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Update – schlafbezogene Atmungsstörungen

Update – sleep-disordered breathing

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Zusammenfassung

Gestörter Schlaf und schlafbezogene Atmungsstörungen (SBAS) können mit einer erheblichen Einschränkung der Lebensqualität und mit einer erhöhten Morbidität einhergehen. Die moderne Diagnostik von SBAS beinhaltet weiterhin die Standardmethoden mit Polygrafie und Polysomnografie für eine Nacht. Aufgrund der hohen Nacht-zu-Nacht-Variabilität des Schweregrades von SBAS gewinnen Methoden, die über einen längeren Zeitraum SBAS erfassen (z. B. Herzschrittmachersysteme), eine zunehmende Bedeutung. Eine effektive Therapie der obstruktiven Schlafapnoe (OSA) kann vor allem bei Patienten mit fehlender physiologischer Nachtabsenkung des arteriellen Blutdrucks den Blutdruck senken. Neben den Standardtherapien der OSA, der kontinuierlichen Positivdrucktherapie (Continuous Positive Airway Pressure, CPAP) und der Unterkieferprotrusionsschiene zeigen sich Lagetrainer (aktive Lagetherapie) und die Hypoglossusstimulation bei ausgewählten Patienten effektiv.

Abstract

Disturbed sleep and sleep-disordered breathing (SDB) may cause significant impairment of quality of life and increased morbidity. Modern diagnosis of SDB include the standard methods polygraphy and polysomnography, usually for one night. As a consequence of the high night-to-night variability of the severity of sleep-disordered breathing, methods with continuous measurement of SDB over a longer time-span (e.g. systems integrated in cardiac pace makers) provide valuable additional information. Effective therapy of obstructive sleep apnea (OSA) has the strongest antihypertensive effect in patients without the physiological dipping of nocturnal blood pressure. In addition to the standard therapies of OSA, such as continuous positive airway pressure (CPAP) and mandibular advancement devices, active position therapy and upper-airway stimulation therapy are effective in selected patients.

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Literatur

  1. Auckley D, Memtsoudis S (2019) Unrecognized obstructive sleep apnea and postoperative cardiovascular complications: a wake-up Call. JAMA 321:1774–1776

    Article  Google Scholar 

  2. Baumert M, Immanuel SA, Stone KL et al (2018) Composition of nocturnal hypoxaemic burden and its prognostic value for cardiovascular mortality in older community-dwelling men. Eur Heart J. https://doi.org/10.1093/eurheartj/ehy838

    Article  Google Scholar 

  3. Baumert M, Linz D, Stone K et al (2019) Mean nocturnal respiratory rate predicts cardiovascular and all-cause mortality in community-dwelling older men and women. Eur Respir J. https://doi.org/10.1183/13993003.02175-2018

    Article  PubMed  Google Scholar 

  4. Berry RB, Uhles ML, Abaluck BK et al (2019) Nightbalance sleep position treatment device versus auto-adjusting positive airway pressure for treatment of positional obstructive sleep apnea. J Clin Sleep Med 15:947–956

    Article  Google Scholar 

  5. Beyers J, Vanderveken OM, Kastoer C et al (2019) Treatment of sleep-disordered breathing with positional therapy: long-term results. Sleep Breath. https://doi.org/10.1007/s11325-019-01792-9

    Article  PubMed  Google Scholar 

  6. Boulos MI, Jairam T, Kendzerska T et al (2019) Normal polysomnography parameters in healthy adults: a systematic review and meta-analysis. Lancet Respir Med 7:533–543

    Article  Google Scholar 

  7. Butler MP, Emch JT, Rueschman M et al (2019) Apnea-hypopnea event duration predicts mortality in men and women in the sleep heart health study. Am J Respir Crit Care Med 199:903–912

    Article  Google Scholar 

  8. Caples SM, Mansukhani MP, Friedman PA et al (2019) The impact of continuous positive airway pressure treatment on the recurrence of atrial fibrillation post cardioversion: a randomized controlled trial. Int J Cardiol 278:133–136

    Article  Google Scholar 

  9. Chan MTV, Wang CY, Seet E et al (2019) Association of unrecognized obstructive sleep apnea with postoperative cardiovascular events in patients undergoing major noncardiac surgery. JAMA 321:1788–1798

    Article  Google Scholar 

  10. Costantino A, Rinaldi V, Moffa A et al (2019) Hypoglossal nerve stimulation long-term clinical outcomes: a systematic review and meta-analysis. Sleep Breath. https://doi.org/10.1007/s11325-019-01923-2 [Epub ahead of print]

    Article  PubMed  Google Scholar 

  11. De Vries GE, Hoekema A, Claessen J et al (2019) Long-term objective adherence to mandibular advancement device therapy versus continuous positive airway pressure in patients with moderate obstructive sleep apnea. J Clin Sleep Med. https://doi.org/10.5664/jcsm.8034

    Article  PubMed  Google Scholar 

  12. Gaisl T, Haile SR, Thiel S et al (2019) Efficacy of pharmacotherapy for OSA in adults: a systematic review and network meta-analysis. Sleep Med Rev 46:74–86

    Article  Google Scholar 

  13. Heiser C, Steffen A, Boon M et al (2019) Post-approval upper airway stimulation predictors of treatment effectiveness in the ADHERE registry. Eur Respir J. https://doi.org/10.1183/13993003.01405-2018

