Skip to main content
Log in

Obstruktive Schlafapnoe als Risikofaktor der Arteriosklerose

Obstructive sleep apnea as a risk factor for atherosclerosis

  • Schwerpunkt
  • Published:
Somnologie - Schlafforschung und Schlafmedizin Aims and scope Submit manuscript

Zusammenfassung

Die obstruktive Schlafapnoe (OSA) ist assoziiert mit Arteriosklerose und ihren Folgeerkrankungen wie Myokardinfarkt und ischämischem zerebralem Insult. Die pathophysiologischen Interaktionen umfassen neurale, vaskuläre, mechanische, inflammatorische und metabolische Mechanismen, die durch repetitive Hypoxämien verursacht sind und zur Progression der kardiovaskulären Erkrankungen führen. Beobachtungsstudien legen für die Therapie mit CPAP („continuous positive airway pressure“) mehrere günstige Effekte auf kardiovaskuläre Erkrankungen und ihre Prognose nahe; die Bewertung dieser Daten sowie eine definitive Therapiestrategie sind jedoch durch den Mangel an prospektiven, randomisierten Daten limitiert.

Abstract

Obstructive sleep apnea (OSA) is associated with atherosclerosis and its consequences including myocardial infarction and stroke. The pathophysiological interactions comprise neural, vascular, mechanical, inflammatory, and metabolic mechanisms, which are caused by repetitive hypoxemia and contribute to cardiovascular disease progression. In mostly observational, albeit valuable studies, treatment with CPAP (continuous positive airway pressure) has been shown to exert several beneficial effects on cardiovascular disease and prognosis; however, evaluation of the data as well as a definitive therapeutic strategy is limited by lack of prospective, randomized data.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1
Abb. 2

Literatur

  1. Skowasch D, Nickenig G (2009) Atherosklerose. In: Classen, Diehl, Kochsiek et al (Hrsg) Lehrbuch Innere Medizin, 6. Aufl. Urban & Fischer, München, S 62–68

  2. Werner N, Kosiol S, Schiegl T et al (2005) Circulating endothelial progenitor cells and cardiovascular outcomes. N Engl J Med 353:999–1007

    Article  CAS  PubMed  Google Scholar 

  3. Andrié R, Bauriedel G, Braun P et al (2009) Increased expression of C-reactive protein and tissue factor in acute coronary syndrome lesions. Atherosclerosis 202:135–143

    Article  PubMed  Google Scholar 

  4. Podszus T, Seevers H, Mayer G, Baumann G (2009) Positionspapier „Schlafmedizin in der Kardiologie“ Kardiologe 3:9–15

    Google Scholar 

  5. Caples SM, Garcia-Touchard A, Somers VK (2007) Sleep-disordered breathing and cardiovascular risk. Sleep 30:291–304

    PubMed  Google Scholar 

  6. Lüthje L, Andreas S (2008) Obstructive sleep apnea and coronary artery disease. Sleep Med Rev 12:19–31

    Article  PubMed  Google Scholar 

  7. Lopez-Jimenez F, Kuniyoshi FHS, Gami A, Somers VK (2008) Obstructive sleep apnea. Implications of cardiac and vascular disease. Chest 133:793–804

    Article  PubMed  Google Scholar 

  8. Somers VK, White DP, Amin R et al (2008) Sleep apnea and cardiovascular disease. Circulation 118:1080–1111

    Article  PubMed  Google Scholar 

  9. Schulz R, Eisele HJ, Weissmann N, Seeger W (2006) Obstruktive Schlafapnoe – ein wichtiger kardiovaskulärer Risikofaktor. Dtsch Arztebl 103:A775–A781

    Google Scholar 

  10. Somers VK, Dyken ME, Clary MP, Abboud FM (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 96:1897–1904

    Article  CAS  PubMed  Google Scholar 

  11. Phillips BG, Narkiewicz K, Pesek CA et al (1999) Effects of obstructive sleep apnea on endothelin-1 and blood pressure. J Hypertens 17:61–66

    CAS  PubMed  Google Scholar 

  12. Teramoto S, Kume H, Matsuse T et al (2003) Oxygen administration improves the serum level of nitric oxide metabolites in patients with obstructive sleep apnea syndrome. Sleep Med 4:403–407

    Article  PubMed  Google Scholar 

  13. Kraici H, Caidahl K, Samuelsson A et al (2001) Impairment of vascular endothelial function and left ventricular filling: association with the severity of apnea-induced hypoxemia during sleep. Chest 119:1085–1091

    Article  Google Scholar 

  14. Lavie L, Lavie P (2009) Molecular mechanisms of cardiovascular disease in OSAHS: the oxidative stress link. Eur Respir J 33:1467–1484

    Article  CAS  PubMed  Google Scholar 

  15. Arias MA, Garcia-Rio F, Alonso-Fernandez A et al (2005) Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects of nasal continuous positive airway pressure in men. Circulation 112:375–383

