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Detektion und Therapie respiratorischer Störungen durch implantierbare (kardiale) Devices

Detection and therapy of respiratory dysfunction by implantable (cardiac) devices

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Zusammenfassung

Schlafbezogene Atmungsstörungen (SAS) stellen eine häufige Komorbidität bei kardiologischen Patienten dar. Die Prävalenz ist insbesondere bei Patienten mit Rhythmusstörungen und Herzinsuffizienz (HI) sehr hoch. Entsprechend finden sich häufig SAS bei Patienten mit Herzschrittmacher (SM)- und/oder implantierbaren Defibrillator (ICD)-Systemen inkl. Resynchronisationstherapien (CRT). Moderne SM-, ICD- oder CRT-Geräte verfügen über die Möglichkeit, aus der transthorakalen Impedanz die Atmung zu quantifizieren und SAS sensitiv zu erfassen, was in Polysomnographiekontrollen gezeigt werden konnte. Diese Methode könnte zukünftig eine bedeutende Rolle für Screening und Verlaufskontrollen spielen. Erste Verlaufsdaten zeigen die Möglichkeit der Therapie von obstruktiven schlafbezogenen Atmungsstörungen (OSA) durch die selektive Stimulation von Hirnnerven (hier v. a. N. hypoglossus) bei selektierten Patienten. Dies erfordert jedoch eine aufwendige Diagnostik und Therapie durch verschiedene Fachdisziplinen und ist nicht Gegenstand dieser Übersichtsarbeit. Mit der Möglichkeit zur einseitigen transvenösen Stimulation des N. phrenicus hingegen bietet sich dem Kardiologen die Möglichkeit, auf bekannten Zugangswegen die zentrale schlafbezogene Atmungsstörung (CSA) und v. a. die HI-assoziierte Cheyne-Stokes-Atmung zu behandeln. Erste Verlaufsdaten werden dargestellt.

Abstract

Sleep-disordered breathing (SDB) represents a common comorbidity in cardiac patients. The prevalence of obstructive sleep apnea (OSA) and central sleep apnea (CSA) is very high, particularly in patients with heart rhythm disorders and heart failure (HF). Patients with pacemakers (PM) and implantable defibrillators (ICD) including cardiac resynchronization therapy (CRT) show SDB prevalences up to 75%. However, some modern PM, ICD and CRT devices allow the detection of SDB via transthoracic impedance analysis with high sensitivity compared to polysomnographic (PSG) controls. Thus, this method could be of relevance in screening and monitoring SDB in patients with implantable cardiac devices. Preliminary studies demonstrated the possibility to treat OSA in selected patients by stimulation of the cranial nerves, especially the hypoglossal nerve. However, this requires extensive diagnostics and advanced surgical approaches including many medical disciplines and is not part of this review article. However, unilateral and transvenous stimulation of the phrenic nerve to treat central sleep apnea and Cheyne-Stokes respiration in HF patients in particular can be performed by cardiologists. This article summarizes preliminary data on the results of this promising therapy.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. H. Fox, O. Oldenburg, G. Nölker und T. Horstkotte geben an, dass kein Interessenkonflikt besteht. K.-J. Gutleben unterhält Beraterverträge mit den Firmen Respicardia und Sorin.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

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

    H. Fox, O. Oldenburg, G. Nölker, D. Horstkotte &  K.-J. Gutleben

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  1. H. Fox
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  2. O. Oldenburg
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  3. G. Nölker
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Correspondence to K.-J. Gutleben.

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Fox, H., Oldenburg, O., Nölker, G. et al. Detektion und Therapie respiratorischer Störungen durch implantierbare (kardiale) Devices. Herz 39, 32–36 (2014). https://doi.org/10.1007/s00059-014-4062-9

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