untersuchung des oberen Atemwegs gibt es verschiedenste Techniken. Als bildgebende Verfahren sind hier v. a. die Radiokephalometrie, die Computertomographie (CT) und die Magnetresonanztomographie (MRT) zu nennen. Ihnen ist die vorliegende Übersichtsarbeit gewidmet. Diese Untersuchungsverfahren haben Einblicke in die Pathophysiologie der OSA bei Erwachsenen und Kindern ermöglicht und das Verständnis der Ursachen und Mechanismen der Atemwegsobstruktion erweitert. Mit Hilfe der Kephalometrie wurden charakteristische Auffälligkeiten in der skelettalen Anatomie des oberen Atemwegs dargestellt und als Risikofaktoren für eine OSA identifiziert. Zum Teil zeigen diese Parameter Zusammenhänge mit der Schwere der Erkrankung und mit einem erfolgreichen Einsatz progenierender Schienen. Mit CT und MRT wurden Unterschiede in der Weichteilanatomie zwischen Gesunden und Patienten mit OSA dargestell. Durch die dynamischen Untersuchungstechniken wurden die Mechanismen der Atemwegsobstruktion teilweise entschlüsselt. Diese Techniken haben sich jedoch in der klinischen Versorgung der Patienten nicht durchgesetzt. Eine Indikation zur routinemäßigen Durchführung besteht derzeit nicht.

Abstract

As the interest in obstructive sleep apnea has increased, various attempts have been made to assess upper respiratory tract anatomy in patients with this relatively frequent disorder. The aim is not only to reveal potential differences in upper airway anatomy between patients with obstructive sleep apnea and healthy controls, but also to better understand the origin and the pathophysiology of the disease. Static radiologic imaging techniques (x-ray cephalometry, computed tomography (CT) scanning and magnetic resonance imaging (MRI)) and dynamic scanning protocols (e.g., ultrafast CT or cine MRI) are the focus of this review. Each technique itself and its history in the field of sleep medicine are briefly reviewed. Insights into the pathophysiology of the disease gained with the help of the investigational techniques are presented, and the impact of the techniques on patient management is reported. Although all these additional techniques for upper respiratory tract assessment have substantially improved our understanding of the pathophysiology of obstructive sleep apnea, their significance in daily practice is limited. In general, there is not enough evidence that these techniques are superior to routine clinical assessment.

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  1. Universitäts-HNO-Klinik Mannheim, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland

    B.A. Stuck & J.T. Maurer

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  1. B.A. Stuck
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  2. J.T. Maurer
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Stuck, B., Maurer, J. Der Stellenwert bildgebender Verfahren bei der obstruktiven Schlafapnoe. Somnologie 13, 144–153 (2009). https://doi.org/10.1007/s11818-009-0415-7

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  • DOI: https://doi.org/10.1007/s11818-009-0415-7

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