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Obstructive sleep apnea: choosing wisely, doing the right thing

Obstruktive Schlafapnoe: klug entscheiden, das Richtige tun

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Abstract

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.

Zusammenfassung

Die obstruktive Schlafapnoe (OSA) kann zu einer erheblichen Einschränkung der Lebensqualität führen, und eine nicht behandelte mittel- bis schwergradige OSA (Apnoe-Hypopnoe-Index ≥ 15/h) erhöht das Risiko vieler – überwiegend kardiovaskulärer – Erkrankungen deutlich. In Anbetracht der Häufigkeit des Krankheitsbilds und der damit verbundenen Beeinträchtigungen ist eine effektive Diagnostik und Therapie der OSA von besonderer Bedeutung. Die Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM) hat daher jeweils 5 praxisnahe Positiv- und Negativempfehlungen zusammengestellt, die das diagnostische und therapeutische Vorgehen bei OSA erleichtern sollen. Sie beziehen sich insbesondere auf die Indikationen zur schlafmedizinischen Diagnostik und zu spezifischen Therapieoptionen unter Berücksichtigung von Alter, Klinik, Risikofaktoren und Komorbiditäten. Die Auswahl der Empfehlungen orientiert sich an der klinischen Relevanz, an bestehenden Defiziten im Sinne einer Über- oder Unterversorgung und an der Stärke der Empfehlungen in der aktuellen S3-Leitlinie der DGSM zu den schlafbezogenen Atmungsstörungen.

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References

  1. Abuzaid AS, Al Ashry HS, Elbadawi A, Ld H, Saad M, Elgendy IY, Elgendy A, Mahmoud AN, Mentias A, Barakat A, Lal C (2017) Meta-analysis of cardiovascular outcomes with continuous positive airway pressure therapy in patients with obstructive sleep apnea. Am J Cardiol 120(4):693–699

    Article  Google Scholar 

  2. American Academy of Sleep Medicine (2014) Five things physicians and patients should question. www.choosingwisely.org/wp-content/uploads/2015/02/AASM-Choosing-Wisely-List.pdf. Accessed 5 Jan 2021

  3. American Academy of Sleep Medicine (2014) International classification of sleep disorders, 3rd edn. American Academy of Sleep Medicine, , pp 139–140

    Google Scholar 

  4. American Board of Internal Medicine www.choosingwisely.com. Accessed 5 Jan 2021

  5. Badelt G, Goeters C, Becke-Jakob K, Deitmer T, Eich C, Höhne C, Stuck BA, Wiater A (2020) S1-Leitlinie: Obstruktive Schlafapnoe im Rahmen von Tonsillenchirurgie mit oder ohne Adenotomie bei Kindern – perioperatives Management. Anasth Intensivmed 61:587–597

    Google Scholar 

  6. Bakker JP, Weaver TE, Parthasarathy S, Aloia MS (2019) Adherence to CPAP: what should we be aiming for, and how can we get there? Chest 155(6):1272–1287

    Article  Google Scholar 

  7. Barbé F, Durán-Cantolla J, Sánchez-de-la-Torre M, Martínez-Alonso M, Carmona C, Barceló A, Chiner E, Masa JA, Gonzalez M, Marín JM, Garcia-Rio F, Diaz de Atauri J, Terán J, Mayos M, de la Pena M, Monasterio C, del Campo F, Montserrat JM (2012) Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. JAMA 307:2161–2168

    Article  Google Scholar 

  8. Bundesministerium der Justiz und für Verbraucherschutz (2010) Verordnung über die Zulassung von Personen zum Straßenverkehr (Fahrerlaubnis-Verordnung – FeV). www.gesetze-im-internet.de/fev_2010/BJNR198000010.html. Accessed 9 Feb 2021

  9. Camacho M, Riaz M, Capasso R, Ruoff CM, Guilleminault C, Kushida CA, Certal V (2015) The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment pressures: a systematic review and meta-analysis. Sleep 38(2):279–286

    Article  Google Scholar 

  10. Chung F, Liao P, Yegneswaran B, Shapiro CM, Kang W (2014) Postoperative changes in sleep-disordered breathing and sleep architecture in patients with obstructive sleep apnea. Anesthesiology 120:287–298

    Article  Google Scholar 

  11. Cote CJ, Posner KL, Domino KB (2014) Death or neurologic injury after tonsillectomy in children with a focus on obstructive sleep apnea: Houston, we have a problem! Anesth Analg 118:1276–1283

    Article  Google Scholar 

  12. De Luca Canto G, Pacheco-Pereira C, Aydinoz S, Bhattacharjee R, Tan HL, Kheirandish-Gozal L et al (2015) Adenotonsillectomy complications: a meta-analysis. Pediatrics 136:702–718

