Institute for Pneumology at the University Witten/Herdecke,Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany.
Eur Respir J. 2011 May;37(5):1000-28. doi: 10.1183/09031936.00099710. Epub 2011 Mar 15.
In view of the high prevalence and the relevant impairment of patients with obstructive sleep apnoea syndrome (OSAS) lots of methods are offered which promise definitive cures for or relevant improvement of OSAS. This report summarises the efficacy of alternative treatment options in OSAS. An interdisciplinary European Respiratory Society task force evaluated the scientific literature according to the standards of evidence-based medicine. Evidence supports the use of mandibular advancement devices in mild to moderate OSAS. Maxillomandibular osteotomy seems to be as efficient as continuous positive airway pressure (CPAP) in patients who refuse conservative treatment. Distraction osteogenesis is usefully applied in congenital micrognathia or midface hypoplasia. There is a trend towards improvment after weight reduction. Positional therapy is clearly inferior to CPAP and long-term compliance is poor. Drugs, nasal dilators and apnoea triggered muscle stimulation cannot be recommended as effective treatments of OSAS at the moment. Nasal surgery, radiofrequency tonsil reduction, tongue base surgery, uvulopalatal flap, laser midline glossectomy, tongue suspension and genioglossus advancement cannot be recommended as single interventions. Uvulopalatopharyngoplasty, pillar implants and hyoid suspension should only be considered in selected patients and potential benefits should be weighed against the risk of long-term side-effects. Multilevel surgery is only a salvage procedure for OSA patients.
鉴于阻塞性睡眠呼吸暂停综合征（OSAS）患者的高发病率及其相关损害，提供了许多方法来承诺对 OSAS 进行明确的治愈或相关改善。本报告总结了 OSAS 中替代治疗选择的疗效。一个跨学科的欧洲呼吸学会工作组根据循证医学的标准评估了科学文献。证据支持在轻度至中度 OSAS 中使用下颌前伸装置。在拒绝保守治疗的患者中，下颌骨和上颌骨截骨术似乎与持续气道正压通气（CPAP）一样有效。牵引成骨术在先天性小颌畸形或中面部发育不全中得到有效应用。减肥后有改善的趋势。体位疗法明显劣于 CPAP，长期依从性差。药物、鼻腔扩张器和呼吸暂停触发肌肉刺激目前不能被推荐为 OSAS 的有效治疗方法。鼻手术、射频扁桃体切除术、舌根手术、悬雍垂腭咽成形术、激光中线舌切除术、舌悬吊术和颏舌肌前徙术不能作为单一干预措施推荐。悬雍垂腭咽成形术、柱植入物和舌骨悬吊术仅应在选定的患者中考虑，并且应权衡长期副作用的风险与潜在益处。多平面手术仅是 OSA 患者的挽救性手术。
