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Der Einsatz der Stimulationstherapie der oberen Atemwege in Deutschland

The use of selective upper airway stimulation therapy in Germany

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Zusammenfassung

Die Stimulationstherapie der oberen Atemwege stellt eine neue Therapieform für Patienten mit einer obstruktiven Schlafapnoe dar. In den vergangenen Jahren konnte die Evidenz stetig gesteigert werden, wobei die deutschen Implantationszentren hier einen wesentlichen Beitrag leisten konnten. Seit der ersten Implantation eines Schrittmachers der oberen Atemwege in Deutschland im Jahre 2009 wurde neben einem anhaltenden Effekt auf die Reduktion des Schweregrads der obstruktiven Schlafapnoe in mehreren Studien der positive Effekt der Therapie auf die subjektiv empfundene Schläfrigkeit der Patienten gezeigt. Untersuchungen zur Schlafarchitektur ergaben unter Therapie eine Verringerung des N1-Anteils, und es zeigten sich Hinweise auf einen REM-Rebound. Die Ergebnisse der Untersuchung der Therapienutzung ergaben einen durchschnittlichen Wert von 5,7 h Nutzung pro Nacht. In weiteren Untersuchungen konnten Erkenntnisse zum Wirkmechanismus der Stimulationstherapie gewonnen werden. Mit der Verbreitung der Stimulationstherapie wurde der Stellenwert einer möglichst exakten Vorstellung zur Anatomie auch des distalen N. hypoglossus zunehmend bedeutender. So konnte ein Klassifikationssystem des Nervs entwickelt werden, das die Platzierung der Stimulationselektrode für zukünftige Chirurgen erleichtern soll. Der Einsatz verschiedener Verfahren zur Beurteilung des Effektes der Therapie auf die oberen Atemwege wird untersucht.

Abstract

Selective upper airway stimulation represents a new therapy for patients with obstructive sleep apnea. In recent years, the evidence supporting this therapy has continuously increased, whereas German implantation centers were involved or initiated investigations on various aspects of the stimulation therapy. Since the first implantation of an upper airway stimulation system in Germany in 2009, the persistent effect on the severity of the obstructive sleep apnea and on the subjective sensation of daytime sleepiness has been confirmed. Investigations into the effect on the sleep architecture revealed a decrease of the N1 amount of sleep and signs of a REM-rebound during the titration night could be gathered. The evaluation of the adherence to therapy resulted in an average of 5.7 h per night. In further examinations insights on the mechanism of upper airway stimulation could be gathered. With increasing application of upper airway stimulation, exact knowledge on hypoglossal nerve anatomy became essential. Therefore, a classification system for the surgical anatomy of the hypoglossal nerve was created. The direct effect on the upper airways is evaluated with different modalities.

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Authors and Affiliations

  1. Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland

    Benedikt Hofauer MD & Clemens Heiser MD

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  1. Benedikt Hofauer MD
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Correspondence to Benedikt Hofauer MD.

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Interessenkonflikt

B. Hofauer hat von Inspire Medical Systems Reisekostenerstattungen und Vortragshonorare erhalten. C. Heiser ist als Berater für Inspire Medical Systems tätig.

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

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Hofauer, B., Heiser, C. Der Einsatz der Stimulationstherapie der oberen Atemwege in Deutschland. Somnologie 22, 98–105 (2018). https://doi.org/10.1007/s11818-018-0162-8

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  • DOI: https://doi.org/10.1007/s11818-018-0162-8

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