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Schlafbezogene Atmungsstörungen und kardiovaskuläre (Folge-)Erkrankungen

Sleep-related breathing disorders and (resulting) cardiovascular diseases

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Zusammenfassung

Schlafbezogene Atmungsstörungen kommen bei kardiologischen Patienten meist in Form der obstruktiven (OSA) oder zentralen Schlafapnoe (CSA) mit Cheyne-Stokes-Atmung vor. Die Prävalenzen und Inzidenzen sind gegenüber der Allgemeinbevölkerung deutlich erhöht. Abhängig von der kardiologischen Grunderkrankung können bis zu 75% eine OSA oder CSA aufweisen, bis zu 50% haben eine nach aktuellen Leitlinien bestehende Therapieindikation. Die OSA wird für viele kardiovaskuläre Herzerkrankungen als eigenständiger und gut behandelbarer Risikofaktor für die Entstehung und Verschlechterung angesehen. Beispielhaft beschreibt diese Übersichtsarbeit in Kurzform die Prävalenzen, die Pathophysiolgie und die aktuelle Studienlage zum Zusammenhang von schlafbezogenen Atmungsstörungen und arterieller Hypertonie, Vorhofflimmern, Arteriosklerose mit koronarer Herzerkrankung (KHK) und Myokardinfarkt sowie der Herzinsuffizienz. Während für diese Erkrankungen die Rolle der OSA als Risikofaktor für ihre Entstehung gut belegt ist, wird die CSA weniger als Risikofaktor per se, sondern vielmehr als Ausdruck einer kardialen Grunderkrankung mit dann weiteren negativen Auswirkungen für diese angesehen. Nicht die Schlafapnoe als solche, sondern die kardiovaskulären Folgeerkrankungen limitieren die Prognose dieser Patienten und rücken sie somit in den kardiologischen Fokus. Durch verschiedene nächtliche Beatmungstherapien können OSA und CSA erfolgversprechend und nachhaltig therapiert werden. Darüber hinaus sind weitere Therapieverfahren in der Erprobung; ihre Wertigkeit wird in den kommenden Jahren untersucht werden.

Abstract

Sleep-related breathing disorders occur in cardiology patients mostly as obstructive or central sleep apnea with Cheyne-Stokes respiration. The prevalence and incidence are clearly increased in comparison to the general population. Depending on the underlying cardiac disease up to 75% of patients can have obstructive or central sleep apnea and up to 50% have indications for therapy according to the current guidelines. Obstructive sleep apnea is considered to be an independent and well treatable risk factor for the development and deterioration of many cardiovascular diseases. This review briefly describes examples of prevalence, pathophysiology and current study situation with respect to the association between sleep-related breathing disorders and arterial hypertension, atrial fibrillation, arteriosclerosis with coronary heart disease, myocardial infarction and heart failure. Although the role of obstructive sleep apnea as a risk factor for the development of these diseases is well documented, central sleep apnea is less of a risk factor per se but is considered to mirror an underlying cardiac disease with then further negative consequences for this disease. It is not the sleep apnea per se but the subsequent cardiovascular diseases which limit the prognosis of these patients and therefore bring them into the focus of cardiology. Obstructive and central sleep apnea can be successfully and sustainably treated by various forms of nocturnal positive airway pressure therapy. Furthermore, there are several therapeutic procedures which are currently being tested and the significance will be investigated in the coming years.

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  1. Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland

    O. Oldenburg, T. Bitter, H. Fox & D. Horstkotte

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  1. O. Oldenburg
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  2. T. Bitter
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  3. H. Fox
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  4. D. Horstkotte
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Correspondence to O. Oldenburg.

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Oldenburg, O., Bitter, T., Fox, H. et al. Schlafbezogene Atmungsstörungen und kardiovaskuläre (Folge-)Erkrankungen. Herz 39, 37–44 (2014). https://doi.org/10.1007/s00059-013-4050-5

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  • DOI: https://doi.org/10.1007/s00059-013-4050-5

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