Die HNO-spezifische operative Therapie bei schlafbezogenen Atmungsstörungen: Neue Techniken und neue Ergebnisse

Background: Surgical treatment for obstructive sleep apnea (OSA) has gained increasing interest in recent years. This is partly the result of a more intensive evaluation of traditional soft palatal surgery (uvulopalatopharyngoplasty, UPPP), but also because of new treatment options such as selective hypoglossal nerve stimulation (sHNS). Additionally, the need for surgical treatment modalities remains high, due to the relevant high rate of intolerance of positive airway pressure (PAP) systems. This article provides an overview of the recent developments in the area of surgical therapy for OSA. Materials and methods: An extensive literature search was done using the key words “obstructive sleep apnea”, “sleep surgery”, and “hypoglossal nerve stimulation” with weighted assessment. Results: There are recent systematic meta-analyses of randomized controlled studies of UPPP,including one that was able to show stable results of UPPP in the two-year follow-up examinations and another that was prepared by means of data collected in the German healthcare system. Over the last few years, sHNS has become a well-established second-line therapy in PAP failure patients and has been analyzed in large registry studies and multi-year follow-up examinations. There are several studies looking at outcome parameters beyond OSA reduction, as well as comparative analyses with traditional sleep surgery approaches, although in a retrospective manner. Conclusions: In the absence of obesity and in the second-line situation after PAP failure, UPPP and sHNS are now well-established treatment options that have been proven to be highly effective. In future, additional efforts should be made to further develop parameters relevant to treatment success for OSA patients.