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In der jüngsten Zeit haben sich auf dem Boden technischer Innovationen zahlreiche neue diagnostische Möglichkeiten in der Schlafmedizin entwickelt, insbesondere im Bereich der schlafbezogenen Atmungsstörungen. Dieser Artikel beleuchtet ausgewählte neue diagnostische Ansätze sowie technische Weiterentwicklungen bereits etablierter Verfahren, mit denen der praktisch tätige Schlafmediziner bereits heute konfrontiert wird.

Hintergrund: Während eine aktuelle Analyse der schlafmedizinischen Qualifikationen in Deutschland Aussagen zu Anzahl und fachlichen Ausrichtung der Schlafmedizinerinnen erlaubt, sind tiefere Einblicke in die schlafmedizinische Versorgungsroutine bisher kaum möglich, wären für strategische Entscheidungen jedoch erforderlich. Methodik: Schlafmedizinisch Tätige wurden zur Teilnahme an einem Online-Survey eingeladen. Erfasst wurden u. a. demografische Faktoren, schlafmedizinische Qualifikationen, Art und Häufigkeit der angebotenen diagnostischen und therapeutischen Verfahren, der Kenntnisstand zu Leitlinien und ausgewählten therapeutischen Verfahren und die Einschätzung zu Hindernissen in der Versorgung. Ergebnisse: Beantwortet wurde der Survey von 435 Personen (Rücklaufquote 8,9 %). Es waren 62 % der Teilnehmerinnen zu etwa gleichen Teilen den Disziplinen Pneumologie und HNO-Heilkunde zugeordnet, 61,4 % hatte einen „BUB-Kurs“ absolviert und 44,1 % die Zusatzbezeichnung (ZB) Schlafmedizin erlangt. Mehr als 10 Jahre schlafmedizinisch tätig waren 72,2% der Teilnehmerinnen, 67,2 % im ambulanten Sektor. Nur ca. ein Viertel ist weiblich, das mittlere Alter lag bei 53 Jahren. Zur Diagnostik wird vornehmlich die Polygraphie angeboten (77,9 %), danach Screeningverfahren (36,3 %) und die stationäre (34,5 %) und ambulante (29,9 %) Polysomnographie. Als Schwerpunkte wurde in 88,7 % die obstruktive Schlafapnoe benannt. Kooperiert wird vornehmlich zwischen HNO-Heilkunde und Pneumologie. Etwa drei Viertel gaben an, die Leitlinien zu den schlafbezogenen Atmungsstörungen (SBAS) zu kennen, bzgl. der Leitlinie zur Insomnie waren es etwas weniger als die Hälfte. Schlussfolgerung: Schlafmedizinisch tätig sind in Deutschland vor allem männliche Pneumologen und HNO-Ärzte mit den Qualifikationen „BUB-Kurs“ und ZB Schlafmedizin, die im ambulanten Sektor eine Diagnostik der SBAS anbieten. Die Daten deuten auf eine Unterversorgung von Patientinnen mit Insomnie hin. Es gibt derzeit kaum schlafmedizinischen Nachwuchs, was die Disziplin in ihrer Existenz gefährdet.

Introduction: While the cochleotoxicity of cisplatin has been well investigated, less is known about the effects of platinum-based chemotherapy on the vestibular system. In particular, there is a lack of prospective studies using modern laboratory vestibular testing that examine the effects of cisplatin on the semicircular canals and on the otolith organs. The aim of the present study was, therefore, to investigate the vestibulotoxic effect of cisplatin in patients with head and neck tumors who are undergoing chemoradiation.Methods: Forty-five patients undergoing cisplatin-based chemoradiation for head and neck cancer received a vestibular assessment consisting of anamnesis, a horizontal video head impulse test (vHIT), ocular and cervical vestibular evoked myogenic potential testing, as well as pure tone audiometry. This assessment was performed before therapy, 6 weeks after therapy, and 3 months after therapy.Results: Video head impulse test showed a significantly reduced median gain 6 weeks after chemoradiation. In addition, significantly more refixational saccades could be detected after therapy. Vestibular evoked myogenic potential testing results also revealed significant changes, whereas pure tone audiometry did not. None of the patients mentioned “dizziness” during the follow-up examinations.Conclusion: We demonstrated a vestibulotoxic effect of cisplatin-based chemoradiation in patients with head and neck cancer. Future studies are needed to better understand cisplatin-induced vestibulotoxicity and to identify possible vestibuloprotective substances. Still, before and after chemoradiation, patients should undergo not only auditory testing but also vestibular testing in order to detect potential vestibular loss as soon as possible and to quickly initiate vestibular physiotherapy.

