Hopp til innhold
NHI.no
Annonse

Søvnapné: Behandling

Innhold i artikkelen

Hovedmålet med behandlingen er å bedre nattesøvnen ved å få slutt på anfallene med pustestopp. Dette vil gjøre at du føler deg mer opplagt på dagtid. Så fremt du ikke har betydelige plager, er det første tiltaket å prøve å "tvinge" deg til å ligge på siden om natten. Dette kan du for eksempel gjøre ved å bruke nattskjorte, og sy tennisballer fast i ryggen til den. Dernest vil det kunne hjelpe overvektige om de går ned i vekt. Vektreduksjon vil også minske risikoen for hjerte- og karsykdom, som kan være økt ved søvnapné.

CPAP-maskeCPAP-maske
Annonse

Kommer man ikke til målet med disse enkle tiltakene, er den beste behandlingsmetoden at du begynner å bruke en såkalt CPAP-maske (CPAP = Continuous Positive Airways Pressure). Dette er en maske som du må ha på om natten, og som tilfører luft med litt overtrykk, slik at du ikke så lett stopper å puste. Masken blir tilpasset av en lungelege eller Øre-nese-hals-lege, som også vil instruere deg i hvordan den skal brukes. Slik behandling anses som livslang. I Norge dekkes utgiftene til CPAP-masken av helseforetaket dersom utstyret er rekvirert av spesialist.

Et annet behandlingsalternativ er en skinne som skyver underkjeven litt forover (apnéskinnen), slik at svelget åpnes mer enn når munnen er lukket på vanlig måte. Apnéskinner tilpasses av tannlege. Minst en fjerdedel opplever dette som en ubehagelig behandling. Noen pasienter sjeneres av neseflod, irritasjon av hud og slimhinner, tåreflod. Flere av disse problemene kan korrigeres med masketilpasning. Etterlevelse av behandlingen er høyest blant dem som sjeneres mest av søvnighet på dagtid.

Har du forsøkt andre behandlingsmetoder uten resultat, og du sammen med legen kommer til at noe må gjøres, kan kirurgi være aktuelt. Formålet med et operativt inngrep vil i såfall være å forsøke å få til åpnere forhold i svelget. En slik operasjon innebærer ofte å fjerne drøvelen og en bit av den bløte ganen. Forskning viser imidlertid at denne typen kirurgisk inngrep kun er til nytte for bare halvparten av dem som blir operert.

Ulike medikamenter er forsøkt mot søvnapné, men studier viser at de er uten effekt. Nye medikamenter er under utprøving, men har så langt ikke demonstrert overbevisende effekt.

Vil du vite mer

Dette dokumentet er basert på det profesjonelle dokumentet Søvnapné . Referanselisten for dette dokumentet vises nedenfor

