Stuck Boris A, Dreher Alfred, Heiser Clemens, Herzog Michael, Kühnel Thomas, Maurer Joachim T, Pistner Hans, Sitter Helmut, Steffen Armin, Verse Thomas
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany,
Sleep Breath. 2015 Mar;19(1):135-48. doi: 10.1007/s11325-014-0979-8. Epub 2014 Apr 13.
This guideline aims to promote high-quality care by medical specialists for subjects who snore and is designed for everyone involved in the diagnosis and treatment of snoring in an in- or outpatient setting.
To date, a satisfactory definition of snoring is lacking. Snoring is caused by a vibration of soft tissue in the upper airway induced by respiration during sleep. It is triggered by relaxation of the upper airway dilator muscles that occurs during sleep. Multiple risk factors for snoring have been described and snoring is of multifactorial origin. The true incidence of snoring is not clear to date, as the incidence differs throughout literature. Snoring is more likely to appear in middle age, predominantly in males. Diagnostic measures should include a sleep medical history, preferably involving an interview with the bed partner, and may be completed with questionnaires. Clinical examination should include examination of the nose to evaluate the relevant structures for nasal breathing and may be completed with nasal endoscopy. Evaluation of the oropharynx, larynx, and hypopharynx should also be performed. Clinical assessment of the oral cavity should include the size of the tongue, the mucosa of the oral cavity, and the dental status. Furthermore, facial skeletal morphology should be evaluated. In select cases, technical diagnostic measures may be added. Further objective measures should be performed if the medical history and/or clinical examination suggest sleep-disordered breathing, if relevant comorbidities are present, and if the subject requests treatment for snoring. According to current knowledge, snoring is not associated with medical hazard, and generally, there is no medical indication for treatment. Weight reduction should be achieved in every overweight subject who snores. In snorers who snore only in the supine position, positional treatment can be considered. In suitable cases, snoring can be treated successfully with intraoral devices. Minimally invasive surgery of the soft palate can be considered as long as the individual anatomy appears suitable. Treatment selection should be based on individual anatomic findings. After a therapeutic intervention, follow-up visits should take place after an appropriate time frame to assess treatment success and to potentially indicate further intervention.
本指南旨在促进医学专家为打鼾患者提供高质量护理，适用于参与门诊或住院环境中打鼾诊断和治疗的所有人员。
迄今为止，尚无令人满意的打鼾定义。打鼾是由睡眠期间呼吸引起的上呼吸道软组织振动所致。它是由睡眠期间上呼吸道扩张肌松弛引发的。已描述了多种打鼾危险因素，打鼾成因是多因素的。由于文献中发病率各不相同，目前打鼾的真实发病率尚不清楚。打鼾更易出现在中年，主要是男性。诊断措施应包括睡眠病史，最好与同床伴侣进行访谈，并可通过问卷完成。临床检查应包括检查鼻子以评估鼻呼吸相关结构，并可通过鼻内镜检查完成。还应进行口咽、喉和下咽的评估。口腔的临床评估应包括舌头大小、口腔黏膜和牙齿状况。此外，应评估面部骨骼形态。在某些情况下，可增加技术诊断措施。如果病史和/或临床检查提示睡眠呼吸紊乱、存在相关合并症以及患者要求治疗打鼾，则应采取进一步的客观措施。根据目前的知识，打鼾与医疗风险无关，一般而言，没有治疗的医学指征。每个打鼾的超重患者都应减轻体重。对于仅在仰卧位打鼾的患者，可考虑体位治疗。在合适的情况下，打鼾可通过口腔矫治器成功治疗。只要个体解剖结构合适，可考虑软腭微创手术。治疗选择应基于个体解剖学发现。治疗干预后，应在适当时间进行随访，以评估治疗效果并可能指示进一步干预。
