[Finding the appropriate therapy with the help of sleep endoscopy].
Nasal continuous positive airway pressure (nCPAP) ventilation is the gold standard in the treatment of obstructive sleep apnea (OSA). For patients with CPAP-intolerance and for those tolerating the CPAP-mask but without success, surgical strategies are of growing interest. There are several surgical concepts which combine different surgical procedures on both the velopharyngeal and the retro-lingual section of the upper airway. The case presented here describes the failed CPAP-therapy in an OSAS-patient who tolerates the CPAP-mask. The apneas and hypopnoes could not be reduced by using the CPAP-mask, even more they increased under CPAP-ventilation. Performing a video-documented sleep-endoscopy of the upper airway (under physiological sleep patterns) the location of the obstruction could be identified. After performing a hyoid suspension in combination with a radiofrequency therapy of the base of tongue the apneas and hypopneas decreased. Only by using the sleep endoscopy the reason for the failed CPAP-therapy could be identified and therefore the surgical protocol succeed. To what extend the sleep video endoscopy becomes a standardized procedure in sleep labs warrants further investigations.
Baisch
A
A
Universitäts-HNO-Klinik, Mannheim. alexander.baisch@hno.ma.uni-heidelberg.de
Hein
G
G
Gössler
U
U
Maurer
J T
JT
Hörmann
K
K
D000368:Aged; D017115:Catheter Ablation; D045422:Continuous Positive Airway Pressure; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D006928:Hyoid Bone / Q000601:surgery; D008297:Male; D010160:Palate, Soft / Q000601:surgery; D017286:Polysomnography; D011183:Postoperative Complications / Q000209:etiology; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000601:surgery*; D014059:Tongue / Q000601:surgery; D017211:Treatment Failure; D014681:Velopharyngeal Insufficiency / Q000175:diagnosis / Q000601:surgery; D014741:Video Recording