  1. Greenstone M, Hack M. Obstructive sleep apnoea. BMJ. 2014;348:g3745.
  2. Semelka M, Wilson J, Floyd R. Diagnosis and treatment of obstructive sleep apnea in adults. Am Fam Physician 2016; 94: 355-60. American Family Physician
  3. Jennum PJ, Tønnesen P, Rasmussen N, Nørregaard O. Søvnrelaterede respirationsforstyrrelser. Definition, forekomst, patofysiologi og konsekvenser. Ugeskr Læger 2005; 167: 2380-5. PubMed
  4. Hensley M. Sleep apnoea (obstructive sleep apnoea-hypopnoea syndrome). Clin Evid 2002; 7: 1566-78. PubMed
  5. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013; 177: 1006. pmid:23589584 PubMed
  6. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002; 165: 1217-39. PubMed
  7. Powell S, Kubba H, O'Brien C, Tremlett M. Pediatric obstructive sleep apnoea. Clinical review. BMJ 2010; 340: c1918. BMJ (DOI)
  8. Rosen CL, Larkin EK, Kirchner L, Emancipator JL, Bivins SF, Surovec SA, et al. Prevalence and risk factors for sleep disordered breathing in 8 to 11 year old children: association with race and prematurity. J Pediatrics 2003; 142: 383-9. PubMed
  9. Dematteis M, Pepin J-L, Jeanmart M, Deschaux C, Labarre-Vila A, Levy P. Charcot-Marie-Tooth disease and sleep apnoea syndrome: a family study. Lancet 2001; 357: 267-72. PubMed
  10. Yaggi HK, Concato J, Kernan WN, et al. Obstructive Sleep Apnea as a Risk Factor for Stroke and Death. N Engl J Med 2005; 353: 2034-41. PubMed
  11. Jacobowitz O. Obstructive sleep apnoea in adults. BestPractice, last updated Jan 23, 2014 .
  12. Tveit RL, Lehmann S, Bjorvatn B. Prevalence of several somatic diseases depends on the presence and severity of obstructive sleep apnea. PLOS One 2018. doi:https://doi.org/10.1371/journal.pone.0192671
  13. Qaseem A, et al. Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(3):210–220.
  14. Povitz M, Bolo CE, Heitman SJ, Tsai WH, Wang J, James MT. Effect of treatment of obstructive sleep apnea on depressive symptoms: systematic review and meta-analysis. PLoS Med. 2014;11(11):e1001762.
  15. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disorder breathing. JAMA 2000; 284: 3015-21. PubMed
  16. Engstrøm M, Aarrestad S, Eldøen G, Alme A, Bjørge T, Miljeteig H, Bjorvatn B, Knudsen S, Indrekvam S, Nilsen KB. Nye anbefalinger for objektiv undersøkelse av søvn og søvnforstyrrelser. Tidsskr Nor Legeforen 2018; 138: 1805-6. doi:10.4045/tidsskr.18.0741 DOI
  17. Jennum PJ, Tønnesen P, Rasmussen N, Nørregaard O. Søvnrelaterede respirationsforstyrrelser. Diagnostik og behandling. Ugeskr Læger 2005; 167: 2385-9. PubMed
  18. Balachandran JS, Patel SR. In the clinic: obstructive sleep apnea. Ann Intern Med. 2014;161(9):ITC1–ITC15.
  19. Fenton ME, Heathcote K, Bryce R, et al. The utility of the elbow sign in the diagnosis of OSA. Chest. 2014;145(3):518–524.
  20. Arnardottir ES, Bjornsdottir E, Olafsdottir KA, et al. Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms. Eur Respir J. 2016 Jan;47(1):194-202. pmid:26541533 PubMed
  21. Kotagal S. Childhood obstructive sleep apnoea. BMJ 2005; 330: 978-9. PubMed
  22. Jennum P, Ibsen R, Kjellberg J. Morbidity and mortality in children with obstructive sleep apnoea: a controlled national study. Thorax. 2013 Jun 8. doi: 10.1136/thoraxjnl-2012-202561. DOI
  23. Holland Gjørup P, Hedner J. Hypertension og obstruktiv søvnapnø. Ugeskr Læger 2009; 171: 2091. Ugeskrift for Læger
  24. Dudenbostel T, Calhoun DA. Resistant hypertension, obstructive sleep. Journal of Human Hypertension 2012; 26: 281-7. PubMed
  25. O'Brien LM, Mervis CB, Holbrook CR, Bruner JL, Klaus CJ, Rutherford J, et al. Neurobehavioral implications of habitual snoring in children. Pediatrics 2004; 114: 44-9. Pediatrics
  26. Norsk barnelegeforening. Obstruktiv søvnapné. Generell veileder i pediatri. Revidert 2017. Siden besøkt 09.04.21. www.helsebiblioteket.no