Obstructive sleep apnea (OSA) can lead to a significant reduction in quality of life, and untreated moderate to severe OSA (apnea–hypopnea index ≥ 15/h) significantly increases the risk of many—predominantly cardiovascular—diseases. Considering the high prevalence of the disease and the associated impairments, effective diagnosis and treatment of OSA is of particular importance. The German Sleep Society (DGSM) has therefore compiled five practical positive and negative recommendations each, which are intended to facilitate the diagnostic and therapeutic process in OSA. They refer in particular to the indications for sleep medical diagnostics and specific treatment options, taking into account the clinical presentation of the disease, individual risk factors and comorbidities. The selection of recommendations is based on clinical relevance, existing deficits in terms of over- or undertreatment, and the strength of recommendations in the current S3 guideline of the DGSM on sleep-related breathing disorders.

Objectives: Obstructive sleep apnea (OSA) is a common sleep disorder, which is associated with recurrent oxygen desaturation during sleep. It has already been shown that nocturnal hypoxia may lead to cochlear dysfunction in patients with OSA. Less is known whether hypoxia during sleep also impacts vestibular function in those patients. Thus, the aim of the presented study was to assess a potential vestibulotoxic effect of nightly desaturations with hypoxia in patients with OSA by investigating a possible correlation between respiratory parameters and vestibular function tests.Methods: A total of 56 patients were included in the study and underwent a fully attended cardiorespiratory polysomnography (PSG). Vestibular function was assessed using video head impulse test to evaluate horizontal semicircular canal function and cervical vestibular evoked myogenic potentials (cVEMPs) and ocular vestibular evoked myogenic potentials (oVEMPs) to measure otolith function. Descriptive data analysis was conducted and correlation analysis between selected PSG parameters and the results of vestibular testing was performed using Kendall τ coefficient.Results: A significant correlation between vestibular function and respiratory polysomnographic parameters could not be demonstrated in the study (P> .05) but cVEMP and oVEMP results showed a trend toward a correlation with oxygen desaturation indices and apnea–hypopnea index. Additionally, otolith hypofunction was more prevalent in patients with hypertension as well as OSA.Conclusion: The results of our study show that there is no significant correlation between vestibular function and sleep apnea parameters, although otolith dysfunction might be more prevalent in patients with OSA and hypertension.

Seit 2009 können sich Kopf-Hals-Tumor-Zentren von der Deutschen Krebsgesellschaft zertifizieren zu lassen. In den vergangenen Jahren hat sich die Zahl der zertifizierten Zentren stetig erhöht. Der vorliegende Beitrag soll einen Überblick über die Grundlagen des Zertifizierungsverfahrens und die praktischen Aspekte der Struktur- und Prozessqualität dieser Einrichtungen bieten.

OBJECTIVE To develop a new, custom-made pressure device that can be used with established designs as an adjuvant therapy for optimized treatment of auricular keloids. METHODS Seven patients (4 males, 3 females; mean [SD] age, 22.6 [8.3] years) were treated with surgical excision and corticosteroid injection followed by application of our new auricular pressure device. RESULTS All patients tolerated the adjuvant therapy and wore the device overnight for 5 nights per week. Usage was not interrupted or cancelled. No recurrence was observed during the follow-up period (mean [SD] duration of follow-up, 24 [6] months). All patients were satisfied with the results; none described pruritus, pain, or dysesthesia. CONCLUSION Overnight usage of the new pressure device seems to be a safe and effective extension of established auricular keloid therapy with the potential for prophylaxis of recurrence.

