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Otorhinolaryngologists play a vital role in the management of patients with obstructive sleep apnea (OSA) in Germany, particularly with regards to outpatient diagnostics as well as conservative and surgical treatment of patients with intolerance to ventilation therapy. Although establishment of differential indications for surgical therapy and performance of additional preoperative drug-induced sleep endoscopy in patients with sleep-disordered breathing are among the core competencies of otorhinolaryngologists, differential diagnostic considerations and detection of comorbid sleep disorders can be challenging, particularly for those without extensive sleep medicine training and experience. However, detection of comorbid sleep disorders is of particular importance when permanent surgical treatment is considered. Daytime sleepiness is the typical leading symptom of OSA; nevertheless, other disorders of hypersomnolence need to be considered in these patients and can easily be overlooked. This may lead to inadequate indications for surgical treatment. Based on two case reports, narcolepsy is presented as a comorbid disorder and differential diagnosis in patients with OSA.

Background and Objective: Tongue base reduction with temperature-controlled radiofrequency for the treatment of obstructive sleep apnea syndrome is a minimally invasive technique. Repeated application leads to a progressive shrinking of the tissue., Patients and Methods: In our study, we summarize the experiences gained from 100 tongue base reductions and compare them with the pilot study that was recently published. An intensified treatment scheme was used with higher amounts of energy applied per treatment session. Visual analogue scales were used for the assessment of postoperative pain and functional parameters. Regular follow-up visits were scheduled to evaluate postoperative complications., Results: Postoperative pain was mostly mild or moderate. Paraoperative complications were not observed. The overall rate for postoperative complications was 8%, with 2% mild and 5% moderate complications. One severe complication--a tongue base abscedation--was observed. Using para- and postoperative antibiotic prophylaxis reduced the rate of complications. Functional parameters such as taste or swallowing were not affected., Conclusions: Our results underline the safety of the procedure and demonstrate the minimal para- and postoperative morbidity. The increased amount of energy applied per session has not led to an increase in postoperative morbidity.

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 clinic 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. [ABSTRACT FROM AUTHOR]

Introduction: Detailed information regarding sleep medical qualifications in Germany are hard to obtain but would be of particular interest for prospective planning of sleep medical care. The aim of this study was to create an inventory of current sleep medical qualifications in Germany with a focus on sleep-disordered breathing and chronic insomnia. Material and methods: The inventory is mainly based on the health care report of the Federal Republic of Germany, data provided by the Medical Associations of the Federal States (Landesärztekammern) and Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen), the registry of members of the German Sleep Society (DGSM) and its committee for certification and quality assurance. Results: The health care report of the Federal Republic of Germany reports 1255 qualified sleep specialists in Germany in 2018. According to the data of the Medical Associations of the Federal States, 1436 sleep specialists are registered accounting for approx. 0.4% of all practicing physicians. The majority of sleep specialists belongs to the disciplines of internal medicine (66.6%) followed by otorhinolaryngology (12.5%) and neurology (10.7%). The number of physicians with a license for home sleep testing (polygraphy) is considerably higher. According to the registry of members of the DGSM, 700 physicians have achieved the additional qualification of the society called somnologist, which accounts for 0.17% of all practicing physicians. Of all certified sleep laboratories of the DGSM, 70% are led by a pneumologist. To date, 75 therapists have undergone the voluntary training for cognitive behavioral therapy for insomnia offered by the DGSM. Conclusion: The inventory reveals that only a relatively small number of physicians seek further sleep medical training or qualification in Germany, which is in considerable contrast to the high prevalence of, in particular, sleep-related breathing disorders and insomnia. [ABSTRACT FROM AUTHOR]