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kent DT, Carden KA, Wang L et al (2019) Evaluation of hypoglossal nerve stimulation treatment in obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg. https://doi.org/10.1001/jamaoto.2019.2723. [Epub ahead of print]

    Article  PubMed  Google Scholar 

  15. Kirchhof P, Benussi S, Kotecha D et al (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962

    Article  Google Scholar 

  16. Linz D, Brooks AG, Elliott AD et al (2018) Nightly variation in sleep apnea severity as atrial fibrillation risk. J Am Coll Cardiol 72:2406–2407

    Article  Google Scholar 

  17. Linz D, Brooks AG, Elliott AD et al (2019) Variability of sleep apnea severity and risk of atrial fibrillation: the VARIOSA-AF study. JACC Clin Electrophysiol 5:692–701

    Article  Google Scholar 

  18. Masa JF, Corral J, Romero A et al (2016) The effect of supplemental oxygen in obesity hypoventilation syndrome. J Clin Sleep Med 12:1379–1388

    Article  Google Scholar 

  19. Masa JF, Mokhlesi B, Benitez I et al (2019) Long-term clinical effectiveness of continuous positive airway pressure therapy versus non-invasive ventilation therapy in patients with obesity hypoventilation syndrome: a multicentre, open-label, randomised controlled trial. Lancet 393:1721–1732

    Article  Google Scholar 

  20. Mayer G, Arzt M, Braumann B et al (2017) German S3 guideline nonrestorative sleep/sleep disorders, chapter “sleep-related breathing disorders in adults,” short version: German sleep society (deutsche Gesellschaft fur Schlafforschung und Schlafmedizin, DGSM). Somnologie 21:290–301

    Article  Google Scholar 

  21. Mazzotti DR, Keenan BT, Lim DC et al (2019) Symptom subtypes of obstructive sleep apnea predict incidence of cardiovascular outcomes. Am J Respir Crit Care Med 200:493–506

    Article  CAS  Google Scholar 

  22. Parati G, Pengo MF, Lombardi C (2019) Obstructive sleep apnea and hypertension: why treatment does not consistently improve blood pressure. Curr Hypertens Rep 21:30

    Article  Google Scholar 

  23. Sanchez-De-La-Torre M, Khalyfa A, Sanchez-De-La-Torre A et al (2015) Precision medicine in patients with resistant hypertension and obstructive sleep apnea: blood pressure response to continuous positive airway pressure treatment. J Am Coll Cardiol 66:1023–1032

    Article  Google Scholar 

  24. Sapina-Beltran E, Torres G, Benitez I et al (2019) Differential blood pressure response to continuous positive airway pressure treatment according to the circadian pattern in hypertensive patients with obstructive sleep apnoea. Eur Respir J. https://doi.org/10.1183/13993003.00098-2019

    Article  PubMed  Google Scholar 

  25. Soghier I, Brozek JL, Afshar M et al (2019) Noninvasive ventilation versus CPAP as initial treatment of obesity hypoventilation syndrome: a systematic review and meta-analysis. Ann Am Thorac Soc. https://doi.org/10.1513/AnnalsATS.201907-528OC

    Article  PubMed  Google Scholar 

  26. Srijithesh PR, Aghoram R, Goel A et al (2019) Positional therapy for obstructive sleep apnoea. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD010990.pub2

    Article  PubMed  Google Scholar 

  27. Taranto-Montemurro L, Messineo L, Sands SA et al (2019) The combination of atomoxetine and oxybutynin greatly reduces obstructive sleep apnea severity. A randomized, placebo-controlled, double-blind crossover trial. Am J Respir Crit Care Med 199:1267–1276

    Article  CAS  Google Scholar 

  28. Traaen GM, Aakeroy L, Hunt TE et al (2018) Treatment of sleep apnea in patients with paroxysmal atrial fibrillation: design and rationale of a randomized controlled trial. Scand Cardiovasc J 52:372–377

    Article  CAS  Google Scholar 

  29. Windisch W, Geiseler J, Simon K et al (2018) German national guideline for treating chronic respiratory failure with invasive and non-invasive ventilation—revised edition 2017: part 2. Respiration 96:171–203

    Article  Google Scholar 

  30. Windisch W, Geiseler J, Simon K et al (2018) German national guideline for treating chronic respiratory failure with invasive and non-invasive ventilation: revised edition 2017—part 1. Respiration 96:66–97

    Article  Google Scholar 

  31. Yamamoto U, Nishizaka M, Tsuda H et al (2019) Crossover comparison between CPAP and mandibular advancement device with adherence monitor about the effects on endothelial function, blood pressure and symptoms in patients with obstructive sleep apnea. Heart Vessels 34:1692–1702

    Article  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    Michael Arzt

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  1. Michael Arzt
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Correspondence to Michael Arzt.

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Interessenkonflikt

M. Arzt erklärt, dass er sich bei der Erstellung des Beitrags nicht von wirtschaftlichen Interessen leiten ließ. Er legt die folgenden potenziellen Interessenkonflikte offen: Forschungsunterstützung: ResMed Foundation, ResMed und Philips. Vortragshonorare von: Philips, ResMed, NRI, Boehringer-Ingelheim. Beraterverträge: Novartis, Bresotec, Bayer.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Der Beitrag basiert auf dem Handbuch Pneumologie 2019 und entspricht den Seminarunterlagen des 16. PneumoUpdate 2019 der med update GmbH.

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Arzt, M. Update – schlafbezogene Atmungsstörungen. Somnologie 24, 28–38 (2020). https://doi.org/10.1007/s11818-020-00239-8

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