Somnologie - Schlafforschung und Schlafmedizin

, Volume 7, Issue 4, pp 140–146 | Cite as

Barorezeptorsensitivität, Schlaf und OSAS

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Zusammenfassung

Fragestellung

Änderungen der Barorezeptorsensitivität (BRS) beim Übergang von Wach zu Schlaf, in Abhängigkeit der Schlaftiefe und bei Erkrankungen wie der arteriellen Hypertonie bzw. einem obstruktiven Schlafapnoesyndrom (OSAS) sind bekannt. Ziel der vorliegenden Untersuchungen war die Analyse der BRS im Schlaf sowohl bei schlafgesunden Probanden in Abhängigkeit des Schlafstadiums NREM-REM als auch bei Patienten mit einem moderaten OSAS in vergleichbaren Apnoe-freien Abschnitten im NREM- und REM-Schlaf.

Patienten und Methodik

Es wurden 43 probanden (45,4±10,7 Jahre) und 21 OSAS-Patienten (55,7±7,0 Jahre) polysomnographisch untersucht. Zusätzlich wurde der Blutdruck nichtinvasiv, kontinuirelich gemessen. Intervalle mit Normalatmung wurden im REM- und NREM-Schlaf selektiert und aus den Spontanänderungen der Herzperiodendauer und des systolischen Blutdrucks mittels Spektralanalyse die Parameter der BRS α-LF, α-HF und α-LFHF extrahiert.

Ergebnisse

Es ergab sich bei den gesunden Schläfern eine signifikant höhere BRS im NREM-Schlaf im Vergleich zum REM-Schlaf, sowohl für den α-LFHF-(P<0,02) als auch α-HF- (P<0,001) Index. Für die Gesamtgruppe der OSAS-Patienten zeigt sich bei signifikant verringerter BRS im NREM-Schlaf (α-LF, α-HF, α-LFHF) im Gegenstz zu den Normalpersonen folglich ein höherer α-HF-Index im REM-als im NREM-Schlaf (P<0,05). Das Vorhandensein einer medikamentös eingestellten arteriellen Hypertonie hat keinen Einfluss auf dieses Ergebnis.

Schlussfolgerung

Die gestörte nächtliche BRS bei Patienten mit einem milden bis moderaten OSAS ist Folge einer Abnahme des Vagotonus im NREM-Schlaf, auch in Apnoefreien Intervallen, und spiegelt das nächtliche Herzkreislaufrisiko bei diesen Patienten wider.

Schlüsselwörter

Barorezeptorsensitivität Schlaf Schlafapnoe 

Baroreceptor Sensitivity, Sleep and OSAS

Summary

Question of the Study

Alterations in baroreceptor sensitivity (BRS) during the transition from waking to sleep are known to depend on sleep depth, and have been studied in patients suffering from diseases such as arterial hypertension and obstructive sleep apnoea syndrome (OSAS). The goal of the present study was the analysis of BRS in sleep, both in subjects with healthy sleep and as a function of the NREM-REM stage of sleep, as well as in patients with mild to moderate OSAS in comparable apnoea-free phases in NREM and REM.

Patients and Methods

A total of 43 subjects (45.4±10.7 years of age) and 21 OSAS patients (55±7 years) were studied by polysomnography. Blood pressure was measured continuously by noninvasive means. Intervals with normal respiration were selected in REM and NREM sleep, and the BRS parameters α-LF, α-HF and α-LFHF were extracted by spectral analysis from spontaneous changes in cardiac cycle duration and in systolic blood pressure.

Results

Findings for healthy sleepers revealed BRS in NREM sleep that was significantly greater than that in REM sleep, both for the α-LFHF (P<0.02) as well as for the α-HF (P<0.001) index. For the entire group of OSAS patients, and in contrast to normal subjects, a greater α-HF index in both REM and in NREM sleep (P<0.05) was consequently determined, with significantly reduced BRS in NREM sleep (α-LF, α-HF, α-LFHF). Existence of arterial hypertension stabilized by medication has no effect on theses results.

Conclusions

Disturbed nocturnal BRS in patients with mild to moderate OSAS is the consequence of loss of vagal tone in NREM sleep, also in apnoea-free intervals, and reflects the nocturnal cardiovascular risks in these patients.

Keywords

Baroreceptor sensitity sleep sleep apnoea 
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Copyright information

© Blackwell Verlag 2003

Authors and Affiliations

  1. 1.Schafmedizinisches Zentrum der Medizinischen Klinik mit Schwerpunkt Kardiologie, Pneumologie, AngiologieCharité-Universitätsmedizin Berlin

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