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Schlafendoskopie und komplett konzentrischer Weichgaumenkollaps bei CPAP-Nutzungsproblemen

Sleep endoscopy and complete concentric collapse in CPAP failure

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Zusammenfassung

Hintergrund

Mittel der ersten Wahl bei obstruktiver Schlafapnoe (OSA) ist die Überdrucktherapie (CPAP). Allerdings kann sie von vielen Patienten nicht ausreichend genutzt werden. Mit einer medikamenteninduzierten Schlafendoskopie (DISE) lässt sich das Kollapsmuster im oberen Atemweg gut beurteilen. Ziel der Arbeit war es, ein Patientenkollektiv mit CPAP-Nutzungsproblemen mittels DISE hinsichtlich von Nutzungsproblemen und Therapieempfehlungen auszuwerten.

Methode

Über einen Zeitraum von 5 Jahren wurden alle Patienten mit einem Apnoe-Hypopnoe-Index (AHI) ≥15/h mittels DISE retrospektiv ausgewertet und die empfohlenen Therapieoptionen erfasst.

Ergebnisse

Die Datenanalyse von 210 Patienten ergab, dass etwa zwei Drittel Maskenprobleme als ursächlich für die CPAP-Ablehnung angaben. Bei 75 % konnte ein komplett konzentrischer Kollaps (CCC) ausgeschlossen werden, diese Patienten wiesen niedrigere AHI-Werte auf und hatten häufiger eine Tonsillektomie (TE) als Patienten mit CCC. Patienten mit einem Body-Mass-Index (BMI) > 35 kg/m2 hatten doppelt so oft einen CCC wie die mit einem BMI < 35 kg/m2. Bei fast gleichem BMI und AHI war bei Patienten ohne vorangegangene TE knapp doppelt so oft ein CCC zu erkennen wie mit TE.

Schlussfolgerung

Die Reihung der Therapieempfehlungen verändert sich häufig bei der Berücksichtigung von CCC, BMI > 35 kg/m2 und vorheriger TE.

Abstract

Introduction

First-line treatment for patients with obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP) therapy. However, many patients cannot use CPAP sufficiently. With drug-induced endoscopy (DISE), it is possible to assess the collapse pattern in the upper airway. The aim of this work was to evaluate a collective of patients with CPAP usage problems using DISE, in order to evaluate their usage problems and therapy recommendations.

Methods

Over a period of 5 years, all patients with an apnea–hypopnea index (AHI) of at least 15/h were retrospectively evaluated using DISE. The recommended treatment options were then analyzed.

Results

Data analysis of 210 patients showed that about two thirds reported mask problems as the cause of non-adherence to CPAP. A complete concentric collapse (CCC) could be excluded in 75%. These patients had a lower AHI and more frequent tonsillectomy (TE) than patients with CCC. Double the number of patients with a body mass index (BMI) > 35 kg/m2 had a CCC compared to those with a BMI < 35 kg/m2. Among patients with similar BMI and AHI, CCC was twice as likely to be found in patients without TE.

Conclusion

The course of treatment recommended for OSA often differs, depending on CCC, BMI > 35 kg/m2, and previous TE.

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Authors and Affiliations

  1. Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Universität zu Lübeck, Ratzeburger Allee, 23538, Lübeck, Deutschland

    K. Hasselbacher, K.-L. Bruchhage, N. Abrams &  A. Steffen

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  1. K. Hasselbacher
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  2. K.-L. Bruchhage
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  3. N. Abrams
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  4. A. Steffen
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Correspondence to A. Steffen.

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Interessenkonflikt

K. Hasselbacher und A. Steffen erhielten Reisekostenunterstützung von Fa. Inspire Medical; A. Steffen erhielt Forschungsförderung von Fa. Inspire Medical. K.‑L. Bruchhage und N. Abrams geben an, dass kein Interessenskonflikt besteht.

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

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Hasselbacher, K., Bruchhage, KL., Abrams, N. et al. Schlafendoskopie und komplett konzentrischer Weichgaumenkollaps bei CPAP-Nutzungsproblemen. HNO 66, 837–842 (2018). https://doi.org/10.1007/s00106-018-0550-1

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