Identifikation und Evaluation der kindlichen Schlafapnoe vor Adenotonsillektomie anhand evaluierter Fragebögen

 

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Zusammenfassung

Schlafbezogene Atmungsstörungen (SBAS) im Kindesalter sind häufig. Etwa 3 - 12 % der Kinder schnarchen, bei ca. 0,7 - 3 % liegt ein obstruktives Schlafapnoe-Syndrom (OSAS) vor. Da die Symptome des OSAS im Kindesalter unspezifisch sein können, kann die Diagnose letztlich nur polysomnographisch gestellt werden. Aufgrund des hohen personellen und finanziellen Aufwandes einer kindlichen Polysomnographie (PSG), die in einem hierfür spezialisierten Schlaflabor durchgeführt werden sollte, ergibt sich die Notwendigkeit einer rationalen Indikationsstellung. Bislang existieren keine einheitlichen Richtlinien oder Entscheidungskriterien, wie diese Kinder zu identifizieren sind. Da die adenotonsilläre Hyperplasie die häufigste Ursache der SBAS im Kindesalter darstellt, wird bei typischer Anamnese die Adenotonsillektomie auch ohne vorhergehende PSG durchgeführt. Hierbei wird jedoch oftmals nicht unterschieden ob das Kind lediglich schnarcht oder ob nächtliche Atemaussetzer vorhanden sind. In diesem Zusammenhang können Fragebögen eine wertvolle Entscheidungshilfe in der präoperativen Identifikation des kindlichen OSAS und der postoperativen Verlaufskontrolle sein.

Identification and Evaluation of Obstructive Sleep Apnea in Children before Adenotonsillectomy using Evaluative Surveys

Sleep-disordered breathing (SDB) caused by enlarged tonsils and adnoids is common in early childhood. SDB without alterations in alveolar ventilation or sleep architecture is called primary snoring and affects up to 3 - 12 % of young children. In contrast, SDB with associated apneas or hypopneas affects between 0,7 - 3 % and is called obstructive sleep apnea syndrome (OSAS). OSAS and primary snoring should be distinguished with polysomnography (PSG) . Despite the large number of patients undergoing tonsillectomy and adenoidectomy, the ability to assess patients-based preoperative diagnosis and surgical outcomes polysomnographically is limited. As a consequence it remains difficult which children will or will not benefit from surgical intervention. In the context of OSAS diagnosis, a discriminative survey is desired, one that cold classify differences before surgery as small, moderate or large. A promising office based surrogate measure are disease-specific quality-of-life surveys. Change within patients can be measured using an evaluative survey, administered before and after an intervention.

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Dr. med. Yvonne Fischer, Gesundheitsökonomin (ebs)

Klinik und Hochschulambulanz für Hals-Nasen-Ohrenheilkunde, Universitätsklinik Ulm

Prittwitzstraße 43 · 89075 Ulm

Email: yvonne.fischer@medizin.uni-ulm.de