[Perioperative risk management of patients with obstructive sleep apnea]. / Perioperative Risikobetreuung bei Patienten mit obstruktiver Schlafapnoe.

Obstructive sleep apnea (OSA) has a relatively high prevalence of 3-7% in the general population in western industrialized countries. The prevalence is higher in older patients and in patients with cardiac or metabolic disorders. In the general surgical population patients with OSA are often unrecognized prior to surgery so that unexpected problems can occur due to the higher risk of airway collapse. Severe apnea can result even hours later and especially after surgery of the upper airway. Anesthesists and ear nose and throat surgeons are equally responsible for the perioperative surveillance. The article will show the importance of the preoperative identification of OSA patients and the perioperative risk management in the different risk phases apart from surgery. Although the importance of guidelines is very high there are no mandatory guidelines in Germany in contrast to the USA and the implementation should be given priority.

[Therapy for sleep-related breathing disorders using positive airway pressure. Data from an HNO sleep laboratory]. / Therapie schlafbezogener Atmungsstörungen mit positivem Atemwegsdruck. Datenanalyse eines HNO-Schlaflabors.

BACKGROUND: Computer-assisted cardiopulmonary polysomnography is generally required to differentiate common snoring from serious sleep-related breathing disorders (SRBD) such as sleep apnea. METHODS: This study investigates data from 2,683 diagnostic and therapeutic cardiopulmonary polysomnographies of 1,087 patients over the period 2003-2004. Indications and efficacy of therapy using positive airway pressure (PAP) in SRBD are analyzed as well as alternative procedures. RESULTS: Of the 1,087 patients, 260 (23.9%) needed PAP therapy. In 61% of the patients CPAP-therapy was applied, 19% needed Bi-PAP-ST and 10% Bi-PAP-S-therapy. A total of 91 patients (8.4%) were treated with alternative procedures, partially combined with positive airway pressure. In 760 patients (69.9%) PAP-therapy was controlled or SRBD was excluded. CONCLUSION: There are no generally accepted guidelines for the therapy of SRBD. Indications for conservative and/or surgical procedures in the treatment have to be determined individually, depending on polysomnographic findings, subjective discomfort and physical comorbidities of the patients.