Sleep Apnea Syndromes: Dreher A

Verse T, de la Chaux R, Dreher A, Fischer Y, Grundmann T, Hecksteden K, Hörmann K, Hohenhorst W, Ilgen F, Kühnel T, Mahl N, Maurer JT, Pirsig W, Roth B, Siegert R, Stuck BA, Anonymous00280. · Klinik für HNO-Heilkunde, Asklepios Klinik Harburg, Hamburg. · Laryngorhinootologie. · Pubmed #17464894 No free full text.

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de la Chaux R, Dreher A, Klemens C, Rasp G, Leunig A. · Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Interdisziplinäres Schlaflabor am Klinikum Grosshadern, München. · MMW Fortschr Med. · Pubmed #15624659 No free full text.

Abstract: Laser-assisted surgery is a valid option for the treatment of respiratory sleep disorders and complements established therapies. Laser-surgery of the inferior turbinates can improve nasal obstruction and amend or eliminate primary snoring. LAUP is as well an ambulant therapeutic method for snoring, but it is leading to strong post-operative pain and should exclusively be applied to patients with small tonsils or who already underwent tonsillectomy. OSAS can be worsened by LAUP and should therefore be excluded before the operation. In childhood OSAS laser tonsillotomy leads to a distinct improvement of sleep-disordered breathing with normalisation of the sleeping profile; it is less painful than tonsillectomy and a part of the tonsil is left to continue to exercise its function in the immune system.

Dreher A, de la Chaux R, Behr J, Eisensehr I, Grevers G, Kastenbauer E. · Klinik und Poliklinik für Hals-, Nasen- und Ohrenkunde, Klinikum Grosshadern, München. · MMW Fortschr Med. · Pubmed #11340905 No free full text.

Abstract: Obstructive sleep apnea syndrome is defined by the American Academy of Sleep Medicine as a combination of at least five obstructive events per hour of sleep and such other symptoms as daytime sleepiness, ischemic heart disease and stroke. In addition to weight reduction, the use of oral appliances, and continuous positive airway pressure (CPAP), a number of surgical interventions such as uvulopalatopharyngoplasty and maxillomandibular advancement are also available for the treatment of sleep apnea. Since no prolongation of life has yet been shown for most of the therapeutic options, treatment needs to be individualized on the basis of symptoms, clinical findings and compliance.

Dreher A, de la Chaux R, Grevers G, Kastenbauer E. · Klinik und Poliklinik für Hals-, Nasen- und Ohrenkranke der Ludwig-Maximilians-Universität München. · Laryngorhinootologie. · Pubmed #10439349 No free full text.

Abstract: BACKGROUND: The influence of nasal obstruction on sleep associated breathing disorders (SABD) and the controversial effects of surgical treatment are discussed. RESULTS: Complete nasal obstruction caused by nasal packing increases SABD, but varies from patient to patient and depends on age and individual anatomy. Especially patients with preexisting obstructive sleep apnea syndrome (OSAS) can develop severe complications. Some authors found a higher frequency of SABD in patients with nasal obstruction due to anatomical alterations, i.e. septal deviation, while others denied this connection. Major causes for the development of SABD in nasal obstruction include certain reflex mechanisms, increased negative inspiration pressure with a tendency for pharyngeal collapse, and transition to transoral breathing. Intermittent dilatation of the nasal valve using stents or tapes will lead to a decrease of nasal airway resistance and might also result in an improvement of SABD according to some studies, while others did not find any improvement. The results of controversial operative treatment in nasal airway obstruction are also described and include complete healing of high degree OSAS, improvement of sleep quality, and elimination of snoring. On the other hand, surgery might also be completely unsuccessful or even induce OSAS. CONCLUSION: As the effect of any kind of nasal operation on SABD is unpredictable from our present knowledge, the decision whether or not nasal surgery is indicated should depend on the individual situation of the patient. If OSAS is suspected, preoperative and post-operative polysomnography should be performed.

de la Chaux R, Klemens C, Patscheider M, Reichel O, Dreher A. · Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich, University Hospital Grosshadern, Germany. · Int J Pediatr Otorhinolaryngol. · Pubmed #18635269 No free full text.

