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Erschienen in: HNO 11/2013

01.11.2013 | Leitlinien

S2k-Leitlinie „Diagnostik und Therapie des Schnarchens des Erwachsenen“

Vorgelegt von der Arbeitsgemeinschaft Schlafmedizin der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

verfasst von: Prof. Dr. B.A. Stuck, A. Dreher, C. Heiser, M. Herzog, T. Kühnel, J.T. Maurer, H. Pistner, H. Sitter, A. Steffen, T. Verse

Erschienen in: HNO | Ausgabe 11/2013

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Zusammenfassung

Ziel dieser Leitlinie ist die Förderung einer qualitativ hochwertigen ärztlichen Versorgung von Erwachsenen mit Schnarchen. Die Leitlinie wurde für die Anwendung im Rahmen der ambulanten und stationären Versorgung konzipiert und richtet sich primär an alle, die mit der Diagnostik und Therapie des Schnarchens befasst sind. Sie entspricht nach dem 3-Stufen-Konzept der AWMF einer S2k-Leitlinie.
Eine befriedigende Definition des Schnarchens existiert derzeit nicht. Das Schnarchen entsteht durch eine Vibration von Weichteilstrukturen an Engstellen des oberen Atemwegs während der Atmungstätigkeit im Schlaf. Auslöser ist letztlich die Abnahme des Muskeltonus im Bereich der Dilatatoren des oberen Atemwegs während des Schlafs. Es wurde eine Vielzahl von Risikofaktoren für das Schnarchen beschrieben. Die Entstehung ist multifaktoriell. Die Angaben zur Häufigkeit des Schnarchens variieren erheblich in Abhängigkeit von der Art der Erhebung. Das Schnarchen tritt am häufigsten im mittleren Lebensalter auf und zeigt eine Dominanz des männlichen Geschlechts. Zur klinischen Diagnostik soll bei Schnarchern die freie Anamnese, wenn möglich unter Einbeziehung des Bettpartners, durchgeführt werden; sie kann durch Fragebögen ergänzt werden. Zur Beurteilung der strömungsrelevanten Strukturen sollte eine klinische Untersuchung der Nase erfolgen. Diese kann auch eine endoskopische Beurteilung beinhalten. Die Untersuchung des Oropharynx ist von großer Bedeutung und soll durchgeführt werden. Eine Untersuchung des Larynx und des Hypopharynx sollte erfolgen. Bei der Untersuchung der Mundhöhle sollen die Größe der Zunge, der Zustand der Schleimhäute und der Zahnbefund beurteilt werden. Eine orientierende Beurteilung der skelettalen Morphologie des Gesichtsschädels sollte erfolgen. Im Einzelfall können technische Untersuchungsverfahren sinnvoll sein. Eine objektivierende schlafmedizinische Untersuchung soll erfolgen, wenn der Verdacht auf eine schlafbezogene Atmungsstörung besteht, relevante Komorbiditäten vorliegen, oder wenn ein Therapiewunsch bezüglich des Schnarchens besteht. Beim Schnarchen handelt es sich, zumindest nach derzeitigem Kenntnisstand, nicht um eine Erkrankung mit einer medizinischen Gefährdung und es besteht daher derzeit keine medizinische Notwendigkeit zur Behandlung. Eine Reduktion des Körpergewichts bei allen übergewichtigen Betroffenen sollte angestrebt werden. Wenn ein rein rückenlagebezogenes Schnarchen besteht, kann die Therapie mit einer Rückenlageverhinderung erwogen werden. In geeigneten Fällen kann die Therapie des Schnarchens mit einer Unterkieferprotrusionsschiene (UKPS) erfolgen. Ausgewählte minimal-invasive chirurgische Verfahren am Weichgaumen können zur Therapie des Schnarchens empfohlen werden, sofern ein geeigneter anatomischer Befund vorliegt. Die Auswahl des Verfahrens hängt in entscheidender Weise vom individuellen anatomischen Befund ab. Nach Einleitung bzw. Durchführung einer therapeutischen Maßnahme sollte nach einem angemessenen Zeitraum zur Überprüfung des Therapieerfolgs und ggf. zur Planung weiterer Maßnahmen eine Nachuntersuchung erfolgen.
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Metadaten
Titel
S2k-Leitlinie „Diagnostik und Therapie des Schnarchens des Erwachsenen“
Vorgelegt von der Arbeitsgemeinschaft Schlafmedizin der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.
verfasst von
Prof. Dr. B.A. Stuck
A. Dreher
C. Heiser
M. Herzog
T. Kühnel
J.T. Maurer
H. Pistner
H. Sitter
A. Steffen
T. Verse
Publikationsdatum
01.11.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
HNO / Ausgabe 11/2013
Print ISSN: 0017-6192
Elektronische ISSN: 1433-0458
DOI
https://doi.org/10.1007/s00106-013-2775-3

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