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Schlafapnoe und Herzinsuffizienz

Sleep apnea and heart failure

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Zusammenfassung

Schlafapnoe-Syndrome (SAS) beeinflussen die Funktion des Herz-Kreislauf-Systems. So können sie die Entstehung einer Herzinsuffizienz begünstigen. Umgekehrt kann eine chronische Herzinsuffizienz zum Auftreten eines Schlafapnoe-Syndroms führen. Diese wechselseitige Beziehung führt dazu, dass klinisch relevante Schlafapnoe-Syndrome bei Patienten mit einer symptomatischen Herzinsuffizienz besonders häufig sind. Dabei gibt es etwa ebenso viele zentrale (ZSAS) wie obstruktive (OSAS) Schlafapnoe-Syndrome. Beide Formen des Schlafapnoe-Syndroms führen zu rezidivierenden Apnoe-Phasen, die zu O2-Entsättigungen führen, welche einen Anstieg der Katecholaminspiegel im Blut zur Folge haben. Dies ist möglicherweise der entscheidende Mechanismus, der zu einer deutlich schlechteren Prognose von Patienten mit Herzinsuffizienz und SAS im Vergleich zu Patienten mit Herzinsuffizienz ohne SAS führt. Daher sollte ein regelmäßiges Screening aller Patienten mit Herzinsuffizienz auf ein Schlafapnoe-Syndrom erfolgen. Ob die Therapie eines SAS, insbesondere eines ZSAS, auch zu einer Verbesserung der Prognose von Patienten mit Herzinsuffizienz führt, wird derzeit in klinischen Studien überprüft (SERVE-HF, ADVENT-HF). Ein neuer Therapieansatz des zentralen Schlafapnoe-Syndroms ist die Stimulation des Nervus phrenicus, durch die Zwerchfellkontraktionen und damit Atemzüge getriggert werden können.

Abstract

Sleep apnea can influence cardiac function, by which the development of heart failure is facilitated. Vice versa, chronic heart failure increases the risk for sleep apnea. Consequently, in patients with symptomatic chronic heart failure, sleep apnea is a frequent comorbidity occuring in up to 75% of cases. More than half of those suffer from central sleep apnea, whereas in the general population, obstructive sleep apnea is far more frequent. Both, the obstructive and the central sleep apnea lead to oxygen desaturations during the night which are followed by increases in serum catecholamines. Possibly, this is the main mechanism why the prognosis of patients with symptomatic heart failure and sleep apnea is much worse than that of patients without sleep apnea. Therefore, a screening of all heart failure patients for sleep apnea is mandatory. Currently, large studies are underway which investigate whether the treatment of sleep apnea, esp. central sleep apnea, will beneficially influence the clinical course of heart failure (SERVE-HF, ADVENT-HF). A new therapeutic approach for central sleep apnea is the phrenic nerve stimulation.

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Literatur

  1. Zeller J, Hetzenecker A, Arzt M (2013) Sleep-disordered breathing in patients with chronic heart failure: epiphenomenon or bidirectional relationship. Pneumologie 67(3):150–156

    Article  PubMed  CAS  Google Scholar 

  2. Gottlieb DJ, Yenokyan G, Newman AB, O’Connor GT et al (2010) Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation 122:352–360

    Article  PubMed  Google Scholar 

  3. Oldenburg O, Lamp B, Faber L et al (2007) Sleep-disordered breathing in patients with symptomatic heart failure: a contemporary study of prevalence in and characteristics of 700 patients. Eur J Heart Fail 9(3):251–257

    Article  PubMed  Google Scholar 

  4. Bitter T, Faber L, Hering D et al (2009) Sleep-disordered breathing in heart failure with normal ejection fraction. Eur J Heart Fail 11:602–608

    Article  PubMed  Google Scholar 

  5. Mayer G, Fietze I, Fischer J et al (2009) S3-Leitlinie „Nicht-erholsamer Schlaf“. Somnologie 13:4–160

    Article  Google Scholar 

  6. Westhoff M (2013) Sleep related breathing disorders – classification, epidemiology, clinic, diagnostics and therapy. Klinikarzt 42(1):12–18

    Article  Google Scholar 

  7. Lurie A (2011) Obstructive sleep apnea in adults: epidemiology, clinical presentation, and treatment options. Adv Cardiol 46:1–42

    Article  PubMed  Google Scholar 

  8. Dempsey JA, Veasey SC, Morgan BJ et al (2010) Pathophysiology of sleep apnea. Physiol Rev 90:47–112

    Article  PubMed  CAS  Google Scholar 

  9. Younes M (2008) Role of respiratory control mechanisms in the pathogenesis of obstructive sleep disorders. J Appl Physiol 105:1389–1405

    Article  PubMed  CAS  Google Scholar 

  10. Westhoff M, Arzt M, Litterst P (2012) Prevalence and treatment of central sleep apnoea emerging after initiation of continuous positive airway pressure in patients with obstructive sleep apnoea without evidence of heart failure. Sleep Breath 16:71–78

