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Was hustet und juckt da im Dunkeln?

Nächtliches Asthma und allergieinduzierte Schlafstörungen bei Kindern und Jugendlichen

Who is coughing and itching in the dark?

Nocturnal asthma and allergy-induced sleep disorder in children and adolescents

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Zusammenfassung

Sowohl Asthma, atopische Dermatitis und allergische Rhinitis zeigen eine ausgeprägte zirkadiane Rhythmik mit einem Beschwerdemaximum in der Nacht. Die damit einhergehende Schlaffragmentation führt dazu, dass die betroffenen Kinder häufig unter Tagesschläfrigkeit und einer relevanten Beeinträchtigung der Lebensqualität leiden. Aufgrund der diagnostischen Lücke zur objektiven Erfassung werden nächtliche Asthmasymptome und allergieinduzierte Schlafstörungen in ihrer Häufigkeit deutlich unterschätzt. Daher sollten bei der Langzeitbetreuung von Patienten mit Asthma, atopischer Dermatitis oder allergischer Rhinitis die strukturierte Erfassung schlafbezogener Beschwerden, sowie die regelmäßige Messung von Schlafqualität und Tagesschläfrigkeit zur Routine gehören. Umgekehrt müssen die sehr häufigen Erkrankungen des atopischen Formenkreises bei der (primär somnologischen) Abklärung von Tagesschläfrigkeit im Kindes- und Jugendalter differenzialdiagnostisch mit in Betracht gezogen werden. Da Asthma und das obstruktive Schlafapnoesyndrom oft gemeinsam auftreten, sollte bei Diagnosestellung der einen Erkrankung auch gezielt nach der jeweils anderen gesucht werden.

Abstract

Asthma, atopic dermatitis, and allergic rhinitis display a marked circadian variation with the maximum of disease activity during the night. Due to the consecutive disruption of sleep architecture, affected children often suffer from daytime sleepiness and have reduced quality of life. Currently there is a diagnostic gap in detecting nocturnal asthma and allergy symptoms, leading to a significant underestimation of the frequency.

Caring for children with asthma, atopic dermatitis, and/or rhinitis should include standardized detection of nocturnal symptoms and a regular assessment of sleep quality and potential daytime sleepiness. Vice versa, in the differential diagnostic of a child with enhanced daytime sleepiness, the very frequent atopic diseases should be routinely considered. As asthma and obstructive sleep apnea syndrome often occur together, the presence of one of these two diseases should prompt the systematic search for the other one.

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Abbreviations

ADHS:

Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung

FEV1:

Forcierte Einsekundenkapazität

IgE:

Immunglobulin E

SCORAD-Index:

Scoring-of-atopic-dermatitis-Index – Score zur Erfassung von Schweregrad und Ausmaß der atopischen Dermatitis

Th2-Zellen:

Subgruppe 2 der T‑Helfer-Zellen

WASO:

wake after sleep onset

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  1. Klinik für Pädiatrische Pneumologie und Allergologie, Kinder-Universitätsklinik Ostbayern (KUNO) am Standort Klinik St. Hedwig, Steinmetzstraße 1–3, 93049, Regensburg, Deutschland

    Sebastian Kerzel MHBA

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S. Kerzel hat Vortragshonorare der Firmen Heinen & Löwenstein GmbH und Nutricia GmbH erhalten.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Kerzel, S. Was hustet und juckt da im Dunkeln?. Somnologie 20, 288–296 (2016). https://doi.org/10.1007/s11818-016-0082-4

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