Ein nicht erholsamer Schlaf kann vielfältige Konsequenzen sowohl gesundheitlicher als auch ökonomischer Art aufweisen. Das durch den demografischen Wandel in seiner Bedeutung zunehmende obstruktive Schlafapnoesyndrom kann mit seinen gesundheitlichen Risiken weitreichende Auswir- kungen auf das Individuum besitzen sowie signifikante gesellschaftliche Risiken und Kosten bergen. Wichtig erscheint demnach, sich der Bedeutung dieser Erkrankung bewusst zu werden und die Notwendigkeit der Therapie zu erkennen. Ziel dieser Arbeit bestand darin, die knochenchirurgischen Therapiemethoden als kausalen Therapieansatz der OSA aus der Primärliteratur darzustellen, deren Wirksamkeit insbesondere im Vergleich zur CPAP-Therapie zu eruieren und darauf aufbauend gegebenenfalls notwendige Diagnostik und prädisponierende Faktoren für einen chirurgischen Erfolg herauszuarbeiten. Dies geschah im Rahmen der Leitlinienerstellung der aktuellen S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen, Kapitel „Schlafbezogene Atmungsstörungen bei Erwachsenen“. Hierbei konnten nach definierten Ein- und Ausschlusskriterien in der Datenbank PubMed und den Literaturverzeichnissen relevanter Studien 50 Studien mit insgesamt 1461 Patienten und zumeist niedrigem Evidenzgrad identifiziert werden, die eine Behandlung der OSA mittels Maxillomandibulärem Advancement MMA, Genioglossus Advancement GA oder der Distraktionsosteogenese DO analysierten. Nach neustem Kenntnisstand erscheinen der Apopnoe-Hypopnoe-Index AHI sowie Respiratory-Disturbance-Index RDI als alleiniges Erfolgskriterium obsolet, eine ganzheitliche Betrachtung des Patienten ist unabdingbar. Notwendig ist eine umfassende Diagnostik, welche über eine Polysomnografie hinausgeht. Das MMA zeigt sich im Rahmen dieser Literaturanalyse als erfolgreichste knochenchirurgische Therapiemethode. Auch wenn ein niedriger BMI sowie AHI und eine gering ausgeprägte Tagessymptomatik positive prädiktive Faktoren für einen Therapieerfolg darstellen, erscheint die MMA auch bei sorgfältig ausgewählten Patienten mit hohem BMI und schwerwiegender OSA erfolgsversprechend, deren Wirksamkeit mit der den Goldstandard setzenden CPAP Therapie in vielfältigen Aspekten ohne signifikanten Unterschied verglichen werden kann. Hierzu zählen unter anderem polysomnografische Werte sowie die Schlafarchitektur und subjektive Veränderungen wie beispielsweise die Tagesmüdigkeit, quantifiziert anhand der Epworth Sleepiness Scale und die subjektive Zufriedenheit. Daneben erfolgte eine detaillierte Auswertung kephalometrischer Daten, der postoperativen Zufriedenheit, des Schnarchens sowie Komplikationen der Behandlungen. Schwierig erscheint allerdings auf der Basis des heutigen Wissenstandes präzise Grenzwerte festzulegen, anhand derer der Einsatz einer chirurgischen Therapie empfohlen werden kann. Die Tatsache der fehlenden Notwendigkeit einer kontinuierlichen Therapie ist ein wichtiger Vorteil dieser kausalen Therapiemethoden. Dennoch benötigt die Schlafmedizin als Querschnittsfach eine Bewertung der therapeutischen Methoden aus unterschiedlichen Sichtweisen. Die knochenchirurgischen Verfahren jedoch lediglich als Zweitlinientherapie anzusehen erscheint nach aktuellem Kenntnisstand obsolet. Die geringe Anzahl an qualitativ hochwertigen Studien erschweren eine differenzierte Aussage. Weitere Studien hoher Evidenz werden zukünftig notwendig sein, um die knochenchirurgischen Therapiemethoden als festen Bestandteil einer fächerübergreifenden Therapie der OSA zu etablieren. / Unrestful sleep can have a variety of consequences, both health-related and economic. Obstructive sleep apnea syndrome, which is growing in importance due to underlying demographic changes, can have far-reaching effects on the individual with its health risks, as well as significant social risks and costs. The aim of this work was to evaluate the primary literature on skeletal surgical therapy methods as a form of causal therapy for OSA and compare their effectiveness to the gold-standard treatment CPAP. This was done within the framework of the guideline development of the S3-guideline "Nonrestorative sleep/sleep disorders", chapter "Sleep-related respiratory disorders in adults" from 2017. By using predefined inclusion and exclusion criteria, 50 studies with a total of 1461 patients and mostly a low level of evidence were identified in the Pub- Med database and the bibliographies of relevant articles, which analyzed the treatment of OSA using maxillomandibular advancement MMA, genioglossus advancement GA or distraction osteogenesis DO. According to the latest knowledge, the apopnea-hypopnea index (AHI) and the respiratory disturbance index (RDI) appear to be obsolete as the sole criteria for success; a holistic view of the patient is essential. Comprehensive diagnostics, which go beyond polysomnography, are necessary. In the context of this literature analysis, MMA is shown to be the most successful bone surgery therapy method. Even though a low BMI and AHI as well as low daily symptomatology are positive predictive factors for a successful therapy, MMA also appears to be effective in carefully selected patients with high BMI and AHI. The efficacy compares to the gold-standard CPAP therapy in many aspects without significant difference. These include polysomnographic values as well as sleep architecture and subjective changes such as daytime sleepiness, quantified using the Epworth Sleepiness Scale, and subjective satisfaction. In addition, a detailed evaluation of cephalometric data, further subjective changes such as snoring and complications of the treatments was performed. However, it seems to be difficult to define precise threshold values on the basis of which the use of surgical therapy can be recommended according to the current literature. The fact that there is no need for continuous therapy, as with CPAP, is an important advantage of the surgical approach. Nevertheless, as a cross-sectional field, sleep medicine needs an evaluation of all therapeutic methods from different points of view. To consider the bone surgical methods only as second-line therapy seems obsolete according to the current state of knowledge. The small number of high-quality studies makes a differentiated statement difficult. Further studies with high evidence will be necessary in the future to establish skeletal surgery as an integral part of an interdisciplinary therapy of OSA.