    Article  PubMed  Google Scholar 

  11. Berry RB, Budhiraja R, Gottlieb DJ et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619

    PubMed  Google Scholar 

  12. Büchner N, Sanner B (2013) Sleep and cardiac symptoms – interaction between sleep-related breathing disorders and cardiac diseases. Klinikarzt 42(1):20–26

    Google Scholar 

  13. Bradley TD, Floras JS (2003) Sleep apnea and heart failure: Part II: central sleep apnea. Circulation 107:1822–1826

    Article  PubMed  Google Scholar 

  14. Ip MS, Tse H, Lam B et al (2004) Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med 169:348–353

    Article  PubMed  Google Scholar 

  15. Minoguchi K, Yokoe T, Tazaki T et al (2005) Increased carotid intima-media thickness and serum inflammatory markers in obstructive sleep apnea. Am J Respir Crit Care Med 172:625–630

    Article  PubMed  Google Scholar 

  16. Marin JM, Carrizo SJ, Vicente E et al (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053

    PubMed  Google Scholar 

  17. Drager LF, Bortolotto LA, Lorenzi MC et al (2005) Early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 172:613–618

    Article  PubMed  Google Scholar 

  18. Westhoff M, Litterst P (2012) Obstruktive Schlafapnoe und oxidativer Stress. Pneumologie 66:610–615

    Article  PubMed  CAS  Google Scholar 

  19. Ross R (1999) Atherosclerosis – an inflammatory disease. N Engl J Med 340:115–126

    Article  PubMed  CAS  Google Scholar 

  20. Shimokawa H (1999) Primary endothelial dysfunction: atherosclerosis. J Mol Cell Cardiol 31:23–37

    Article  PubMed  CAS  Google Scholar 

  21. Schulz R, Seeger W, Fegbeutel C et al (2005) Changes in extracranial arteries in obstructive sleep apnoea. Eur Respir J 25:69–74

    Article  PubMed  CAS  Google Scholar 

  22. Suzuki M, Guilleminault C, Otsuka K et al (1996) Blood pressure „dipping“ and „non-dipping“ in obstructive sleep apnea syndrome patients. Sleep 19:382–387

    PubMed  CAS  Google Scholar 

  23. Calhoun DA, Jones D, Textor S et al (2008) Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 117:e510–e526

    Article  PubMed  Google Scholar 

  24. Shivalkar B, Heyning C van de, Kerremans M et al (2006) Obstructive sleep apnea syndrome: more insights on structural and functional cardiac alterations, and the effects of treatment with continuous positive airway pressure. J Am Coll Cardiol 47:1433–1439

    Article  PubMed  Google Scholar 

  25. Wang Q, Xi B, Liu M et al (2012) Short sleep duration is associated with hypertension risk among adults: a systematic review and meta-analysis. Hypertens Res 35:1012–1018

    Article  PubMed  Google Scholar 

  26. Verdecchia P, Schillaci G, Guerrieri M et al (1990) Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 81:528–536

    Article  PubMed  CAS  Google Scholar 

  27. Mehra R, Benjamin EJ, Shahar E et al (2006) Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 173:910–916

    Article  PubMed  Google Scholar 

  28. Gami AS, Hodge DO, Herges RM et al (2007) Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol 49:565–571

    Article  PubMed  Google Scholar 

  29. Yumino D, Redolfi S, Ruttanaumpawan P et al (2010) Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure. Circulation 121:1598–1605

    Article  PubMed  Google Scholar 

  30. Redolfi S, Yumino D, Ruttanaumpawan P et al (2009) Relationship between overnight rostral fluid shift and obstructive sleep apnea in nonobese men. Am J Respir Crit Care Med 179:241–246

    Article  PubMed  Google Scholar 

  31. Lorenzi-Filho G, Azevedo ER, Parker JD et al (2002) Relationship of carbon dioxide tension in arterial blood to pulmonary wedge pressure in heart failure. Eur Respir J 19:37–40

    Article  PubMed  CAS  Google Scholar 

  32. Solin P, Bergin P, Richardson M et al (1999) Influence of pulmonary capillary wedge pressure on central apnea in heart failure. Circulation 99:1574–1579

    Article  PubMed  CAS  Google Scholar 

  33. Arzt M, Harth M, Luchner A et al (2003) Enhanced ventilatory response to exercise in patients with chronic heart failure and central sleep apnea. Circulation 107:1998–2003

    Article  PubMed  Google Scholar 

  34. Tkacova R, Hall MJ, Liu PP et al (1997) Left ventricular volume in patients with heart failure and Cheyne-Stokes respiration during sleep. Am J Respir Crit Care Med 156:1549–1555

    Article  PubMed  CAS  Google Scholar 

  35. Naughton M, Benard D, Tam A et al (1993) Role of hyperventilation in the pathogenesis of central sleep apneas in patients with congestive heart failure. Am Rev Respir Dis 148:330–338