Objectives:Surgical treatment of obstructive sleep apnea (OSA) caused by hypopharyngeal collapse of the upper airway can be considered in patients who are intolerant to continuous positive airway pressure (CPAP). The present procedures addressing the hypopharynx are invasive and have substantial morbidity and limited efficacy.Methods:Ten patients (mean age, 44 years) with moderate to severe OSA, ie, an apnea-hypopnea index (AHI) between 15 and 50, with CPAP intolerance were included in a prospective, nonrandomized, multicenter study to evaluate the feasibility, safety, and efficacy of a novel tongue advancement procedure. The procedure consists of the implantation of a tissue anchor in the tongue base and an adjustment spool at the mandible. Titration of this tissue anchor results in advancement of the tongue and a patent upper airway.Results:The mean AHI decreased from 22.8 at baseline to 11.8 at the 6-month follow-up (p = 0.007). The Epworth Sleepiness Scale score decreased from 11.4 at baseline to 7.7 at the 6-month follow-up (p = 0.094), and the snoring score decreased from 7.5 at baseline to 3.9 at the 6-month follow-up (p = 0.005). Four technical adverse events were noted, and 1 clinical adverse event occurred.Conclusions:Adjustable tongue advancement is a feasible and relatively safe way to reduce the AHI and snoring in selected patients with moderate to severe OSA and CPAP intolerance. Technical improvements and refinements to the procedure are ongoing.

The interaction of sensory physiology and sleep has been studied for various sensory systems. Nevertheless, the question whether chemosensory (especially olfactory) stimuli may lead to arousals during sleep remains under discussion. Specifically, the central processing of olfactory information shows fundamental differences compared to other sensory systems.

Recent publications have demonstrated a reduction in snoring with radiofrequency (RF) surgery of the soft palate. Yet so far, all published data has been based on non-controlled trials.

Radiofrequency surgery of the soft palate presents a promising alternative for the treatment of snoring. The aim of this study was to give an overview of the current literature and to quantify the results in terms of a meta-analysis of treatment efficacy.

ObjectivesTemperature controlled radiofrequency volumetric tissue reduction (RFVTR) of the tongue base is a minimally invasive technique for the treatment of obstructive sleep apnea. But despite its widespread use, little is yet known about in vivo effects in humans. Such knowledge would be essential for evidence‐based criteria in the selection of energy application.

The increasing prevalence of allergic rhinitis, its impact on individual quality of life and social costs, as well as its role as a risk factor for asthma, underline the need for improved treatment options for this disorder. We reviewed the recent literature published in English, dealing with relevant and appropriately controlled clinical trials on the treatment of allergic rhinitis.

Objectives/HypothesisMagnetic resonance imaging (MRI) potentially offers various advantages in assessing the upper airway. The aims of the presented study were 1) to evaluate which anatomical parameters of upper airway soft tissue morphology (distances, areas, volumes) could be defined using MRI scans, 2) to examine the stability or variability of these parameters over time and between different investigators, and 3) to develop a standardized protocol for MRI measurements of the upper airway.

Background:The beneficial effects of phosphodiesterase 4 (PDE4) inhibitors in allergic asthma have been shown in previous preclinical and clinical studies. Because allergic rhinitis and asthma share several epidemiologic and pathophysiologic factors, PDE4 inhibitors might also be effective in allergic rhinitis. Objective:The main objective of this study was to investigate the efficacy of oral roflumilast (500 μg/day) in allergic rhinitis. Methods:In a randomized, placebo-controlled, double-blinded, crossover study, 25 subjects (16 male, 9 female; median age, 28 years) with histories of allergic rhinitis but asymptomatic at screening received roflumilast (500 μg once daily) and placebo for 9 days each with a washout period of at least 14 days in between treatment periods. In each of the treatment periods, controlled intranasal allergen provocation with pollen extracts was performed daily beginning the third day of treatment, each time approximately 2 hours after study drug administration. Five and 30 minutes after each allergen provocation, rhinal airflow was measured by means of anterior rhinomanometry and the subjective symptoms obstruction, itching, and rhinorrhea were assessed by means of a standardized visual analog scale. Results:Rhinal airflow improved almost consistently during the 9 days of roflumilast treatment, and it was significantly higher at study day 9 on roflumilast in comparison with placebo, a result also found for itching and rhinorrhea. With respect to the subjective obstruction score, a significant difference in comparison with placebo could be demonstrated within 4 days. Conclusion:This study shows that a PDE4 inhibitor, roflumilast, effectively controls symptoms of allergic rhinitis. Thus PDE4 inhibitors might be a future treatment option not only in allergic asthma but also in allergic rhinitis or the combination of the 2 diseases. (J Allergy Clin Immunol 2001;108:530-6.)

