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Schlafbezogene Atmungsstörungen und Schwangerschaft

Sleep-related breathing disorders and pregnancy

  • Leitthema
  • Published:
Zeitschrift für Pneumologie Aims and scope

Zusammenfassung

Schlafbezogene Atmungsstörungen (SBAS) bei Schwangeren treten in bis zu 30 % der Schwangerschaften auf. Ihre Koinzidenz war und ist ein wenig beachtetes Thema sowohl in der Schlafmedizin, aber ganz besonders auch im klinischen Alltag der Geburtshilfe. Dennoch stellt gerade diese Koinzidenz ein erhebliches Risiko für Schwangerschaftskomplikationen sowohl für die Mutter als auch das Ungeborene dar. Zu den sog. „adverse pregnancy outcomes“, also den nachteiligen Schwangerschaftsverläufen, gehören bei den Müttern u. a. der Gestationshypertonus, der Gestationsdiabetes, die Präeklampsie bzw. Eklampsie, eine gesteigerte Rate von Kaiserschnittentbindungen sowie eine gesteigerte Müttersterblichkeit. Bei den Kindern stehen Fehl‑, Früh- und in seltenen Fällen Totgeburten, ein retardiertes intrauterines Wachstum und postpartale Entwicklungsstörungen in den ersten 6 Lebensjahren im Vordergrund. Die CPAP-Therapie (CPAP: „continuous positive airway pressure“) ist auch bei Schwangeren mit SBAS der Goldstandard der Therapie. In der Literatur stehen nur wenige Studien mit kleinen Patientenkollektiven zu diesem Thema zur Verfügung. Sie zeigen aber einheitlich die positive Wirkung von CPAP im Hinblick auf die oben angeführten Faktoren sowie keine negative Beeinflussung des Schwangerschaftsverlaufs. Sowohl bei Schlafmedizinern als auch insbesondere bei Geburtshelfern ist eine Sensibilisierung für das Thema SBAS und Schwangerschaft erforderlich.

Abstract

Sleep-related breathing disorders (SDB) in pregnant women occurs in up to 30% of pregnancies. The coincidence has been and still is a relatively neglected topic in sleep medicine and especially in the clinical routine in obstetrics; nevertheless, the coincidence of SDB and pregnancy represents a substantial risk for both the mother and the unborn child. With respect to adverse pregnancy outcomes, pregnant women have an increased risk of gestational hypertension, gestational diabetes, preeclampsia and eclampsia, an increased rate of cesarean sections and an increased maternal mortality. With respect to the children the predominant risks are miscarriage, premature birth and in rare cases stillbirth, retarded intrauterine growth and postpartum developmental disorders in the first 6 years. Continuous positive airway pressure (CPAP) treatment is the gold standard also in pregnant women. Only a few studies on CPAP treatment with small patient collectives are available in the literature; however, they uniformly show the positive effect of CPAP with respect to the abovementioned factors with no negative influences on the course of pregnancy. For both sleep specialists and particularly obstetricians there is a need to raise awareness with respect to the topic of SDB and pregnancy.

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Authors and Affiliations

  1. Medizinische Klinik III, Pneumologie, Pneumologische Onkologie, Allergologie, Schlaf- und Beatmungsmedizin, Theresienkrankenhaus und St. Hedwig Klinik GmbH, Bassermannstr. 1, 68165, Mannheim, Deutschland

    M. Orth

  2. Zentrum für medizinische Lehre, Ruhr-Universität Bochum, Universitätsstr. 150, 44801, Bochum, Deutschland

    T. Schäfer

  3. Klinikum der Universität Witten/Herdecke, Bergisches Lungenzentrum, Klinik für Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin, HELIOS Klinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Deutschland

    K. Rasche

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M. Arzt, Regensburg

C. Schöbel, Essen

Aktualisierte Version der Originalpublikation: Orth M, Rasche K (2016) Auswirkungen und Therapie des obstruktiven Schlafapnoe-Syndroms bei Schwangeren und Ungeborenen. Atemwegs Lungenkrankh 42(11):555–560. https://doi.org/10.5414/ATX02190

https://doi.org/10.1007/s11818-021-00333-5

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Orth, M., Schäfer, T. & Rasche, K. Schlafbezogene Atmungsstörungen und Schwangerschaft. Z Pneumologie 19, 201–223 (2022). https://doi.org/10.1007/s10405-022-00451-3

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