    Article  Google Scholar 

  13. Deutsche Gesellschaft für Innere Medizin e. V. (2019) Klug entscheiden. www.klug-entscheiden.com. Accessed 9 Feb 2021

  14. Eckert DJ (2018) Phenotypic approaches to obstructive sleep apnoea—new pathways for targeted therapy. Sleep Med Rev 37:45–59

    Article  Google Scholar 

  15. European Medicines Agency (2013) Restrictions on use of codeine for pain relief in children—CMDh endorses PRAC recommendation. www.ema.europa.eu/en/news/restrictions-use-codeine-pain-relief-children-cmdh-endorses-prac-recommendation#:~:text=Because%20of%20a%20risk%20of%20breathing%20problems,%20the,by%20other%20painkillers%20such%20as%20paracetamol%20or%20ibuprofen. Accessed 11 Feb 2021

  16. Faßbender P, Herbstreit F, Eikermann M, Teschler H, Peters J (2016) Obstructive sleep apnea—a perioperative risk factor. Dtsch Arztebl Int 113:463–469

    PubMed  PubMed Central  Google Scholar 

  17. Fietze I, Laharnar N, Obst A, Ewert R, Felix SB, Garcia C, Gläser S, Glos M, Schmidt CO, Stubbe B, Völzke H, Zimmermann S, Penzel T (2019) Prevalence and association analysis of obstructive sleep apnea with gender and age differences—results of SHIP-trend. J Sleep Res 28(5):e12770. https://doi.org/10.1111/jsr.12770

    Article  PubMed  Google Scholar 

  18. Fietze I, Ficker JH, Heiser C, Hofauer B, Schädlich S, Warmuth R, Stuck BA (2020) Wenn CPAP nicht genutzt oder nicht vertragen wird – Vorschlag für eine standardisierte Terminologie. Somnologie 24:102–105

    Article  Google Scholar 

  19. Gaisl T, Haile SR, Thiel S, Osswald M, Kohler M (2019) Efficacy of pharmacotherapy for OSA in adults: a systematic review and network meta-analysis. Sleep Med Rev 46:74–86

    Article  Google Scholar 

  20. GBA (2004) Bekanntmachungen. www.g-ba.de/downloads/39-261-146/2004-06-15-BUB-Polysomnographie.pdf. Accessed 14 Jan 2021

  21. Gräcmann N, Albrecht M (2019) Begutachtungsleitlinien zur Kraftfahreignung. www.bast.de/BASt_2017/DE/Verkehrssicherheit/Fachthemen/U1-BLL/Begutachtungsleitlinien.pdf?__blob=publicationFile&v=20. Accessed 5 Jan 2021

  22. Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3(4):310–318

    Article  CAS  Google Scholar 

  23. Koutsourelakis I, Georgoulopoulos G, Perraki E, Vagiakis E, Roussos C, Zakynthinos SG (2008) Randomised trial of nasal surgery for fixed nasal obstruction in obstructive sleep apnoea. Eur Respir J 31(1):110–117

    Article  CAS  Google Scholar 

  24. Labarca G, Schmidt A, Dreyse J, Jorquera J, Enos D, Torres G, Barbe F (2021) Efficacy of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) and resistant hypertension (RH)-systematic review and meta-analysis. Sleep Med Rev 58:101446. https://doi.org/10.1016/j.smrv.2021.101446

    Article  PubMed  Google Scholar 

  25. Lumeng JC, Chervin RD (2008) Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc 5(2):242–252

    Article  Google Scholar 

  26. Mason M, Cates CJ, Smith I (2015) Effects of opioid, hypnotic and sedating medications on sleep-disordered breathing in adults with obstructive sleep apnoea. Cochrane Database Syst Rev 7:CD11090. https://doi.org/10.1002/14651858.CD011090.pub2

    Article  Google Scholar 

  27. Mayer G, Arzt M, Braumann B, Ficker JH, Fietze I, Frohnhofen H, Galetke W, Maurer JT, Orth M, Penzel T, Pistner H, Randerath W, Rösslein M, Sitter H, Stuck BA (2017) German S3 guideline nonrestorative sleep/sleep disorders, chapter “sleep-related breathing disorders in adults,” short version: German sleep society (Deutsche Gesellschaft für Schlafforschung und Schlafmedizin, DGSM). Somnologie 21(4):290–301

    Article  Google Scholar 

  28. McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ (1999) Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159(4 Pt 1):1108–1114

    Article  CAS  Google Scholar 

  29. Ni YN, Yang H, Thomas RJ (2021) The role of acetazolamide in sleep apnea at sea level: a systematic review and meta-analysis. J Clin Sleep Med. https://doi.org/10.5664/jcsm.9116

    Article  PubMed  PubMed Central  Google Scholar 

  30. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG (2019) Treatment of adult obstructive sleep apnea with positive airway pressure: an American academy of sleep medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med 15(2):301–334

