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Die Muskulatur der oberen Atemwege: Strukturelle und pathophysiologische Aspekte beim obstruktiven Schlafapnoe-Syndrom

The upper airway muscles: Structural and pathophysiological aspects in the obstructive sleep apnoea syndrome

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Zusammenfassung

Der Querschnitt der oberen Atemwege und damit die Pathophysiologie des obstruktiven Schlafapnoe-Syndroms (OSAS) werden wesentlich von der Funktion der dilatatorischen Muskeln bestimmt. Besondere Wichtigkeit kommt dabei dem M. genioglossus zu. Die Muskeln unterliegen einer tonischen Grundaktivität, die kontinuierlich mit der Schlaftiefe abnimmt, und teilweise aber auch einer phasischen, inspirationsgetriggerten Aktivität. Aber auch lokale Reflexmechanismen, z.B. auf mechanische Reize, bestimmen die Muskelspannung. Zur Stabilisierung der oberen Atemwege ist es notwendig, dass die pharyngealen Muskeln zeitlich vor dem Zwerchfell erregt werden. Anatomische Veränderungen der oberen Atemwege prädisponieren zum einen durch eine Verkleinerung des Querschnitts, zum anderen durch eine ungünstigere Positionierung der Muskeln zum OSAS. Zwar werden im Wachzustand Aktivitätssteigerungen der Muskulatur nachgewiesen, diese Kompensations-mechanismen scheinen jedoch im Schlaf zu versagen. Die Dauerbelastung der Muskulatur führt jedoch auch zu einer Veränderung der Verteilung der Muskelfasertypen. Der Anteil der Typ-IIa-Fasern, die als dauerbelastungsresistent gelten, nimmt zu. Es findet sich jedoch auch ein neurogenes Schädigungsbild mit einem Nebeneinander von atrophischen und homogen hypertrophierten Fasern. Es wird vermutet, dass dieses Muster aus dem langfristigen Vibrationstrauma durch das Schnarchen resultiert. Die periphere Nervenläsion macht sich auch mit sensorischen Störungen und damit einer Beeinträchtigung der Reflexmechanismen bemekbar. Beim OSAS kommt somit dem peripheren Nerven und der Schädigung der Muskeln der oberen Atemwege größte Bedeutung zu.

Summary

The width of the upper airways and the pathophysiology of the obstructive sleep apnoea syndrome (OSAS) essentially depend on the function of the dilating muscles. Especially the genioglossus muscle is of crucial importance. The tonic activity of the muscles continuously decreases during sleep. Moreover, several muscles show phasic activity, which is triggered during inspiration. Local reflex mechanisms, e.g. due to mechanical irritations, additionally influence the muscle tone. It is of central importance that the pharyngeal muscles are activated earlier than the diaphragm to stabilise the upper airways. Morphological abnomalities predispose to obstructions due a diminution in the width of the upper airways and due to disadvantageous positioning of the muscles. Although muscle activity is increased in sleep apnoea patients during wakefulness, this compensatory mechanism seems to fail in sleep. The continuous mechanical load of the muscles leads to morphological changes such as a modified distribution of the fibre types. The proportion of the fatigue-resistant type IIa fibres increases. Moreover, the muscles show the typical pattern of a neurogenic lesion with atrophic areas side by side with regions of hypertrophy of a single fibre type. The sensory characteristics of the peripheral nerves are affected, too, which impair the upper airway reflexes. These lesions seem to result from long-term snoring, which induces a vibration trauma. Therefore, lesions of the peripheral nerves and the subsequent impairment of the upper airway muscles are essential in the pathophysiology of OSAS.

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  1. Zentrum für Schlaf-und Beatmungsmedizin. Krankenhaus Bethanien, Institut für Pneumologie an der Universität Witten/Herdecke. Klinik für Pneumologie und Allergologie, Aufderhöher Strasse 169-175, D-42699, Solingen

    Winfried J. Randerath & Wolfgang Galetke

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  1. Winfried J. Randerath
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  2. Wolfgang Galetke
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Randerath, W.J., Galetke, W. Die Muskulatur der oberen Atemwege: Strukturelle und pathophysiologische Aspekte beim obstruktiven Schlafapnoe-Syndrom. Somnologie 10, 201–204 (2006). https://doi.org/10.1111/j.1439-054X.2006.00103.x

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  • DOI: https://doi.org/10.1111/j.1439-054X.2006.00103.x

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