    Article  PubMed  Google Scholar 

  16. Ohga E, Tomita T, Wada H et al (2003) Effects of obstructive sleep apnea on circulating ICAM-1, IL-8, and MCP-1. J Appl Physiol 94:179–184

    CAS  PubMed  Google Scholar 

  17. Zund G, Uezono S, Stahl GL et al (1997) Hypoxia enhances induction of endothelial ICAM-1: role for metabolic acidosis and proteasomes. Am J Physiol 273:C1571–C1580

    CAS  PubMed  Google Scholar 

  18. Dyugoskava L, Lavie P, Lavie L (2002) Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am J Respir Crit Care Med 165:934–939

    Google Scholar 

  19. Shamsuzzaman AS, Winnicki M, Lanfranchi P et al (2002) Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 105:1462–1464

    Article  Google Scholar 

  20. Svatikova A, Wolk R, Shamsuzzaman AS et al (2003) Serum amyloid A in obstructive sleep apnea. Circulation 108:1451–1454

    Article  CAS  PubMed  Google Scholar 

  21. Larkin EK, Rosen CL, Kirchner HL et al (2005) Variation of C-reactive protein levels in adolescents: association with sleep-disordered breathing and sleep duration. Circulation 111:1978–1984

    Article  CAS  PubMed  Google Scholar 

  22. Guillemiault C, Kirisoglu C, Ohayon MM (2004) C-reactive protein and sleep-disordered breathing. Sleep 27:1507–1511

    Google Scholar 

  23. Jelic S, Padeletti M, Kawut SM et al (2008) Inflammation, oxidative stress and repair capacity of the vascular endothelium in obstructive sleep apnea. Circulation 117:2270–2278

    Article  CAS  PubMed  Google Scholar 

  24. Ip MS, Tse HF, 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 

  25. Nieto FJ, Herrington DM, Redline S et al (2004) Sleep apnea and marker of vascular endothelial function in a large community sample of older adults. Am J Crit Care Med 169:354–360

    Article  Google Scholar 

  26. El Solh AA, Akkinnusi ME, Baddoura FH, Mankowski CR (2007) Endothelial cell apoptosis in obstructive sleep apnea: a link to endothelial dysfunction. Am J Respir Crit Care Med 175:1186–1191

    Article  Google Scholar 

  27. von Känel R, Loredo JS, Ancoli-Israel S et al (2007) Association between polysomnographic measures of disrupted sleep and prothrombotic factors. Chest 131:733–739

    Article  Google Scholar 

  28. Phillips BG, Hisel TM, Kato M et al (1999) Recent weight gain in patients with newly diagnosed obstructive sleep apnea. J Hypertens 17:1297–1300

    Article  CAS  PubMed  Google Scholar 

  29. Chin K, Shimizu K, Nakamura T et al (1999) Changes in intraabdominal visceral fat and serum leptin levels in patients with obstructive sleep apnea syndrome following nasal continuous sleep apnea pressure therapy. Circulation 100:706–712

    CAS  PubMed  Google Scholar 

  30. Philipps BG, Kato M, Narkiewicz K et al (2000) Increases in leptin levels, sympathetic drive and weight gain in obstructive sleep apnea. Am J Physiol Heart Circ Physiol 279:H234–H237

    Google Scholar 

  31. Barelo A, Barbe F, Llompart E et al (2005) Neuropeptide Y and leptin in patients with obstructive sleep apnea syndrome: role of obesity. Am J Respir Crit Care Med 171:183–187

    Article  Google Scholar 

  32. Coughlin SR, Mawdyley L, Mugarza JA et al (2004) Obstructive sleep apnea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 25:735–741

    Article  PubMed  Google Scholar 

  33. McArdle N, Hillman D, Beilin L, Watts G (2007) Metabolic risk factors for vascular disease in obstructive sleep apnea: a link to endothelial dysfunction. Am J Respir Crit Care Med 175:190–195

    Article  CAS  PubMed  Google Scholar 

  34. Ip MS, Lam B, Ng MM et al (2002) Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 165:670–676

    PubMed  Google Scholar 

  35. Elmasry A, Lindberg E, Berne C et al (2001) Sleep-disordered breathing and glucose metabolism in hypertensive men: a population-based study. J Intern Med 249:153–161

    Article  CAS  PubMed  Google Scholar 

  36. Iiyori N, Alonso LC, Li J et al (2007) Intermittent hypoxia causes insulin resistance in lean mice independent of autonomic activity. Am J Respir Crit Care Med 175:851–857

    Article  CAS  PubMed  Google Scholar 

  37. Savransky V, Nanayakkara A, Li J et al (2007) Chronic intermittent hypoxia induces atherosclerosis. Am J Respir Crit Care Med 175:1290–2197