Sleep-disordered breathing (SDB) is highly prevalent and accompanied by a considerable reduction in quality of life and an increase in cardiovascular morbidity and mortality. To diagnose SDB and to assess the localization of an airway obstruction, multichannel pressure measurements in the pharynx and esophagus have been used but are still under debate. Specifically, these devices are often labeled to be uncomfortable for patients and to influence the parameters of sleep recordings. The aims of the current study were to determine the tolerability of multilevel pressure measurement and to assess their impact on the parameters of polysomnography (PSG). Patients who were referred for two nights of standard PSG for diagnostic purposes were included. The device for multilevel pressure recordings was applied in addition to PSG on one of the two nights according to a randomization protocol. Tolerability of the device was assessed and the most relevant outcome measures of PSG were compared between the nights with and without the pressure sensor. All polysomnographic data were analyzed by the same trained observer who was blinded to the presence of the pressure catheter. Fifty-one patients were included in the trial. Ten of the patients tolerated insertion of the pressure catheter but complained about persisting discomfort during the night, requiring removal of the device. Forty-one patients tolerated the multilevel pressure transducer, which is equivalent to a tolerability of 80 %. The results of the sleep parameters are based on the data of 31 patients. The pressure device minimally influenced the outcome data of the PSG. None of the recorded differences however were clinically relevant or statistically significant. Pressure measurements with devices of small diameter (≈2 mm) are well accepted by patients and have a tolerability of at least 80 %. The impact of multilevel pressure recordings on objective sleep parameters is negligible. The study strongly supports the use of multilevel pressure recordings and disproves the most relevant objections against their use. [ABSTRACT FROM AUTHOR]

Research regarding the incorporation of external stimuli presented during sleep into dream content is reviewed. Comparing the incorporation rates between studies indicates two possible influencing factors on the integration of external stimuli into dreams: “physical closeness” (stimuli applied to the skin are more effective than acoustic stimuli) and the significance of the stimulus. Olfactory stimuli are special because their cortical processing differs from the processing of, for example, auditory stimuli (bypassing the thalamus, direct connections to the amygdala). A recent study indeed indicated that the valence of olfactory stimuli affected dream emotions but dream content was not altered. Overall, the studies clearly demonstrate that information processing during sleep takes place. To continue this branch of research, it would be interesting to study the effect of internal stimuli on dream content, e.g., pain in patients with chronic pain or breathing pauses in sleep apnea patients. [ABSTRACT FROM AUTHOR]

Surgical strategies for the treatment of obstructive sleep apnoea are still under critical discussion. Although they appear to be a valuable treatment option from the patients’ perspective, they have barely been incorporated into national or international guidelines. This is mostly explained by the lack of randomized controlled clinical trials. Although those trials are not feasible with every surgical intervention and randomization appears to be problematic compared to conservative treatment, current publications have demonstrated that such critical controlled studies can be performed even with surgical interventions. Although conservative approaches (CPAP) are still the standard of treatment for obstructive sleep apnoea, numerous issues remain unsolved. Primary acceptance and long-term compliance are still problematic. The limited compliance in everyday practice needs to be taken into account when success rates of conservative and surgical treatment strategies are compared. Furthermore, published trials regarding the reduction in cardiovascular morbidity and mortality with CPAPs have predominantly been undertaken in patients with moderate to severe sleep apnoea or with relevant comorbidities. In those patients, surgery may be considered as second line treatment. However, in patients with mild sleep apnoea without daytime sleepiness or relevant comorbidities surgery may be considered as first line treatment. [ABSTRACT FROM AUTHOR]

As the interest in obstructive sleep apnea has increased, various attempts have been made to assess upper respiratory tract anatomy in patients with this relatively frequent disorder. The aim is not only to reveal potential differences in upper airway anatomy between patients with obstructive sleep apnea and healthy controls, but also to better understand the origin and the pathophysiology of the disease. Static radiologic imaging techniques (x-ray cephalometry, computed tomography (CT) scanning and magnetic resonance imaging (MRI)) and dynamic scanning protocols (e.g., ultrafast CT or cine MRI) are the focus of this review. Each technique itself and its history in the field of sleep medicine are briefly reviewed. Insights into the pathophysiology of the disease gained with the help of the investigational techniques are presented, and the impact of the techniques on patient management is reported. Although all these additional techniques for upper respiratory tract assessment have substantially improved our understanding of the pathophysiology of obstructive sleep apnea, their significance in daily practice is limited. In general, there is not enough evidence that these techniques are superior to routine clinical assessment. [ABSTRACT FROM AUTHOR]