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Schlaf und Demenz

Sleep and dementia

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Zusammenfassung

Schlafstörungen sind auf morphologische Veränderungen des Gehirns zurückzuführen, die bei neurodegenerativen Erkrankungen in vorhersehbaren Stadien ablaufen: Mit zunehmender Schwere einer Demenz nehmen auch Schlafstörungen zu. Die Reduktion des Tiefschlafs, die den Alterungsprozess begleitet, ist bei einer Demenz deutlich ausgeprägter als bei nichtdementen älteren Menschen.

Aufgrund der häufig anzutreffenden Multimorbidität älterer Menschen ist es zwar schwierig abzuschätzen, wie stark Schlafstörungen auf den Neurodegenerationsprozess selbst zurückzuführen sind. Die strukturelle Schädigung neuronaler Systeme macht jedoch eine Rolle neurodegenerativer Prozesse bei der Manifestierung von Schlafstörungen sehr wahrscheinlich. Umgekehrt konnte in Studien nachgewiesen werden, dass Schlafstörungen, geringe Schlafqualität sowie eine obstruktive Schlafapnoe mit einem signifikant erhöhten relativen Risiko für kognitive Beeinträchtigungen oder eine Demenzerkrankung assoziiert sind. Einige Untersuchungsergebnisse deuten zudem darauf hin, dass eine Therapie mit kontinuierlichem positivem Atemwegsdruck (CPAP) die Schlafqualität wie auch die kognitive Leistungsfähigkeit bei leichter und mittelschwerer Demenz signifikant verbessern kann.

Der vorliegende Beitrag stellt zunächst die neuronalen Systeme und Prozesse dar, die für die Regulation von Schlaf und Wachheit verantwortlich sind. Eine Übersicht über die Studienlage zeigt die Wechselwirkung zwischen Schlaf und den kognitiven Symptomen bei einer Demenz auf. Abschließend werden die therapeutischen Optionen zur Behandlung von Schlafstörungen bei Demenzerkrankungen erörtert. Zukünftige Studien zu Demenzerkrankungen sollten systematischer als bisher Schlaf und Schlafstörungen der Betroffenen erfassen.

Abstract

Sleep disorders are attributed to morphological changes of the brain, which in neurodegenerative diseases proceed through predictable stages: sleep disorders worsen as the severity of dementia increases. The reduction of deep sleep that accompanies the aging process is more pronounced in dementia than in elderly people without dementia.

Because of multimorbidity, which is common in elderly people, it is difficult to assess how severe sleep disorders can be attributed to the neurodegeneration process itself. The structural damage to the neuronal system, however, increases the probability of neurodegenerative processes playing a role in the manifestation of sleep disorders. In contrast, it could be proven in studies that sleep disorders, low sleep quality, in addition to obstructive sleep apnoea, are associated with a significantly increase in the relative risk for cognitive impairments or a dementia-related illness. Moreover, some experimental findings indicate that continuous positive airway pressure (CPAP) therapy can significantly improve sleep quality in addition to cognitive ability in slight and moderate dementia.

The present article first outlines the neuronal systems and processes that are responsible for sleep and wakefulness. An overview of the research demonstrates the correlation between sleep and the cognitive symptoms of dementia. Finally, the therapeutic options for the treatment of sleep disorders in dementia-related illnesses are discussed. Future studies on dementia-related illnesses should include the sleep and sleep disorders of those affected in a more systematic way than thus far.

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Authors and Affiliations

  1. Lehrstuhl für vaskuläre Neurologie, Demenz und Altersforschung, Klinik für Neurologie, Universitätsklinikum Essen, Essen, Deutschland

    Dirk M. Hermann

  2. Lehrstuhl für Geriatrie, Fakultät für Gesundheit, Universität Witten-Herdecke, Alfred-Herrhausen-Straße 50, 58448, Witten, Deutschland

    Helmut Frohnhofen

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Hermann, D.M., Frohnhofen, H. Schlaf und Demenz. Somnologie 22, 233–239 (2018). https://doi.org/10.1007/s11818-018-0182-4

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