  27. McEvoy RD, Antic NA, Heeley E, et al. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. N Engl J Med 2016 Aug 28. PMID: 27571048 PubMed
  28. Yu J, Zhou Z, McEvoy RD, et al. Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea: A Systematic Review and Meta-analysis. JAMA 2017; 318: 156.66. pmid:28697252 PubMed
  29. Randerath WJ, et al.; European Respiratory Society task force on non-CPAP therapies in sleep apnoea. Non-CPAP therapies in obstructive sleep apnoea. Eur Respir J. 2011;37(5):1000–1028.
  30. Tuomilehto HP, Seppä JM, Partinen MM, et al, for the Kuopio Sleep Apnea Group. Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med 2009; 179: 320-7. PubMed
  31. Foster GD, Borradaile KE, Sanders MH, et al. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes. Arch Intern Med 2009; 169: 1619-26. PubMed
  32. Smith I, Lasserson T, Wright J. Drug treatments for obstructive sleep apnoea (Cochrane Review). In: The Cochrane Library, Issue 2, 2002 Oxford: Update Software. The Cochrane Library
  33. Mason M, Cates CJ, Smith I. Effects of opioid, hypnotic and sedating medications on sleep-disordered breathing in adults with obstructive sleep apnoea. Cochrane Database Syst Rev 2015; 7: CD011090. doi:10.1002/14651858.CD011090.pub2 DOI
  34. Chapman JL, Kempler L, Chang CL, et al. Modafinil improves daytime sleepiness in patients with mild to moderate obstructive sleep apnoea not using standard treatments: a randomised placebo-controlled crossover trial. Thorax 2013. pmid:24287166 PubMed
  35. Strollo PJ Jr, Hedner J, Collop N, et al. Solriamfetol for the Treatment of Excessive Sleepiness in OSA: A Placebo-Controlled Randomized Withdrawal Study. Chest. 2019 Feb;155(2):364-374. PMID: 30471270 PubMed
  36. Brouilette RT, Manoukian JJ, Ducharme FM, Oudjhane K, Earle LG, Ladan S, et al. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr 2001; 138: 838-4. PubMed
  37. Goldbart AD, Greenberg-Dotan S, Tal A. Montelukast for children with obstructive sleep apnea: A double-blind, placebo-controlled study. Pediatrics 2012; 130: 575-80. Pediatrics
  38. Giles TL, Lasserson TJ, Smith B, et al. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database of Syst Rev 2006, Issue 3. Art. No.: CD001106. DOI: 10.1002/14651858.CD001106.pub3. DOI
  39. Marshall NS, Barnes M, Travier N, et al. Continuous positive airway pressure reduces daytime sleepiness in mild to moderate obstructive sleep apnoea: a meta-analysis. Thorax 2006; 61: 430-4. PubMed
  40. Weaver TE, Mancini C, Maislin G, et al. Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: Results of the CPAP apnea trial north american program (CATNAP) randomized clinical trial. Am J Respir Crit Care Med 2012; 186: 677-83. PubMed
  41. Fava C, Dorigoni S, Dalle Vedove F, et al. Effect of CPAP on blood pressure in patients with OSA/hypopnea: A systematic review and meta-analysis. Chest 2014;145:762-71. PMID: 24077181 PubMed
  42. Bratton DJ, Gaisl T, Wons AM, et al. CPAP vs Mandibular Advancement Devices and Blood Pressure in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. JAMA 2015; 314(21): 2280-93. pmid:PMID: 26624827 PubMed
  43. Marin JM, Agusti A, Villar I, et al. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA 2012; 307: 2169-76. Journal of the American Medical Association
  44. Gottlieb DJ, Punjabi NM, Mehra R, et al. CPAP versus oxygen in obstructive sleep apnea. N Engl J Med 2014 Jun 12;370(24):2276-85. PubMed
  45. Schwarz EI, Schlatzer C, Rossi VA, et al. Effect of CPAP Withdrawal on BP in OSA: Data from Three Randomized Controlled Trials. Chest. 2016; 150: 1202-10. PMID: 27452767 PubMed
  46. Marti S, Sampol G, Munoz X et al. Mortality in severe sleep apnoea/hypopnoea syndrome patients: impact of treatment. Eur Respir J 2002; 20: 1511-8. PubMed
