De rhoncho dormientium : Dedicated to Prof. Dr. Wolfgang Pirsig on his 80th birthday

Abstract

Obstructive sleep apnea (OSA) is a wide spread affliction that affects 4% of men and 2% of women in industrialised countries. Patients complain about disruptive snoring, daytime sleepiness and loss of intellectual power. OSA is associated with increased mortality. OSA has to be distinguished from simple snoring which is socially annoying but physically harmless. History taking, clinical examination, recording of daytime sleepiness, and cardio-respiratory sleep studies are necessary to make a proper diagnosis. In some cases more sophisticated studies are requested. Simple snoring does not harm the physical health. This indicates that the treatment itself may not harm the patient either. Therefore adjuvants or minimally invasive surgical techniques are favoured. The patients bedpartners should be involved to find the proper treatment for simple snorers. In sleep apneics the treatment focuses on the removal of the sleep related breathing disturbances and their health related consequences. Gold standard treatment of OSA is nasally applied continuous positive airway pressure (nCPAP). Unfortunately the longterm compliance of nCPAP is below 70%. Therefore, alternative treatment modalities are used. As conservative approaches oral appliances and conditioning (to avoid supine sleeping position) show promising results. Nasal appliances and transcutaneously performed electrostimulation have shown to be less effective. There are no drugs that have shown to be helpful in patients with sleep related breathing disorders. Surgical treatment complies with the severity of the disease and with the anatomical findings. A variety of surgical approaches to the soft palate, the base of tongue, the tonsils, and the upper and lower jaws have been described. Surgical success rates seem to decrease with increasing body weight and with increasing severity of OSA. Nasal surgery is mainly used to facilitate a necessary nCPAP therapy. Isolated nasal procedures show low impact on the severity of OSA. Modern sleep medicine is an interdisciplinary field which requires co-operation with different specialists in order to cope with our patients complaints.