    Article  Google Scholar 

  31. Peker Y, Glantz H, Eulenburg C, Wegscheider K, Herlitz J, Thunström E (2016) Effect of positive airway pressure on cardiovascular outcomes in coronary artery disease patients with nonsleepy obstructive sleep apnea. The RICCADSA randomized controlled trial. Am J Respir Crit Care Med 194(5):613–620

    Article  CAS  Google Scholar 

  32. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleepdisordered breathing and hypertension. N Engl J Med 342:1378–1384

    Article  CAS  Google Scholar 

  33. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, Mullins R, Jenkinson C, Stradling JR, Davies RJ (2002) Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 359(9302):204–210

    Article  Google Scholar 

  34. Richards D, Bartlett DJ, Wong K, Malouff J, Grunstein RR (2007) Increased adherence to CPAP with a group cognitive behavioral treatment intervention: a randomized trial. Sleep 30(5):635–640

    Article  Google Scholar 

  35. Stuck BA, Arzt M, Fietze I, Galetke W, Hein H, Heiser C, Herkenrath SD, Hofauer B, Maurer JT, Mayer G, Orth M, Penzel T, Randerath W, Sommer JU, Steffen A, Wiater A (2020) Teil-Aktualisierung S3-Leitlinie Schlafbezogene Atmungsstörungen bei Erwachsenen. Somnologie 24:176–208

    Article  Google Scholar 

  36. Taranto-Montemurro L, Messineo L, Wellman A (2019) Targeting endotypic traitss with medications for the pharmacological treatment of obstructive sleep apnea. A review of the current literature. J Clin Med 8:1846

    Article  CAS  Google Scholar 

  37. Urschitz MS, Poets CF, Stuck BA, Wiater A (2014) Schnarchen bei Kindern – Algorithmus zum diagnostischen Vorgehen. HNO 62:586–589

    Article  CAS  Google Scholar 

  38. Urschitz MS, Poets CF, Stuck BA, Wiater A, Kirchhoff F (2014) Medikamentöse Behandlung von Atmungsstörungen bei adenotonsillärer Hyperplasie. HNO 62:582–558

    Article  CAS  Google Scholar 

  39. Weaver TE, Maislin G, Dinges DF, Bloxham T, George CF, Greenberg H, Kader G, Mahowald M, Younger J, Pack AI (2007) Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep 30(6):711–719

    Article  Google Scholar 

  40. Wiater A, Lehmkuhl G, Alfer D (2020) Praxishandbuch Kinderschlaf. Elsevier,

    Google Scholar 

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Acknowledgements

The publisher would like to thank Christine Rye (Windsor, UK) for translating the article from German into English.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Germany

    Boris A. Stuck

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  1. Boris A. Stuck
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Correspondence to Boris A. Stuck.

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Conflict of interest

B.A. Stuck has received financial support for research work, as well as consultancy and speaker’s fees from the following companies: Sutter Medizintechnik, Neuwirth Medical Products, Philips Healthcare, Itamar Medical, Inspire Medical und SnooZeal Ltd. He has also received financial support (sponsoring) for organization of his institution from: Löwenstein Medical, Inspire Medical und Neuwirth Medical Products. He acts as a consultant to Itamar Medical and Signifier Medical Technologies. C. Schöbel declares that his institution has received institutional research funding in the form of monetary benefits as part of Investigator Initiated Trials or clinical trials from the companies Bayer, Novartis, Novamed, Nox medical, ResMed GmbH, and Sleepiz. His institution has received honoraria for speaker’s activities from the following companies: AstraZeneca, Berlin Chemie, Bristol-Myers Squibb, Löwenstein Medical, JAZZ, Johnson & Johnson, LivaNova, Neuwirth Medical Products, Novartis, Pfizer, ResMed GmbH, and UCB Pharma. His institution has received honoraria for consultancy activities from the following companies: AstraZeneca, Actelion, Bertelsmann Stiftung, JAZZ, LivaNova, Novartis, ResMed GmbH, and UCB Pharma. D. Triché has received consultancy fees as well as fees for lectures and training activities from JAZZ Pharmaceuticals, Roche Pharmaceuticals, Inspire Medical, Neuwirth Medical Products, and ResMed GmbH. A. Wiater declares that no competing interests exist.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

Additional information

This is a modified version of the original publication: Stuck et al. (2021): Klug entscheiden: Obstruktive Schlafapnoe; Dtsch Arztebl 118(19–20): A‑996; Dtsch Arztebl.

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Stuck, B.A., Schöbel, C., Wiater, A. et al. Obstructive sleep apnea: choosing wisely, doing the right thing. Somnologie 26, 49–54 (2022). https://doi.org/10.1007/s11818-022-00340-0

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