Das Ziel dieser Studie lag darin, die Auswirkung zentraler schlafbezogener Atemstörungen (zSBA) auf die zerebrale Oxygenierung bei Kindern mit Meningomyelozele (MMC) und Chiari-II-Malformation zu untersuchen. Im Schlaflabor der Universitäts-Kinderklinik Würzburg wurden Kinder mit MMC und Chiari-II-Malformation, bei denen zuvor eine zentrale Atemstörung diagnostiziert worden war, polysomnographisch untersucht. Zusätzlich zur standardisierten Polysomnographie (PSG) wurde die zerebrale Sauerstoffsättigung mittels Nahinfrarotspektroskopie (NIRS) abgeleitet. Die Nahinfrarotspektroskopie ermöglicht eine kontinuierliche, nicht-invasive Messung der zerebralen Oxygenierung. Diese Methode beruht auf der relativen Durchlässigkeit von Gewebe im Nahinfrarotbereich. Beim Durchtritt von Licht durch Gewebe kommt es zur Absorption durch die Chromophoren O2Hb und HHb. Mit Hilfe des modifizierten Lambert-Beer-Gesetzes können Veränderungen der Chromophorenkonzentration berechnet werden. Zusätzlich zu dieser Methode ist es mit dem NIRO-200-Gerät möglich, absolute Werte des Gewebeoxygenierungsindexes (TOI) zu ermitteln. Mittels Spatially Resolved Spectroscopy (SRS) wird die Änderung der Lichtabschwächung über eine Distanz gemessen und unter Verwendung einer modifizierten Diffusionsgleichung TOI berechnet. Die respiratorischen Ereignisse während der Polysomnographie wurden in Bezug auf die Dauer, den peripheren Sättigungsabfall, das Schlafstadium und die Veränderungen der zerebralen Sauerstoffsättigung ausgewertet. Die zerebralen Werte wurden mit dem NIRO-200-Gerät (Fa. Hamamatsu Phototonics) gemessen: oxygeniertes Hämoglobin (O2Hb), deoxygeniertes Hämoglobin (HHb) und der Gewebeoxygenierungsindex (TOI). Es konnte ein typisches Reaktionsmuster der zerebralen Parameter während zSBA beschrieben werden mit Abfall des O2Hb, zum Anstieg des HHb und zum Abfall des TOI. Zudem konnte gezeigt werden, dass zSBA mit sehr starken zerebralen Sauerstoffabfällen assoziiert sein können. Es zeigte sich eine starke Korrelation mit der Dauer einer Atemstörung, sowie dem Ausmaß des peripheren Sättigungsabfalls. Eine signifikante Korrelation mit dem Schlafstadium konnte nicht hergestellt werden. Je länger demnach eine Apnoe ist bzw. je stärker der peripher gemessene Sauerstoffabfall, desto stärker ist auch der zerebrale Sauerstoffabfall. Es ist zu vermuten, dass wiederkehrende Episoden von Hypoxie während zentraler Apnoen und zentraler Hypopnoen über Jahre zu Schädigungen des Gehirns führen und dadurch einen negativen Einfluss auf die Entwicklung von Kindern mit Chiari-II-Malformation haben bzw. eine neurologische Verschlechterung begünstigen. Daher erscheint es wichtig, zSBA möglichst frühzeitig aufzudecken und zu behandeln. / Central Apnea are very common in Children with Meningomyelocele and Chiari-II-Malfromation. Previous studies showed, that these central Apneas often are assotiated with peripheral Deoxygenation. To show, wether these deoxygenations are just a phenomenon of peripheral circulation or if they are affecting the cerebral oxygenation we used Near-infrared-Spectroskopy (NIRS). NIRS is a method for continously, noninvasively monitoring cerebral oxygenation (NIRO-200 Fa. Hamamatsu). This study shows, that there is a typical reaction of cerebral parameters: dedrease of oxygenatet heamoglobin, increase of deoxy-heamoglobin and decrease of tissue oxygenation index. In addition it is shown that the duration and the peripheral Desaturation have an impact on cerebral Deoxygenation.

