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Neues zur Pathophysiologie schlafbezogener Atmungsstörungen

Current insights in the pathophysiology of sleep disordered breathing

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Zusammenfassung

Schlafbezogene Atmungsstörungen umfassen die obstruktive und zentrale Schlafapnoe sowie schlafbezogene Hypoventilationssyndrome. Zugrundeliegende pathophysiologische Charakteristika dieser Krankheitsbilder weisen essenzielle Unterschiede auf. Während bei der obstruktiven Schlafapnoe der obere Atemwegskollaps im Vordergrund steht, basiert die zentrale Schlafapnoe vor allem auf einer fehlerhaften Regulation der Ventilation. Eine erhöhte atemmechanische Last und/oder eine fehlerhafte neuronale Signalübertragung/Muskeldystrophie prädisponieren für das Auftreten einer (schlafbezogenen) Hypoventilation. Im Regelfall definieren wir bei Patienten eine dieser Entitäten auf Basis polysomnografischer und kapnometrischer Charakteristika, nicht selten finden wir jedoch eine Koexistenz verschiedener pathophysiologischer Aspekte. Dies trifft insbesondere auf den multimorbiden älteren Patienten zu. Um Krankheitsbilder klar zu definieren und suffiziente Therapiekonzepte zu entwickeln, ist eine differenzierte Betrachtung jedweder zugrundeliegenden Störung essenziell. Nur der integrative Therapieansatz orientiert an der zugrundeliegenden Pathophysiologie supprimiert die schlafbezogene Atmungsstörung effektiv und sichert eine langfristige Therapieadhärenz. Der vorliegende Artikel beschreibt aktuelle pathophysiologische Konzepte schlafbezogener Atmungsstörungen und soll dabei helfen, integrative Therapiestrategien orientiert an der Pathophysiologie zu entwickeln.

Abstract

Sleep-related breathing disturbances include obstructive and central sleep apnea as well as sleep-related hypoventilation syndromes. The underlying pathophysiological characteristics of these diseases essentially differ. While obstructive sleep apnea is primarily due to upper airway collapse, central sleep apnea is mainly driven by a disturbed ventilatory control. Increased respiratory mechanical load and/or an impaired neuronal signal transduction/muscle dystrophy promote the occurrence of a (sleep-related) hypoventilation. Usually we diagnose one of these entities based on polysomnographic und capnometric characteristics, but frequently a co-existence of different pathophysiological aspects can be found. This is especially true in the multi-morbid elderly patient. In order to define disease entities more clearly and develop sufficient therapy concepts, a differentiated appraisal of each and every underlying disturbance is needed. Only the integrative therapy approach oriented towards the underlying pathophysiology facilitates effective suppression of sleep-related breathing disturbances and ensures long-term therapy adherence. This article describes current pathophysiological concepts of sleep-related breathing disturbances and is intended to help develop integrative therapy strategies oriented towards pathophysiology.

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  1. Institut für Pneumologie an der Universität zu Köln, Krankenhaus Bethanien, Aufderhöher Str. 169–175, 42699, Solingen, Deutschland

    S. D. Herkenrath & W. J. Randerath

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Herkenrath, S.D., Randerath, W.J. Neues zur Pathophysiologie schlafbezogener Atmungsstörungen. Somnologie 23, 164–171 (2019). https://doi.org/10.1007/s11818-019-00220-0

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