いびき・無呼吸にお悩みの方ご相談ください。

それぞれの治療にメリット・デメリットがありますので、
どのような方法が自身にあっているかを検討した上で
治療に臨まれる事が大切です。

原文の意訳（原文は下記に記載）睡眠時無呼吸症候群は睡眠中に気道が潰れることによりおこる病気である。

上気道（口腔咽頭喉頭）を専門とする耳鼻咽喉科は専門家として睡眠時無呼吸患者の評価治療に関与している。

成人の睡眠時無呼吸症候群の評価、長期にわたる管理やケアーの臨床ガイドラインでは、外科的治療可能な上気道狭窄や、C-PAPが使用できない患者さんにおいては外科治療を考慮すべきである。

成人の睡眠時無呼吸症候群の第一選択はC-PAPであるが、一晩の睡眠時間の70%以上、4時間以上の使用が可能な場合をC-PAP治療有効とされているが、C-PAP使用の患者さんの50%（半数）以上は実際には使用できていないが、こうした患者さんは他の治療法を考慮すべきである。

マウスピースも他の治療法の一つであるが、使用できない場合は、外科的治療を考慮すべきであり、この外科的治療により著明に生命予後や生活の質の向上が認められた。

Treatment of Obstructive Sleep Apnea: Overview

Obstructive Sleep Apnea(OSA) is a common disorder involving collapse of the upper airway during sleep. This repetitive collapse results in sleep fragmentation, hypoxemia, hypercapnia, increased sympathetic activity. As specialists in upper airway anatomy, physiology and surgery, Otolaryngologists are uniquely qualified to treat patients with OSA. In the Clinical Guidelines for Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults, it is recommended that evaluation for primary surgical treatment be considered in select patients who have severe obstructing anat¬omy that is surgically correctible (e.g., tonsillar hypertrophy obstructing the pharyngeal airway) and in patients in whom continuous positive airway pressure (CPAP) therapy is inadequate.(Epstein, EJ, Evidence Based Clinical Guideline)
Surgical treatment of pediatric sleep disordered breathing with tonsillectomy and adenoidectomy is the recommended first line treatment. In the pediatric population, resolution of OSA occurs in 82% of patients who are treated with tonsillectomy and adenoidectomy. (Breitzke,S, Meta-analysis). One other recent publication of specific interest for otolaryngologists is a large multicenter retrospective review on the treatment outcomes for OSA after an adenotonsillectomy. This review included 578 children of which 90 percent of the children were less than 13 years of age. Fifty percent of the children were obese (BMI > 95%). Only 27% of the children had complete resolution of OSA (AHI < 1 total sleep time) while 21.6% had an AHI>5/hr TST. Surgical success was variable and depended upon outcome measures selected. So success is as low as 27% (AHI of < 1) or as high as 78% (AHI < 5). Fifty nine percent of the obese children had an AHI>5/hr TST. An analysis of factors which were associated with an elevated post-operative AHI in order of influence were age > 7 years, elevated BMI, presence of asthma and more severe OSA pre-operatively.
In most patients with moderate to severe OSA, continuous positive airway pressure (CPAP) is the first line treatment. Successful long term treatment of OSA with CPAP is difficult to achieve and fewer than 50% of patients on CPAP are adequately treated, as defined by 4 hours of use 70% of nights.(Weaver, TE, Level 2 evidence and Kribbs, NB, Level 2 evidence) Other treatment options must be available to patients with OSAS.
“Surgical pro¬cedures may be considered as a secondary treatment for OSA when the outcome of PAP therapy is inadequate, such as when the patient is intolerant of CPAP, or CPAP therapy is unable to eliminate OSA (Consensus). Surgery may also be considered as a secondary therapy when there is an inadequate treatment out¬come with an oral appliance (OA), when the patient is intolerant of the OA, or the OA therapy provides unacceptable improvement of clinical outcomes of OSA (Consensus). Surgery may also be considered as an adjunct therapy when obstructive anatomy or functional deficiencies compromise other therapies or to improve toler¬ance of other OSA treatments (Consensus)”(Epstein, EJ) Surgery for OSAS has been shown to improve important clinical outcomes including survival and quality of life. (Weaver, EM. Level 2 evidence)