耳鼻咽喉科实践中的睡眠医学——诊断与当前治疗概述

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中文摘要

睡眠对健康和生活质量至关重要。在耳鼻咽喉科（ENT）领域，睡眠医学已成为患者诊疗中不可或缺的一部分，尤其是在阻塞性睡眠呼吸暂停（OSA）的管理方面。随着睡眠障碍患病率不断上升，尤其是在德国人群中，并且其与多种共病相关，现代治疗方法至关重要。本概述对睡眠相关呼吸障碍可用的诊断方法和当前治疗选择进行了实用性总结。诊断OSA通常采用结构化、分步的方法，首先进行全面的病史采集和经验证的问卷评估，随后进行便携式多导睡眠监测，在某些情况下还需在睡眠实验室进行多导睡眠图（PSG）检查。美国睡眠医学会（AASM）和国际睡眠障碍分类（ICSD-3）为睡眠障碍（包括OSA等睡眠相关呼吸障碍）的诊断和分类提供了标准。患病率数据表明，约30%的男性和13%的女性在其一生中会发生OSA。危险因素包括年龄、肥胖、遗传易感性以及上气道的解剖变异。OSA的有效治疗包括减重和持续气道正压通气（CPAP）治疗等保守措施，以及扁桃体切除术、悬雍垂腭咽成形术（UPPP）等手术选择，在严重病例中还可采用舌下神经刺激。CPAP治疗仍是金标准，尤其对于中重度OSA，可显著改善日间嗜睡和心血管共病。诊断过程包括临床评估、经验证的筛查工具（如STOP-BANG问卷）以及多导睡眠监测或PSG评估的结合。治疗旨在减少呼吸暂停事件、改善睡眠结构并提高生活质量。对于无法耐受CPAP或偏好微创选择的患者，可推荐下颌前移装置或体位治疗。当解剖因素对OSA有显著贡献时，可考虑手术干预。未得到处理的OSA与严重健康风险相关，包括心血管疾病和认知功能受损，并且带来安全隐患，尤其是对驾驶员和重型机械操作者。因此，及时诊断和个体化治疗对于改善受影响个体的健康结局和生活质量至关重要。

英文摘要

Sleep is essential for health and quality of life. In the field of otorhinolaryngology (ENT), sleep medicine has become an integral part of patient care, particularly in the management of obstructive sleep apnea (OSA). With an increasing prevalence of sleep disorders, especially in the German population, and their association with various comorbid conditions, modern therapeutic approaches are crucial. This overview provides a practical summary of diagnostic methods and current treatment options available for sleep-related breathing disorders. Diagnosing OSA typically involves a structured, stepwise approach, beginning with a comprehensive medical history and validated questionnaires, followed by ambulatory polygraphy, and in some cases, polysomnography (PSG) in sleep laboratories. The American Academy of Sleep Medicine (AASM) and the International Classification of Sleep Disorders (ICSD-3) provide standards for diagnosing and classifying sleep disorders, including sleep-related breathing disorders like OSA. Prevalence rates indicate that about 30% of men and 13% of women develop OSA in their lifetime. Risk factors include age, obesity, genetic predisposition, and anatomical variations in the upper airway. Effective treatment for OSA includes conservative measures like weight loss and continuous positive airway pressure (CPAP) therapy, as well as surgical options such as tonsillectomy, uvulopalatopharyngoplasty (UPPP), and, in severe cases, hypoglossal nerve stimulation. CPAP therapy remains the gold standard, especially for moderate to severe OSA, offering significant improvement in daytime sleepiness and cardiovascular comorbidities. The diagnostic process involves a combination of clinical evaluation, validated screening tools like the STOP-BANG questionnaire, and polygraphic or PSG assessments. Treatment aims to reduce apneic episodes, improve sleep architecture, and enhance quality of life. In patients who cannot tolerate CPAP or prefer less invasive options, mandibular advancement devices or positional therapy may be recommended. Surgical interventions are considered when anatomical factors significantly contribute to OSA. Unaddressed OSA is associated with severe health risks, including cardiovascular diseases and impaired cognitive function, and it poses safety concerns, particularly for drivers and operators of heavy machinery. Therefore, timely diagnosis and individualized treatment are essential for improving both health outcomes and quality of life in affected individuals.