[Sleep disturbances--aspects of obstructive and sleep-related breathing disorders]

Obstructive sleep apnea (OSA) is a wide spread affliction in industrialised countries. OSA has to be distinguished from simple snoring which is socially annoying but physically harmless, since it does not harm the physical health. Patients with OSA complain about disruptive snoring, daytime sleepiness, and loss of intellectual power. OSA is associated with increased mortality. It is possible to distinguish between complete respiratory pauses or apnoea and periods of too shallow breathing or hypopnoea. History taking, clinical examination, recording of daytime sleepiness, and cardio-respiratory sleep studies are necessary to make a proper diagnosis. OSA should primarily be treated, not so the simple snoring. In sleep apneics the treatment focuses on the removal of the sleep-related breathing disturbances and their health-related consequences. Therefore adjuvants or minimally invasive surgical techniques are favoured. Gold standard treatment of OSA is nasally applied continuous positive airway pressure (nCPAP). Alternative treatment modalities are also used. As conservative approaches oral appliances and conditioning (to avoid supine sleeping position) show promising results. Surgical treatment complies with the severity of the disease and with the anatomical findings. A variety of surgical approaches to the soft palate, the base of tongue, the tonsils, and the upper and lower jaws have been described.