This master‘s thesis deals with a detailed description of sleep apnea and methods of detection of sleep apnea. The first part of the work is focused on the physiology of sleep, sleep apnea itself, its distribution, symptoms, risk factors and treatment. The next part of the work deals with polysomnographic examination and methods for analysis of polysomnographic data. The last part is devoted to the procedure design for detecting sleep apnea by using only one kind of signal and by using more kinds of signals, implementation of these proposals, their testing on real data, evaluating the detection performance and comparing the results with data available in the literature.

This thesis deals with the detection of sleep apnea using polysomnographic data and attempt to find a possible alternative and simpler method of this detection. The thesis consists of three parts: The first part is important for introduction to the lungs anatomy and the physiology of breathing and the sleep phisiology. The second part deals with the ways of testing sleep apnea. The third part then continues with implementation of alternative methods of testing in Matlab software. The final program calculates the breathing curve from ECG data. The curve is important for the final detection of sleep apnea.

No abstract available

Title: The influence of spinning on a time extension in the static apnea during free diving Objectives: The objective of this work was to find out whether even a short and intensive training can have an affect on the increase of a vital lung capacity, on a time extension in the static apnea, and on a performance improvement during free diving. Methods: The search of available literature and its recherche. Measurement methods determination: digital stopwatch for the apnea, spirometer for the vital lung capacity, and a Sport-tester and a Borg scale for the spinning program. Data collection. Results: The statistical analysis of the values of a vital lung capacity and a static apnea before and after sports training Keywords: diving, vital lung capacity, spinning, apnea, free diving

