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Update: Diagnostik der oberen Atemwege bei Schlafapnoe-Syndrom

Update on upper airway evaluation in obstructive sleep apnea

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Zusammenfassung

In den beiden vergangenen Jahrzehnten wurden verschiedene Methoden der differenzierten Atemwegsdiagnostik bei Patienten mit SBAS erprobt.

Während die klinisch-endoskopische Untersuchung die Basis jeder Diagnostik darstellt, scheint das Müller-Manöver keine Bedeutung zu haben. Bildgebende Verfahren haben wesentlich zum Verständnis der Pathophysiologie der obstruktiven Schlafapnoe beigetragen. Die Kephalometrie ist nur vor geplanter maxillomandibulärer Vorverlagerung erforderlich. Dynamische Untersuchungen mittels CT oder MRT können den Kollaps darstellen und bieten für die Zukunft die Chance, den Effekt therapeutischer Interventionen zu simulieren. Die Videoendoskopie in Sedierung kann bisher lediglich den Therapieerfolg von Unterkieferprotrusionsschienen vorhersagen. Mehrkanaldruckmessungen erlauben eine quantitative Aussage über die Häufigkeitsverteilung von obstruktiven Ereignissen im oberen und unteren Pharynxsegment während der gesamten Schlafzeit.

Der Nutzen der differenzierten Atemwegsdiagnostik ist derzeit eher kritisch zu beurteilen. Die vielversprechenden Ansätze bedürfen weiterer, intensiver Forschung, um zu wertvollen Hilfsmitteln in der diagnostischen Abklärung von Schlafapnoikern werden zu können.

Abstract

During the past two decades, different methods of upper airway evaluation for patients with obstructive sleep apnea (OSA) have been investigated. Although clinical assessment is the basis of any diagnostic workflow in OSA, the Mueller maneuver is apparently of no importance. Imaging techniques have increased our knowledge of the pathophysiology of OSA. Cephalometry is done only if maxillomandibular advancement is planned; dynamic investigations such as computed tomography and magnetic resonance imaging are able to picture the pharyngeal collapse and have the capacity to simulate the effect of interventions on OSA severity. So far, video endoscopy under sedation can only predict the success of oral appliances. Multichannel pressure recordings depict the distribution of obstructive events in the upper or lower pharyngeal segment during the entire night. The impact of sophisticated upper airway evaluation remains limited compared with standard clinical assessment. Further research is needed to develop valuable tools for the diagnostic workup of patients with OSA.

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  1. Schlafmedizinisches Zentrum, Universitäts-Hals-Nasen-Ohren-Klinik Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, 68135, Mannheim, Deutschland

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Herrn Prof. Dr. med. Karl Hörmann, Direktor der Universitäts-HNO-Klinik Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, zum 60. Geburtstag gewidmet.

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Maurer, J., Stuck, B. Update: Diagnostik der oberen Atemwege bei Schlafapnoe-Syndrom. HNO 56, 1089–1097 (2008). https://doi.org/10.1007/s00106-008-1758-2

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