Abstract: INTRODUCTION: The therapy of choice in the treatment of pediatric obstructive sleep apnea syndrome (OSAS) consists of tonsillectomy or tonsillotomy combined with adenoidectomy. While tonsillectomy unfortunately has a notable risk of secondary hemorrhage and postoperative pain, tonsillotomy is safer and less painful for children. The effect of both surgical methods on symptoms of OSAS seems to be equal, but up to now postoperative polysomnographic data for children treated by tonsillotomy are missing. MATERIALS AND METHODS: Twenty children aged 2-9 years (mean age: 4.1+/-2.0 years) with OSAS diagnosed by full-night polysomnography were included in the study. OSAS was defined as an apnea-hypopnea index (AHI) of 5 or more with minimum oxygen saturation (SaO(2) min) of less than 90%. Exclusion criteria were obesity, craniofacial abnormalities or other pulmonary, cardiac or metabolic diseases as well as a history of recurrent tonsillitis. All children were treated by CO(2) laser tonsillotomy and adenoidectomy. Three to 12 months (mean: 7.7 months) after the procedure a control-polysomnography was performed in all children. RESULTS: No statistically significant changes were seen in the pre- and postoperative distribution of sleep stages, sleep efficacy and total sleep time. The AHI decreased from 14.9+/-8.7 to 1.1+/-1.6 (p<0.001), SaO(2) min increased from 71.1+/-11.1% to 91.2+/-3.5% (p<0.001). Thus, all children were cured by the operation. DISCUSSION: These polysomnographic data show that CO(2) laser tonsillotomy in combination with adenoidectomy is highly effective in the treatment of pediatric OSAS and should be preferred over tonsillectomy because of less postoperative pain and a lower risk of postoperative bleeding.

de la Chaux R, Klemens C, Patscheider M, Dreher A. · Interdiszip-linären Schlaflabors, Klinik und Poliklinik für HNO, Klinikum Grosshadern, LMU München. · MMW Fortschr Med. · Pubmed #17987743 No free full text.

Abstract: Primary snoring is mainly the bed partner's problem and not that of the snorer.The request for treatment arises from how annoying the snoring is and how sensitive the bed partner is to noise. In addition to a thorough medical history and an ENT examination, a polysomnography should be always performed to differentiate between primary snoring, upper airway resistance and obstructive sleep apnoea syndromes. Primarily weight loss and avoidance of alcohol in the evening as well as devices and surgery are used in the treatment of snoring.

Dreher A, Klemens C, Patscheider M, Kramer M, Feucht N, Schultheiss C, Baker F, de la Chaux R. · HNO-Klinik der Ludwig-Maximilians-Universität, München, Germany. · Laryngorhinootologie. · Pubmed #17594610 No free full text.

Abstract: BACKGROUND: Depending on age and gender up to 60 % of the population snore regularly. As simple snoring is more a social than a medical problem, unlike OSAS, CPAP-therapy or multilevel surgery are not appropriate therapies for snoring. But alternative therapies, such as laser-assisted uvulopalatoplasty (LAUP) or uvulopalatopharyngoplasty (UPPP) address distinct sites of the pharynx. Therefore a correct identification of the snoring-source should optimise the selection of patients and improve the outcome of therapy. As there is no commonly recommended tool for identifying the snoring-source, the use of a new technique, based on pharyngeal pressure measurement, was tested. METHODS: 25 patients with suspected OSAS had standard polysomnography recordings during two nights with esophagopharyngeal pressure measurement on the second night. The pressure probe had 5 pharyngeal and 1 esophageal transducers. The curves of the pharyngeal pressure were examined for quick pressure changes superimposed on the slow pressure-changes caused by breathing. The appearance of these quick pressure changes was documented for each transducer throughout the whole night. RESULTS: The average (+/- SD) Apnea-Hypopnea-Index in the patients was 28.3 +/- 24.8. 17 patients (68 %) had an AHI of more than 10. All patients showed heavy snoring. 23 patients (92 %) showed a high frequency, sawtooth-pattern, superimposed on the slow breathing rhythm in at least one channel and in association with snoring. 91 % of the patients showed a sawtooth pattern in more than one channel, but the pattern was always more pronounced in one channel compared to others. The sawtooth-pattern of the highest amplitude was seen in the pressure curves from the velum in 56 % of the patients, from the tonsils in 24 %, and from the tonguebase in 12 % of the patients. CONCLUSIONS: Quick pressure changes from distinctive pharyngeal pressure transducers during snoring are common in OSAS patients and may indicate the source of snoring. Further investigations have to show whether this assumption is correct, and whether the quick pressure changes are also apparent in simple snorers.