    Article  CAS  PubMed  Google Scholar 

  38. 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 

  39. Sorajja D, Gami AS, Somers VK et al (2008) Independent association between obstructive sleep apnea and subclinical coronary artery disease. Chest 133:927–933

    Article  PubMed  Google Scholar 

  40. Drager LF, Bortolotto LA, Figueiredo AC et al (2007) Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am Respir Crit Care Med 176:706–712

    Article  CAS  Google Scholar 

  41. Wattanakit K, Boland L, Punjabi NM, Shabar E (2008) Relation of sleep-disordered breathing to carotid plaque and intima-media thickness. Atherosclerosis 197:125–131

    Article  CAS  PubMed  Google Scholar 

  42. Schäfer H, Koehler U, Ewig S et al (1999) Obstructive sleep apnea (OSA) as risk factor in coronary artery disease. Cardiology 92:79–84

    Article  PubMed  Google Scholar 

  43. Mooe T, Franklin KA, Holmstrom K et al (2001) Sleep-disordered breathing and coronary artery disease: long-term prognosis. Am J Respir Crit Care Med 164:1910–1913

    CAS  PubMed  Google Scholar 

  44. Shahar E, Whitney DW, Redline S et al (2001) Sleep-disordered breathing and cardiovascular disease. Cross sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163:19–25

    CAS  PubMed  Google Scholar 

  45. Marin JM, Carrizo SJ, Vicente E, Augusti AGN (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnea-hypopnea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053

    PubMed  Google Scholar 

  46. Arzt M, Young T, Finn L et al (2005) Association of sleep-disordered breathing and the occurrence of stroke. J Respir Crit Care Med 172:1447–1451

    Article  Google Scholar 

  47. Yaggi HK, Concato J, Kernan WN et al (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353:2034–2041

    Article  CAS  PubMed  Google Scholar 

  48. Yumino D, Tsurumi Y, Takagi A et al (2007) Impact of obstructive sleep apnea on clinical and angiographic outcomes following percutaneous coronary intervention in patients with acute coronary syndrome. Am J Cardiol 99:26–30

    Article  PubMed  Google Scholar 

  49. Valham F, Mooe T, Rabben T et al (2008) Increased risk of stroke in patients with coronary artery disease and sleep apnea: A 10-year follow-up. Circulation 118:995–960

    Article  Google Scholar 

  50. Doherty LS, Kiely JL, Swan V, McNicholas WT (2005) Long-term effect of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome. Chest 127:2076–2084

    Article  PubMed  Google Scholar 

  51. Milleron O, Pilliere R, Foucher A et al (2004) Benefits of obstructive sleep apneas treatment in coronary artery disease: a long-term follow-up study. Eur Heart J 25:728–734

    Article  PubMed  Google Scholar 

  52. Martinez-Garzia MA, Galiano-Blancart R, Roman-Sanchez P et al (2005) Continuous positive airway pressure treatment in sleep apnea prevents new vascular events after ischemic stroke. Chest 128:2123–2129

    Article  Google Scholar 

  53. Buchner NJ, Sanner BM, Borgel J, Rump LC (2007) Continuous positive airway pressure treatment of mild to moderate obstructive sleep apnea reduces cardiovascular risk. Am J Respir Crit Care Med 176:1274–1280

    Article  PubMed  Google Scholar 

  54. Cassar A, Morgenthaler TI, Lennon RJ et al (2008) Treatment of obstructive sleep apnea is associated with decreased cardiac death after percutaneous coronary intervention. J Am Coll Cardiol 50:1310–1314

    Article  Google Scholar 

  55. Peled N, Abinader EG, Pillar G et al (1999) Nocturnal ischemic events in patients with obstructive sleep apnea syndrome and ischemic heart disease: effects of continuous positive air pressure treatment J Am Coll Cardiol 34:1744–1749

    Google Scholar 

  56. Parra O, Arboix A, Bechich S et al (2000) Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack. Am J Respir Crit Care Med 161:375–380

    CAS  PubMed  Google Scholar 

  57. Franklin KA (2002) Cerebral haemodynamics in obstructive sleep apnea and Cheyne-Stokes respiration. Sleep Med Rev 6:429–441

    Article  PubMed  Google Scholar 

  58. Minoguchi K, Yokoe T, Tazaki T et al (2007) Silent brain infarction and platelet activation in obstructive sleep apnea. Am J Respir Crit Care Med 17:612–617

    Article  Google Scholar 

  59. Hu FB, Willett WC, Manson JE et al (2000) Snoring and risk of cardiovascular disease in women. J Am Coll Cardiol 35:308–313

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to D. Skowasch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Skowasch, D., Bönner, G. & Nickenig, G. Obstruktive Schlafapnoe als Risikofaktor der Arteriosklerose. Somnologie 13, 215–220 (2009). https://doi.org/10.1007/s11818-009-0436-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11818-009-0436-2

Schlüsselwörter

Keywords

Navigation