  47. Findley L, Smith C, Hooper J et al. Treatment with nasal CPAP decreases automobile accidents in patients with sleep apnea. Am J Respir Crit Care Med 2000; 161: 857-9. PubMed
  48. George CF. Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax 2001; 56: 508-12. PubMed
  49. Povitz M, Bolo CE, Heitman SJ, et al. Effect of treatment of obstructive sleep apnea on depressive symptoms: systematic review and meta-analysis. PLoS Med. 2014; 11. doi: 10.1371/journal.pmed.1001762 DOI
  50. Lim J, Lasserson TJ, Fleetham J, Wright JJ. Oral appliances for obstructive sleep apnoea. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004435. DOI: 10.1002/14651858.CD004435.pub3. DOI
  51. Sharples L, Glover M, Clutterbuck-James A, et al. Clinical effectiveness and cost-effectiveness results from the randomised controlled Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and long-term economic analysis of oral devices and continuous positive airway pressure. Health Technol Assess. 2014;18:1-296. PMID: 25359435 PubMed
  52. Marklund M, Carlberg B, Forsgren L, et al. Oral appliance therapy in patients with daytime sleepiness and snoring or mild to moderate sleep apnea: a randomized clinical trial. JAMA Intern Med. 2015 Jun 1.
  53. Sundaram S, Lim J, Lasserson TJ. Surgery for obstructive sleep apnoea in adults. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD001004. DOI: 10.1002/14651858.CD001004.pub2. DOI
  54. Marcus CL, Moore RH, Rosen CL, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 2013; 368: 2366-76. New England Journal of Medicine
  55. Garetz S, Mitchell RB, Parker PD, et al. Quality of life and obstructive sleep apnea symptoms after pediatric adenotonsillectomy. Pediatrics 2015. doi:10.1542/peds.2014-0620 DOI
  56. den Herder C, Schmeck J, Appelboom DJK, de Vries N. Risks of general anaesthesia in people with obstructive sleep apnoea. BMJ 2004; 329: 955-9. PubMed
  57. Campos-Rodriguez F, Martinez-Garcai MA, de la Cruz-Moron I, et al. Cardiovascular mortality in women with obstructive sleep apnea with or without continuous positive airway pressure treatment. Ann Intern Med 2012; 156: 115-22. PubMed
  58. Molnar MZ, Mucsi I, Novak M, et al. Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans. Thorax. 2015. PMID: 26038534 PubMed
  59. Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet 2009; 373: 82-93. PubMed
  60. Ferrier K, Campbell A, Yee B, et al. Sleep-disordered breathing occurs frequently in stable outpatients with congestive heart failure. Chest 2005; 128: 2116-22. PubMed
  61. Javaheri S. Sleep disorders in systolic heart failure: a prospective study of 100 male patients. The final report. Int J Cardiol 2006; 106: 21-8. PubMed
  62. Lindberg E, Gislason T. Epidemiology of sleep-related obstructive breathing. Sleep Med Reviews 2000; 4: 411-33. PubMed
  63. Redline S. Morbidity, mortality and public health burden of sleep apnea. In: McNicholas WT, Phillipson EA, eds. Breathing disorders in sleep. London:: WB Saunders. 2002; 222-35.
  64. Durán-Cantolla J, Aizpuru F, Montserrqat JM, et al. Continous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial. BMJ 2010; 341: c5991. BMJ (DOI)
  65. Pedrosa RP, Drager LF, de Paula LKG, et al. Effects of OSA treatment on BP in patients with resistant hypertension. Chest 2013; 144: 1487-94. doi:10.1378/chest.13-0085 DOI
  66. Gottlieb DJ. Can sleep apnea be treated without modifying anatomy?. N Engl J Med 2005; 353: 2604-6. PubMed
  67. Barbé F, Durán-Cantolla J, Sánchez-de-la-Torre M, et al. Effect of continous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea. A randomized controlled trial. JAMA 2012; 307: 2161-8. Journal of the American Medical Association
  68. Marin JM, Carrizo SJ, Vicente E, Agusti AGN. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365: 1046-53. PubMed
Annonse
Annonse