Die Nicht-CPAP-Therapie des obstruktiven Schlafapnoe-Syndroms: ein Überblick

Abstract

Optimal treatment of the obstructive sleep apnoea syndrome (OSAS) requires an individually designed and interdisciplinary approach. Continuous positive airway pressure (CPAP) is accepted as the first line therapy for patients with OSAS. However, non-CPAP therapies may be indicated as supportive therapeutical approach in CPAP failure or as an alternative approach in CPAP intolerance. Overall, the level of evidence for the majority of non-CPAP therapies is low. Mandibular advancement devices as a medical non-CPAP treatment have proven to reduce respiratory disturbances to a level which may be sufficient in mild to moderate sleep apnoea. Apnoea triggered neurostimulation of upper airway muscles is an innovative approach that has shown promising results in preclinical studies. Surgical treatment has previously been performed as single level surgery of the nasal, the oropharyngeal or hypopharyngeal level. However, only tonsillectomy in the presence of tonsillar hypertrophy and maxillomandibular advancement are recommended in carefully selected cases. Due to low success rates for single level surgery, multilevel surgery has been proposed as the surgical approach for the future.

The Role of Midline Glossectomy With Coblation in Obstructive Sleep Apnea

“…A recent review about the new treatments for OSA, they try to affirm that midline glossectomy is not a good option and cases of moderate sleep apnea, especially in obese people, obviously believe that when there is a body mass index above 40 kg/m2, no surgical alternative is coherent, and the first step should be weight loss [13]. The evidence we present does not disagree with this statement, but when there is a correct surgical indication seen the patient as a whole, as well as the topographic evaluation evidencing that the base of the tongue is the problem in question, glossectomy alone can become a strong ally and can be effective in the treatment of OSA.…”