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Eingeschränkte Leistungsfähigkeit bei pneumologischen Erkrankungen

Hat der Schlaf einen Einfluss?

Reduced exercise capacity and respiratory diseases

Does sleep have an influence?

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Somnologie - Schlafforschung und Schlafmedizin Aims and scope Submit manuscript

Zusammenfassung

Schlafentzug reduziert bei Gesunden die körperliche Leistungsfähigkeit, v. a. bei komplexer motorischer Aktivität. Statische und dynamische Lungenfunktionswerte werden etwa um 5% bei Patienten mit chronisch obstruktiver Lungenerkrankung (COPD) reduziert. Besonders auffällig ist eine zunehmende Hypoventilation bei Schlafentzug, wenn vorher eine hyperkapnische Insuffizienz tagsüber besteht. Bei diesen Patienten zeigt sich auch im Schlaf eine deutliche Steigerung der Hypoventilation, sichtbar an verstärkter Hyperkapnie und Hypoxämie. Das führte zur Hypothese, dass der Schlaf bzw. eine Schlafstörung per se einen Einfluss auf die hyperkapnische Insuffizienz hat.

Die Rekompensation der hyperkapnischen Insuffizienz durch intermittierende Beatmung ist unabhängig von der Dauer der Beatmung während des Schlafs oder im Wachzustand identisch. Dies stärkt die Hypothese, dass der Organismus bei der hyperkapnischen Insuffizienz den Schlaf zumindest teilweise zur Erholung der überlasteten Atemmuskulatur durch Entlastung benutzt, vermutlich durch Wiederauffüllung der Glykogenspeicher im Muskel.

Die vorgestellten Daten zeigen, dass der Schlaf bei der hyperkapnischen Insuffizienz einen positiven Effekt hat. Bei der hypoxischen Insuffizienz hat der Schlaf keinen spezifischen Effekt.

Abstract

Sleep deprivation reduces physical fitness and in particular complex motor abilities in healthy people. Static and dynamic lung function parameters are reduced by 5% in chronic obstructive pulmonary disease (COPD). Progressive hypoventilation associated with sleep deprivation, however, is most notable in the presence of existing hypercapnic insufficiency during the day. Affected patients demonstrate enhanced hypoventilation during sleep, which becomes apparent by pronounced hypercapnea and hypoxemia. This association has led to the hypothesis that sleep and sleep disturbances, respectively, have an impact on the hypercapnic insufficiency.

Intermittent ventilation compensates hypercapnic insufficiency independent from the duration of ventilation in the same manner, regardless of whether the patient is awake or asleep. This reinforces the hypothesis that the human organism suffering from hypercapnea uses sleep to unload and recompensate the overloaded respiratory muscles, most likely by repletion of glycogen stores.

The data in the review suggest that sleep has a positive effect on hypercapnic insufficiency. No specific impact of sleep, however, is seen in hypoxemic insufficiency.

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  1. Schlafmedizin und häusliche Beatmung, FachkrankenhausKloster Grafschaft GmbH, Annostraße 1, 57392, Schmallenberg, Deutschland

    D. Köhler, D. Dellweg & J. Kerl

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  1. D. Köhler
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  2. D. Dellweg
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  3. J. Kerl
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Correspondence to D. Köhler.

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Köhler, D., Dellweg, D. & Kerl, J. Eingeschränkte Leistungsfähigkeit bei pneumologischen Erkrankungen. Somnologie 15, 205–211 (2011). https://doi.org/10.1007/s11818-011-0536-7

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  • DOI: https://doi.org/10.1007/s11818-011-0536-7

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