Obstruktıf Uyku Sendromunda Alternatif ve Yeni Geliştirilen Tedaviler
Özet
Obstrüktif uyku apne sendromu (OSAS), uykuda solunum bozukluğu olup kardiyovasküler sistem başta olmak üzere tüm sistemleri etkileyen, mortalite ve morbiditeyi artıran bir rahatsızlıktır. CPAP altın standart tedavi yöntemi olmasına rağmen, uzun dönemde gelişen uyum problemleri nedeniyle alternatif ve yeni tedavi arayışları ön plana çıkmıştır. Bu kapsamda uygulanan davranış tedavileri arasında iş ve okul yaşamına programlanmış kısa uykular, akustik faringometri ile desteklenen ağız içi araçlar ve pozisyon tedavileri yer almaktadır. CPAP dışındaki temel yöntemler ise üst solunum yolu direncine, anormal nöromusküler ve ventilatuar cevaplara yönelik tedaviler ile farmakolojik yaklaşımlardan oluşur. Bu doğrultuda medikal kilo verme, burun içi valfler, ağız içi basınç ve burun içi yüksek akım tedavilerinin yanı sıra yeni cerrahi teknikler uygulanmaktadır. Ayrıca, nöromusküler yanıtı artırmak için hipoglossal sinir stimülasyonu, sürekli deri altı elektrik stimülasyonu ve miyofonksiyonel terapi kullanılırken; akupunktur, kronoterapi ve tıbbi hipnoz gibi tamamlayıcı yöntemler de denenmektedir. Tedaviye rağmen devam eden gündüz aşırı uykululuk halinde ise modafinil ve armodafinil gibi psikostimulan ajanlar primer tedaviye ek olarak tercih edilmektedir. OSAS'ın artan sıklığı ve tedavi uyumundaki güçlükler, yeni alternatif tanı ve tedavi yöntemlerine yönelik çalışmaları zorunlu kılmaktadır.
Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder that affects all body systems, particularly the cardiovascular system, leading to increased mortality and morbidity. Although continuous positive airway pressure (CPAP) therapy remains the gold standard, long-term compliance issues have driven the search for alternative and newly developed treatments. Behavioral therapies in this context include scheduled short naps, oral appliances optimized by acoustic pharyngometry, and positional therapy. Main non-CPAP modalities focus on addressing upper airway resistance, abnormal neuromuscular and ventilatory responses, and pharmacological interventions. Accordingly, medical weight loss, nasal valves, oral pressure therapy, nasal high-flow therapy, and novel surgical techniques are utilized. To enhance neuromuscular responses, methods such as hypoglossal nerve stimulation, subcutaneous electrical stimulation, and myofunctional therapy are employed, alongside complementary approaches like acupuncture, chronotherapy, and medical hypnosis. For residual daytime sleepiness despite treatment, psychostimulant agents such as modafinil and armodafinil are used in conjunction with primary pressure therapy. The rising prevalence of OSAS and challenges in treatment adherence necessitate further research into these alternative diagnostic and therapeutic strategies.
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