Stuck Boris A
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany.
GMS Curr Top Otorhinolaryngol Head Neck Surg. 2006;5:Doc04. Epub 2006 Oct 5.
Surgical strategies for the treatment of sleep disordered breathing, although widespread and frequently used, continue to be a controversial issue. Colleagues who primarily focus on conservative treatment options point to the limitations in the available data and remind us of serious methodological concerns surrounding the current literature for surgical treatment alternatives. In accordance with the principles of evidence based medicine the best available evidence should be used to assess the efficacy of surgical treatment. While placebo-controlled trials are feasible only in selected cases, recent examples of controlled clinical trials demonstrate that well designed prospective studies are indeed possible in the field of surgical treatment. Aim of the presented review is to critically evaluate current knowledge and evidence in this field and to give examples for how to overcome methodological issues in the future. Furthermore it will be demonstrated that even the "gold standard" of conservative treatment still leaves numerous questions open in regard to primary acceptance, long term compliance and surveillance. The assessment of treatment strategies is still based primarily on the effects seen in respiratory surrogate parameters under laboratory conditions. In the future, a broad spectrum of subjective and long-term objective parameters such as cardiovascular mortality needs to be kept in mind when critically evaluating beneficial effects of any kind of treatment for sleep disordered breathing. The presented review intends to initiate an open and critical discussion on the available treatment options.
治疗睡眠呼吸障碍的手术策略虽然广泛且常用，但仍是一个有争议的问题。主要关注保守治疗方案的同行指出现有数据存在局限性，并提醒我们当前关于手术治疗替代方案的文献存在严重的方法学问题。根据循证医学原则，应使用现有最佳证据来评估手术治疗的疗效。虽然安慰剂对照试验仅在特定情况下可行，但近期的对照临床试验实例表明，精心设计的前瞻性研究在手术治疗领域确实是可能的。本综述的目的是批判性地评估该领域的当前知识和证据，并举例说明未来如何克服方法学问题。此外，还将证明，即使是保守治疗的“金标准”，在初次接受度、长期依从性和监测方面仍存在诸多问题。治疗策略的评估仍主要基于实验室条件下呼吸替代参数的观察效果。未来，在批判性评估睡眠呼吸障碍任何治疗方法的有益效果时，需要考虑广泛的主观和长期客观参数，如心血管死亡率。本综述旨在就现有治疗选择展开公开且批判性的讨论。