Background: Sufficiently long and high-quality sleep is necessary for the daily renewal of brain and cognitive activity as well as for the maintenance of the whole organism. Apnea is defined as complete cessation of respiration or reduction of respiratory flow by more than 90% continuously for at least 10 seconds. The repeated respiratory arrest comes in repeated series. They are caused by episodes of upper airway obstruction, caused by an increased tendency of the airway walls to collapse. Sleep is an important lifestyle factor that needs to be addressed along with diet and physical activity. Short sleep leads to greater desire for food and sweets high in fat. Aim: The aim of this work was to determine the eating habits of patients with sleep apnea syndrome (OSA) and to compare the data with patients with simple ronchopathy. Methodology: Data collection took place in a specialized ENT clinic for sleep disorders at the University Hospital Ostrava for three months. A questionnaire was completed with newly arrived patients with regard to the eating habits of patients and anthropometric indicators, and physical activity. After that, the patients were clinically examined, and a limited polygraphy was performed, according to which the patients were divided. The collected data were statistically...

Author's first name and surname: Bc. Martin Dvořáček Title of the master thesis: Physiotherapy as a way to improve adherence to CPAP therapy of patients with obstructive sleep apnea syndrom Department: Department of physiotherapy Supervisor: Mgr. Petr Bitnar The year of presentation: 2018 Abstract: Obstructive sleep apnea is the most common type of sleeping disorder. It is characterized by an excessive daytime sleepiness, deficits of cognitive functions, serious cardiovascular issues and general decrease in the quality of life. The golden standard of the treatment is CPAP therapy. However the long-term disadvantage of this method is the low rate of patients adherence. The minimum requirements for CPAP machines usage are only met by approximately fifty percent of the patients. The presented thesis is divided into three main parts. Firstly, the positive effects of CPAP therapy such as reduction of excessive daytime sleepiness, improvement of cognitive functions and overall increase of life quality of the patients were reviewed. In the next part the relationship between the monitored factors and patients adherence to CPAP was investigated. Lastly, the desired increase of patients adherence to CPAP therapy was tested. Selected patients were divided into three different groups according to their therapeutical...

Sleep apnea syndrome, or sleep apneic syndrome, is a serious illness that causes a high risk of cardiovascular disease development in patients. This disease is characterized by a breathless breathing disorder and falls into a class of disorder that accompanies sleep disturbances. Sleep apnea syndrome (SAS) affects 5-15% of the population, and 50-80% of patients with type 2 diabetes mellitus (T2DM) or severe obesity. SAS has a causal contribution to the development of disorders in glucose metabolism and T2DM. Diabetes mellitus type 2 is a complex metabolic disorder in which the organism is unable to process glucose as under normal physiological conditions due to a relative insulin deficiency and simultaneous peripheral insulin resistance. Insulin resistance is eventually compensated for by increased insulin secretion, which leads to the development of hyperglycemia after failure of this compensation. T2DM is very often associated with the presence of obesity, arterial hypertension, dyslipidemia and hyperuricemia. The aim of this study is to determine if the presence of SAS in non-diabetic subjects and patients with type 2 diabetes mellitus leads to disorders in the metabolism of fatty acids in the skeletal muscle. The results of the study contribute to the understanding of the molecular mechanisms...

Title: Prolonged apnea: monitoring brain activity in freedivers Objectives: The aim of this study is to monitor the brain electrical activity during the prolonged apnea in freedivers. Prolonged apnea in the water and prolonged dry apnea were compared to each other and also to a resting state before the apnea, all states with the eyes closed. Brain activity was obtained from the scalp EEG and evaluated using the sLORETA program. Methods: The research was conducted in 11 healthy men at the age of 23 - 51. The data was obtained from the scalp EEG. The record was first taken at a resting state before the apneas with eyes closed, then at maximum prolonged dry apnea with eyes closed and finally at maximum prolonged apnea in the water with eyes closed. The lenghts of the prolonged apneas ranged from 2:15 minutes to 5:30 minutes in idividual probands. There were pauses of at least three minutes between each apnea as by the proband's needs. The compared pair groups were following: prolonged apnea in the water against prolonged dry apnea, prolonged apnea in the water against resting state before the apnea and finally prolonged dry apnea against resting state before the apnea, all with the eyes closed. Selected sections of EEG record without artefacts were processed by sLORETA program. In the statistical...