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Tonsillektomie mit Uvulopalatopharyngoplastik zur Behandlung der obstruktiven Schlafapnoe des Erwachsenen

Ein systematisches Review in der Kurzfassung

Tonsillectomy with uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea

A short version systematic review

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Zusammenfassung

Die obstruktive Schlafapnoe (OSA) ist eine der häufigsten schlafbezogenen Atmungsstörungen. Sie betrifft 2–26 % der Gesamtbevölkerung. Die Überdruckbeatmung mittels „continuous positive airway pressure“ (CPAP) wird nach wie vor als Goldstandard in der Therapie angesehen, wobei die Evidenz anderer Behandlungsverfahren stetig wächst. Die am häufigsten durchgeführte chirurgische Therapie der OSA ist die Uvulopalatopharyngoplastik (UPPP). Bisher existiert jedoch keine systematische Übersichtsarbeit hierzu.

Es wurden ein systematisches Review und eine Metaanalyse zur Erfassung des Effekts der UPPP bei Patienten mit OSA durchgeführt. Studien jedweden Designs, welche sich auf erwachsene OSA-Patienten bezogen, deren Diagnose mittels Polysomnographie oder mittels vergleichbarer Messung gestellt wurde, wurden in die Analyse einbezogen, solange eine isolierte „Standard-UPPP“ durchgeführt wurde.

92 Studien wurden in das systematische Review einbezogen, 53 waren prospektiver und 36 retrospektiver Natur, 3 waren Fallberichte. 18 Studien verwendeten eine Kontrollgruppe zum Vergleich, davon waren 7 randomisiert kontrollierte Studien (RCT). Von diesen qualifizierten sich 3 für die quantitative Metaanalyse. Alle außer 2 (96,4 %) Studien konnten eine Reduktion in der Frequenz der respiratorischen Ereignisse zeigen. Die Erfolgs‑/Ansprechraten variierten zwischen 31,3 und 96 %. In den 7 Studien, die einen prä- und postoperativen Mittelwert der Epworth Sleepiness Scale (ESS) berichteten, konnte eine Reduktion der Schläfrigkeitsscores gezeigt werden. Kombiniert man die Daten der Studien, welche einen Effekt der UPPP im Vergleich mit einer Kontroll- oder unbehandelten Gruppe ausweisen, war die UPPP bezüglich einer Reduktion des Apnoe-Hypopnoe-Index (AHI) sowie des ESS gegenüber einer Kontroll- oder unbehandelten Gruppe signifikant überlegen. Verschiedene andere positive Effekte konnten bezüglich der UPPP in nicht randomisierten Studien nachgewiesen werden.

Zusammenfassend reduziert die UPPP sowohl die respiratorischen Ereignisse als auch die Tagesschläfrigkeit bei erwachsenen OSA-Patienten. Die UPPP zeigte sich einer nicht-behandelten Kontrollgruppe in dieser Hinsicht überlegen. Weitere Studien sollten zur differenzierteren Erfassung des Langzeiteffekts, des Einflusses auf die kardiovaskuläre Mortalität und der Rolle der UPPP im verfügbaren Kanon der Therapien der OSA erfolgen.

Abstract

Obstructive sleep apnea (OSA) is one of the the most prevalent sleep-related breathing disorders, affecting 2–26% of the general population. Continuous positive airway pressure (CPAP) is regarded as the gold standard treatment although a growing body of evidence is becoming available with regard to other treatment modalities, including surgery. The most commonly performed surgical procedure for OSA is uvulopalatopharyngoplasty (UPPP), however, there is currently no comprehensive and detailed systematic review of UPPP.

A systematic review and meta-analysis were performed to assess the effects of UPPP in patients with OSA. Studies of any design referring to adult patients with obstructive sleep apnea diagnosed via polysomnography or comparable objective measures were considered as long as isolated “standard” UPPP was performed. Ninety-two studies were included in the systematic review, 53 were prospective, 36 were retrospective, and 3 were case reports. Eighteen studies used a control group for comparison, 7 of which were randomized controlled trials (RCT), and 3 of which were suitable for the quantitative meta-analysis. All but two (96.4%) studies demonstrated a reduction in the frequency of respiratory events and success/response rates ranged from 31.3 and 96%. In the 7 studies that reported pre- and postoperative mean scores of the Epworth Sleepiness Scale (ESS), a reduction in sleepiness scores was demonstrated.

When combining the data for studies reporting on the effect of UPPP in comparison to no treatment or control, UPPP was significantly more effective in reducing the apnea/hypopnea index (AHI) and ESS. Various additional beneficial effects of UPPP were demonstrated in non-randomized trials.

In conclusion, UPPP reduces respiratory events and daytime sleepiness in adult patients with OSA and UPPP is superior to non treated controls in this regard. Further research is needed to establish the long-term benefit, the impact on cardiovascular morbidity and the role of UPPP in the variety of available treatment options for OSA.

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Danksagung

Wir möchten Hr. Maurizio Grilli (Mannheim) für seine Unterstützung bei der Literaturrecherche danken.

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Authors and Affiliations

  1. Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland

    Boris A. Stuck

  2. Department of Otorhinolaryngology, Head and Neck Surgery, OLVG location West, Amsterdam, Niederlande

    Madeline J. L. Ravesloot

  3. Universitäts-HNO-Klinik Mannheim, Mannheim, Deutschland

    Till Eschenhagen

  4. Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Wuppertal, Wuppertal, Deutschland

    J. Ulrich Sommer

Authors
  1. Boris A. Stuck
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  2. Madeline J. L. Ravesloot
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  3. Till Eschenhagen
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  4. J. Ulrich Sommer
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Correspondence to Boris A. Stuck.

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B.A. Stuck, M.J.L. Ravesloot, T. Eschenhagen und J.U. Sommer geben an, dass kein Interessenkonflikt besteht.

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

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Stuck, B.A., Ravesloot, M.J.L., Eschenhagen, T. et al. Tonsillektomie mit Uvulopalatopharyngoplastik zur Behandlung der obstruktiven Schlafapnoe des Erwachsenen. Somnologie 22, 85–97 (2018). https://doi.org/10.1007/s11818-018-0167-3

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  • DOI: https://doi.org/10.1007/s11818-018-0167-3

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