Zusammenfassung
Konservative Therapiemethoden wie die nächtliche Heimbeatmungstherapie beseitigen zwar symptomatisch die nächtliche pharyngeale Obstruktion, müssen aber dazu lebenslang angewandt werden. Die nächtliche Heimbeatmungstherapie ist zwar risikolos, das allnächtliche Aufsetzen der Nasenmaske und der Anschluß an Schläuche ist aber trotz der erheblichen Verbesserung dieser Geräte nicht jedermanns Sache und kann gerade bei jüngeren Patienten erhebliche psychosoziale Probleme verursachen. Der Wunsch nach dauerhafter kausaler Therapie beispielsweise chirurgische Eingriffe ist daher nur allzu verständlich. Leider hat gerade in Deutschland der unkritische Einsatz ablativer Maßnahmen wie Weichteilresektionen im Rachen chirurgische Therapiemaßnahmen stark diskreditiert. Dieser Beitrag mag der Standortbestimmung und der Wertung chirurgischer Therapiemethoden zur Beseitigung obstruktiver schlafbezogener Atemstörungen (obstruktive Schlafapnoe, obstruktives Schnarchen) dienen. Das setzt zunächst voraus, daß tatsächlich überwiegend obstruktive und nicht zentrale schlafbezogene Atemstörungen vorliegen, so selbstverständlich dies klingen mag. Unklar ist ferner noch, ab wann bei obstruktiven schlafbezogenen Atemstörungen tatsächlich ein Therapiebedarf besteht. Während es nicht schwerfällt, nebenwirkungsarme konservative Maßnahmen probatorisch anzuwenden, sollte man sich bei der Erwägung chirurgischer Eingriffe derzeit an eindeutigen Befunden orientieren: ein RDI (Respiratory-disturbance-Index) bzw. AHI als Zahl der Apnoen und Hypopnoen pro Stunde Schlaf über 20 gilt als dringlich behandlungsbedürftig angesichts nachgewiesener erhöhter Mortalität. Dennoch können auch geringe Werte eine klare Indikation darstellen, wenn beispielsweise Atemstörungen, die den Begriff Apnoe oder Hypopnoe definitionsgemäß nicht erfüllen, durch repetitiven Arousal die Schlafstruktur zerstören.
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Hochban, W. (1998). Operative Therapie obstruktiver schlafbezogener Atemstörungen. In: Konietzko, N., Teschler, H., Freitag, L. (eds) Schlafapnoe. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-58815-0_12
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