Over the last few years, different surgical techniques for the treatment of obstructive sleep apnea syndrome have been developed. While new methods for the treatment of velopharyngeal obstruction turned out to be safe and effective, treatment of hypopharyngeal obstruction due to tongue base hypertrophy has remained, in many aspects, an unsolved problem. Surgical techniques for partial resection of the tongue base (midline glossectomy, lingualplasty) are effective but very invasive procedures requiring temporary tracheotomy, and have high postoperative morbidity. A maxillofacial approach showed significant reduction in the Respiratory Disturbance Index (RDI), especially when bimaxillar osteotomies are performed. Along with the concerns of postoperative morbidity, these techniques require general anesthesia and hospitalization. Tongue base reduction with temperature-controlled radiofrequency tissue ablation was introduced in 1998, and has proven to be a safe and simple procedure. Significant reduction in RDI has been shown in the majority of the treated patients. This procedure does not require general anesthesia and has low postoperative morbidity. For curative results, tongue base reduction with radiofrequency requires multiple treatment sessions. The goal of the present study is to investigate the beneficial effect of increased amount of energy applied per treatment session, reducing the number of treatment sessions per patient. By delivering increased amounts of energy, a similar cure and/or responder rate with 2 treatment sessions, rather than 5 to 6 as published in earlier studies, was accomplished. Postoperative morbidity was similar to previously published results although there was a slight increase in postoperative complications. Apart from the reduced number of treatment sessions needed per patient, we also demonstrated the beneficial effect of prophylactic use of antibiotics in our study group. This more aggressive treatment scheme appears to be well tolerated by the patients and may be an effective means of reducing the overall number of treatments.

Abstract Patients with sleep-disordered breathing (SDB) suffer from repetitive upper airway occlusion. Various techniques have been described to assess the site of upper airway collapse. In most cases the soft palate or the base of tongue, or both, are the major levels of obstruction; rarely, the larynx, including the epiglottis, are found to be involved. We present five cases in which sleep videoendoscopy finally revealed the true mechanism of the inspiratory airway behavior. Two patients were sent to our service because of inefficacy of nasal ventilation therapy. One had a floppy epiglottis that was being sucked into the glottis. The other had a normal larynx during videoendoscopy. Instead, common pharyngeal collapse could be detected. Increasing the pressure normalized sleep, breathing, and videoendoscopy. The third patient showed apneas due to the adduction of the lateral parts of his omega-shaped epiglottis. In another case, inspiratory fluttering of the vocal cords caused snoring and arousals. The last case came in for bilateral vocal cord palsy with heavy nocturnal desaturations suggesting airway closure. Yet, the pharynx and larynx remained open throughout the night. Sleep videoendoscopy is a convenient method to define the level and mechanism of occlusion in obstructive SDB, particularly if the larynx is involved. It is useful to rule out airway compromise in case of recurrent nocturnal hypoxemias. Thus the results of sleep videoendoscopy have a strong therapeutical impact.

Over the last few years, different surgical techniques for the treatment of obstructive sleep apnea syndrome have been developed. While new methods for the treatment of velopharyngeal obstruction turned out to be safe and effective, treatment of hypopharyngeal obstruction due to tongue base hypertrophy has remained, in many aspects, an unsolved problem. Surgical techniques for partial resection of the tongue base (midline glossectomy, lingualplasty) are effective but very invasive procedures requiring temporary tracheotomy, and have high postoperative morbidity. A maxillofacial approach showed significant reduction in the Respiratory Disturbance Index (RDI), especially when bimaxillar osteotomies are performed. Along with the concerns of postoperative morbidity, these techniques require general anesthesia and hospitalization. Tongue base reduction with temperature-controlled radiofrequency tissue ablation was introduced in 1998, and has proven to be a safe and simple procedure. Significant reduction in RDI has been shown in the majority of the treated patients. This procedure does not require general anesthesia and has low postoperative morbidity. For curative results, tongue base reduction with radiofrequency requires multiple treatment sessions. The goal of the present study is to investigate the beneficial effect of increased amount of energy applied per treatment session, reducing the number of treatment sessions per patient. By delivering increased amounts of energy, a similar cure and/or responder rate with 2 treatment sessions, rather than 5 to 6 as published in earlier studies, was accomplished. Postoperative morbidity was similar to previously published results although there was a slight increase in postoperative complications. Apart from the reduced number of treatment sessions needed per patient, we also demonstrated the beneficial effect of prophylactic use of antibiotics in our study group. This more aggressive treatment scheme appears to be well tolerated by the patients and may be an effective means of reducing the overall number of treatments.