    Article  PubMed  CAS  Google Scholar 

  36. Solin P, Bergin P, Richardson M et al (1999) Influence of pulmonary capillary wedge pressure on central apnea in heart failure. Circulation 99:1574–1579

    Article  PubMed  CAS  Google Scholar 

  37. Garrigue S, Bordier P, Jais P et al (2002) Benefit of atrial pacing in sleep apnea syndrome. N Engl J Med 346:404–412

    Article  PubMed  Google Scholar 

  38. Sinha AM, Skobel EC, Breithardt OA et al (2004) Cardiac resynchronization therapy improves central sleep apnea and Cheyne-Stokes respiration in patients with chronic heart failure. J Am Coll Cardiol 44:68–71

    Article  PubMed  Google Scholar 

  39. Mansfield DR, Solin P, Roebuck T et al (2003) The effect of successful heart transplant treatment of heart failure on central sleep apnea. Chest 124:1675–1681

    Article  PubMed  Google Scholar 

  40. Javaheri S, Abraham WT, Brown C et al (2004) Prevalence of obstructive sleep apnoea and periodic limb movement in 45 subjects with heart transplantation. Eur Heart J 25:260–266

    Article  PubMed  Google Scholar 

  41. McMurray JJV, Adamopoulos S, Anker SD et al (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 14(8):803–869

    Article  PubMed  CAS  Google Scholar 

  42. Kushida CA, Littner MR, Hirshkowitz M et al; American Academy of Sleep Medicine (2006) Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 29:375–380

    PubMed  Google Scholar 

  43. Tkacova R, Rankin F, Fitzgerald FS et al (1998) Effects of continuous positive airway pressure on obstructive sleep apnea and left ventricular afterload in patients with heart failure. Circulation 98:2269–2275

    Article  PubMed  CAS  Google Scholar 

  44. Usui K, Bradley TD, Spaak J et al (2005) Inhibition of awake sympathetic nerve activity of heart failure patients with obstructive sleep apnea by nocturnal continuous positive airway pressure. J Am Coll Cardiol 45:2008–2011

    Article  PubMed  Google Scholar 

  45. Naughton MT, Benard DC, Liu PP et al (1995) Effects of nasal CPAP on sympathetic activity in patients with heart failure and central sleep apnea. Am J Respir Crit Care Med 152:473–479

    Article  PubMed  CAS  Google Scholar 

  46. Naughton MT, Rahman MA, Hara K et al (1995) Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circulation 91:1725–1731

    Article  PubMed  CAS  Google Scholar 

  47. Kaneko Y, Floras JS, Usui K et al (2003) Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med 348:1233–1241

    Article  PubMed  Google Scholar 

  48. Malone S, Liu PP, Holloway R et al (1991) Obstructive sleep apnoea in patients with dilated cardiomyopathy: effects of continuous positive airway pressure. Lancet 338:1480–1484

    Article  PubMed  CAS  Google Scholar 

  49. Bradley TD, Logan AG, Kimoff RJ et al (2005) Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med 353:2025–2033

    Article  PubMed  CAS  Google Scholar 

  50. Arzt M, Floras JS, Logan AG et al (2007) Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure: a post hoc analysis of the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure Trial (CANPAP). Circulation 115:3173–3180

    Article  PubMed  Google Scholar 

  51. Teschler H, Dohring J, Wang YM et al (2001) Adaptive pressure support servo-ventilation: a novel treatment for Cheyne-Stokes respiration in heart failure. Am J Respir Crit Care Med 164:614–619

    Article  PubMed  CAS  Google Scholar 

  52. Allam JS, Olson EJ, Gay PC et al (2007) Efficacy of adaptive servoventilation in treatment of complex and central sleep apnea syndromes. Chest 132:1839–1846

    Article  PubMed  Google Scholar 

  53. Aurora RN, Chowdhuri S, Ramar K et al (2012) The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses. Sleep 35:17–40

    PubMed  Google Scholar 

  54. Sharma BK, Bakker JP, McSharry DG et al (2012) Adaptive servo-ventilation for treatment of sleep-disordered breathing in heart failure: a systematic review and meta-analysis. Chest 142:1211–1221

    Article  PubMed  Google Scholar 

  55. Randerath WJ, Nothofer G, Priegnitz C et al (2012) Long-term auto-servoventilation or constant positive pressure in heart failure and coexisting central with obstructive sleep apnea. Chest 142:440–447

    Article  PubMed  CAS  Google Scholar 

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. J. Müller-Ehmsen und T. Plenge geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    T. Plenge &  J. Müller-Ehmsen

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Plenge, T., Müller-Ehmsen, J. Schlafapnoe und Herzinsuffizienz. Herz 38, 604–609 (2013). https://doi.org/10.1007/s00059-013-3878-z

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