Stuck B A, Abrams J, de la Chaux R, Dreher A, Heiser C, Hohenhorst W, Kühnel T, Maurer J T, Pirsig W, Steffen A, Verse T
Universitäts-HNO-Klinik, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim.
HNO. 2010 Mar;58(3):272-8. doi: 10.1007/s00106-010-2103-0.
Due to the frequency of this phenomenon and the often considerable distress caused to the affected person, competent advice, diagnosis and treatment of snoring in adults is of particular importance. The aim of this guideline is to promote high-quality medical care for patients affected by this problem. According to the three-level concept of the AWMF, it corresponds to an S1 guideline. Prior to any therapeutic intervention, relevant sleep medical history, clinical examination, as well as a mandatory objective diagnostic measure are performed. Snoring is only treated if the patient asks for it. In general, invasive methods should be viewed critically and the patient should be advised correspondingly. In the case of surgical therapy, minimally invasive techniques are preferred. Reducing body weight (in the case of overweight snorers), abstinence from alcohol, nicotine and sleep medication, as well as maintaining a healthy sleep-wake cycle can be recommended from a sleep-medicine perspective, although convincing clinical studies are not yet available. Since evidence for the effectiveness of muscle stimulation or various methods for toning and training of the muscles of the floor of mouth is not available, these methods are not recommended. Snoring can be successfully treated with the use of an intraoral device; however, careful patient selection is important. Avoiding a supine position during sleep can be helpful in some cases. Only limited data is available on the success rates of the surgical approaches and long term data is often lacking, and not all techniques have been sufficiently evaluated from a scientific point of view. Nasal surgery is only indicated if the patient suffers from nasal obstruction. Extensive data supports the effectiveness of laser-assisted resection of excessive soft palate tissue (laser-assisted uvuloplasty, LAUP). In principle, however, such resections can be performed using other techniques. Placebo-controlled studies were able to prove the effectiveness of radiofrequency surgery of the soft palate. A reduction in snoring could also be achieved in many cases by means of soft palate implants with minimal post-operative morbidity. The indication for tonsillectomy and uvulopalatopharyngoplasty should be made cautiously due to the comparatively high morbidity associated with these procedures.
由于这种现象的频繁发生以及给患者带来的巨大痛苦，对成人打鼾进行专业的咨询、诊断和治疗尤为重要。本指南的目的是促进对受此问题影响的患者提供高质量的医疗服务。根据德国医学科学院（AWMF）的三级概念，它相当于S1指南。在进行任何治疗干预之前，要了解相关睡眠病史、进行临床检查以及一项强制性的客观诊断措施。只有患者提出要求时才对打鼾进行治疗。一般来说，应谨慎看待侵入性方法，并相应地向患者提供建议。对于手术治疗，首选微创技术。从睡眠医学角度来看，建议超重的打鼾者减轻体重、戒酒、戒烟和停用助眠药物，以及保持健康的睡眠-清醒周期，不过目前尚无令人信服的临床研究。由于缺乏肌肉刺激或各种口底肌肉锻炼方法有效性的证据，不推荐使用这些方法。使用口腔矫治器可以成功治疗打鼾；然而，仔细挑选患者很重要。在某些情况下，睡眠时避免仰卧位可能会有帮助。关于手术方法的成功率，仅有有限的数据，而且往往缺乏长期数据，并且并非所有技术都经过了充分的科学评估。只有在患者患有鼻阻塞时才考虑进行鼻部手术。大量数据支持激光辅助切除过多软腭组织（激光辅助悬雍垂成形术，LAUP）的有效性。然而，原则上这种切除也可以使用其他技术进行。安慰剂对照研究能够证明软腭射频手术的有效性。在许多情况下，通过软腭植入物也可以减少打鼾，且术后发病率很低。由于扁桃体切除术和悬雍垂腭咽成形术相关的发病率相对较高，应谨慎确定其适应症。
