Randerath W, Bauer M, Blau A, Fietze I, Galetke W, Hein H, Maurer J T, Orth M, Rasche K, Rühle K-H, Sanner B, Stuck B A, Verse T
Institut für Pneumologie, Universität Witten/Herdecke, Krankenhaus Bethanien, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Solingen, Germany.
Pneumologie. 2007 Jul;61(7):458-66. doi: 10.1055/s-2007-959204. Epub 2007 May 31.
Many patients with the obstructive sleep apnea syndrome (OSAS) look for alternative conservative or surgical therapies to avoid to be treated with continuous positive airway pressure. In view of the high prevalence and the relevant impairment of the patients lots of methods are offered which promise definitive cure or relevant improvement of OSAS. The working group "Apnea" in the German Society of Sleep Medicine and Research established a task force to evaluate the scientific literature on non-CPAP therapies in the treatment of OSAS according to the standards of evidence-based medicine. This paper summarizes the results of the task force. The data were unsatisfactorily for most of the methods. Sufficient data were available for intraoral appliances (IOA) and the maxillomandibular osteotomy (MMO). IOA's can reduce mild to moderate respiratory disturbances, MMO are efficient in the short and long term but are performed only in special situations such as craniofacial dysmorphias. Weight reduction and body positioning cannot be recommended as a single treatment of OSAS. Most surgical procedures still lack sufficient data according to the criteria of evidence based medicine. Resections of muscular tissue within the soft palate have to be strictly avoided. But even success following gentle soft palate procedures is difficult to predict and often decreases after years. Results in other anatomical regions seem to be more stable over time. Today combined surgeries in the sense of multi-level surgery concepts are of increasing interest in the secondary treatment after failure of nasal ventilation therapy although more data from prospective controlled studies are needed. There is no evidence for any other treatment options.
许多阻塞性睡眠呼吸暂停综合征（OSAS）患者寻求替代性的保守或手术治疗方法，以避免接受持续气道正压通气治疗。鉴于该疾病的高患病率以及对患者的相关损害，人们提供了许多有望根治或显著改善OSAS的方法。德国睡眠医学与研究协会的“呼吸暂停”工作组成立了一个特别小组，根据循证医学标准评估关于非持续气道正压通气疗法治疗OSAS的科学文献。本文总结了该特别小组的结果。大多数方法的数据并不理想。对于口腔矫治器（IOA）和上颌下颌截骨术（MMO）有足够的数据。IOA可减少轻度至中度呼吸紊乱，MMO在短期和长期均有效，但仅在特殊情况下进行，如颅面畸形。不建议将减重和体位调整作为OSAS的单一治疗方法。根据循证医学标准，大多数外科手术仍缺乏足够的数据。必须严格避免软腭内肌肉组织的切除术。但即使是温和的软腭手术成功也难以预测，且往往在数年后效果会降低。其他解剖区域的结果似乎随时间更稳定。如今，在鼻腔通气治疗失败后的二级治疗中，多级手术概念意义上的联合手术越来越受到关注，尽管还需要更多来自前瞻性对照研究的数据。没有证据支持任何其他治疗选择。