Dreher A, de la Chaux R, Klemens C, Werner R, Baker F, Barthlen G, Rasp G. · Department of Otorhinolaryngology, Ludwig-Maximilians-University, Munich, Germany. · Arch Otolaryngol Head Neck Surg. · Pubmed #15723938 links to  free full text

Abstract: OBJECTIVES: To examine whether medical history and nasopharyngeal examination are useful for predicting obstructive sleep apnea syndrome (OSAS) and to compare these findings with those of the gold standard, polysomnography. DESIGN: Patients underwent polysomnography recordings for 2 nights and an otorhinolaryngologic examination, including flexible endoscopy and the Muller maneuver. Nasal and pharyngeal findings were scored in a semiquantitative way. The medical history of each patient was taken using a standardized questionnaire. Anatomic and functional findings and patient history were correlated with the mean apnea-hypopnea index (AHI). SETTING: An otorhinolaryngologic clinic. PATIENTS: A total of 101 patients presenting with a primary complaint of snoring. MAIN OUTCOME MEASURES: Differences between patients with OSAS and primary snorers were assessed using the Mann-Whitney test (anatomic findings), t test (Muller maneuver), and chi(2) test after Pearson correlation (questionnaire). P values less than .05 were considered statistically significant. RESULTS: The mean +/- SD AHI of the patients was 19.7 +/- 21.5); 52 patients had an AHI higher than 10, which confirmed the diagnosis of OSAS. These patients tended to report the occurrence of apneas more frequently than patients with an AHI of 10 or lower. The average ranks (Mann-Whitney findings) of patients with AHIs higher than 10 vs those with AHIs of 10 or lower were 52 vs 50 for septal deviation; 50 vs 52 for tonsil size; 53 vs 49 for low velum level; and 56 vs 46 for hyperplasia of the tongue base. None of these differences reached statistical significance. Mean +/- SD narrowing of the airway during the Müller maneuver was significantly (P<.05) more pronounced in patients with an AHI higher than 10 than in patients with an AHI of 10 or lower at the levels of the velum (80% +/- 20% vs 68% +/- 30%) and the tongue base (57% +/- 24% vs 44% +/- 27%). CONCLUSIONS: None of the reported medical history and/or anatomic parameters alone or in combination could be used to distinguish patients with OSAS from snoring patients. Snoring patients, therefore, should be examined at least by a nocturnal screening test for OSAS before any therapeutic decision is made.

Kramer MF, De La Chaux R, Dreher A, Pfrogner E, Rasp G. · Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig-Maximilian-University, Munich, Germany. · Acta Otolaryngol. · Pubmed #11508511 No free full text.

Abstract: Obstructive sleep apnea syndrome (OSAS) is a condition characterized by recurrent episodes of obstruction of the upper airway. The aim of this study was to evaluate whether nasal obstruction due to allergic rhinitis constitutes a risk factor for OSAS. Patients (n = 119) presenting typical symptoms of sleep apnea were tested for OSAS using polysomnography. Additionally all patients were tested in vivo and in vitro (including nasal eosinophilic cationic protein) for allergic rhinitis. Examination for allergic rhinitis revealed that 88.3% of all patients had no allergic rhinitis, whereas only 11.7% were diagnosed as allergic. No significant differences in sleeping parameters were observed between allergic and non-allergic patients. Comparison of parameters indicative of relevant OSAS (apnea-hypopnea index [AHI] > 10) revealed that 60% of non-allergic patients had relevant OSAS, compared to only 50% of allergic patients. Investigation of allergic subgroups revealed similar results: no significant differences in sleeping parameters or elevated rates of relevant OSAS parameters were observed, especially in perennial allergic rhinitis due to house dust mites. No elevated rates of allergic rhinitis were observed in the studied cohort of patients suffering from sleep apnea or OSAS. Furthermore, no significant differences in sleeping behavior or polysomnography parameters were found on comparing allergic and non-allergic patients. In summary, our data rule out allergic rhinitis as a major risk factor for OSAS.