Diagnostik und Therapie des obstruktiven Schlafapnoesyndroms

 

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Zusammenfassung

Die Adipositas gehört neben dem männlichen Geschlecht und dem höheren Lebensalter zu den wichtigsten Risikofaktoren des obstruktiven Schlafapnoesyndroms (OSAS). Dabei handelt es sich um ein Krankheitsbild, das aufgrund des individuellen gesundheitlichen Risikos, der Gefährdung durch Unfälle und kardiovaskuläre Folgeerkrankungen und durch die hohe Prävalenz eine erhebliche sozioökonomische Bedeutung hat. Typische Leitsymptome sind das laute und unregelmäßige Schnarchen, Atempausen, die von Bettpartnern beobachtet werden, sowie die vermehrte Tagesschläfrigkeit. Angesichts der hohen Zahl unerkannter Patienten kommt der Anamnese hohe Bedeutung zu. In der weiteren Diagnostik kommt die Erfassung des Atemflusses, der Atemanstrengung und der Sauerstoffsättigung zum Einsatz. Die genaue Erfassung der Schlafstadien und Weckreaktionen erlaubt nur die Polysomnografie. In der Therapie des OSAS stellt die Positivdruck-Therapie (Continuous Positive Airway Pressure, CPAP) den Standard dar, der sehr effektiv die Symptomatik, aber auch das Unfallrisiko und die kardiovaskuläre Belastung beseitigen kann. Bei Patienten mit leichtem OSAS können alternativ auch Unterkieferprotrusionsschienen oder Hals-Nasen-Ohren-ärztliche Operationen eingesetzt werden.

Summary

Obesity is one of the most important risk factors of the obstructive sleep apnoea syndrome (OSAS). OSAS represents a serious problem of individual health and a huge socioeconomic challenge due to its high prevalence, the risk of occupational and traffic accidents and the cardiovascular consequences. Loud and irregular snoring, witnessed apneas during sleep and excessive daytime sleepiness are the most typical symptoms. However, a huge number of patients remain undiagnosed. Diagnosis is built up by the history, questionnaires on daytime symptoms and polygraphical measurement of cardio-pulmonary parameters such as airflow through mouth and nose, breathing effort or oxygen saturation. The polysomnography represents the gold standard of diagnosis and measures additionally sleep stages and arousals from sleep. Continuous positive airway pressure treatment (CPAP) has proven to be the most effective treatment of OSAS. It normalizes symptoms, the risk of accidents and cardiovascular diseases. Intraoral appliances, ENT operations can alternatively be used in a number of patients with mild OSAS.

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