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Funktionelle Dynamik des rechten Ventrikels und des Lungenkreislaufes bei obstruktiver Schlafapnoe

Therapeutische Konsequenzen

Functional dynamics of the right ventricle and pulmonary circulation in obstructive sleep apnea

Therapeutic consequences

  • Schwerpunkt: Der kranke rechte Ventrikel
  • Published:
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Zusammenfassung

Alleine in Deutschland leiden mindestens 500.000 Menschen an dem durch die Leitsymptome Tagesmüdigkeit, morgendliche Kopfschmerzen und nächtliches Schnarchen charakterisierten obstruktiven Schlafapnoesyndrom (OSAS). Dabei ist die Prognose mutmaßlich durch kardiovaskuläre Komplikationen bestimmt. Während es bei diesen Patienten regelhaft während der Nacht zu pulmonalarteriellen Druckerhöhungen kommt, besteht bei etwa jedem 5. Patienten eine am Tage persistierende pulmonalarterielle Hypertonie, bei jedem 4.—am ehesten als Folge der nächtlichen Druckerhöhung—eine eingeschränkte rechtsventrikuläre Funktion. Tierexperimentelle und klinische Studien konnten darüber hinaus zeigen, dass die intermittierende Hypoxie mit der Entwicklung einer Rechtsherzhypertrophie assoziiert ist. Die funktionelle Ventrikeldynamik unterscheidet sich grundlegend zwischen linkem und rechtem Herzen. Die rechtsventrikuläre Funktion ist wesentlich durch Druckänderungen und nur in geringem Ausmaß durch Volumenänderungen beeinflusst. Die Therapie mit einem kontinuierlichen positiven Atemwegsdruck (CPAP) führt neben einer Suppression der Apnoephasen zu einer Senkung der Vor- und Nachlast, was—insbesondere beim dilatierten Herzen—zu günstigen myokardialen Effekten führt.

Abstract

Obstructive sleep apnea (OSA) is common with an incidence of at least 500,000 patients in the German population. Typical symptoms are daytime sleepiness, headache in the morning, and snoring. Presumably obstructive sleep apnea via various mechanisms increases cardiovascular morbidity. Hypoxemia causes nocturnal hypertension in most of the patients. Nevertheless, about 20% of the patients develop daytime pulmonary hypertension and right heart dysfunction. Clinical and animal studies demonstrated right ventricular hypertrophy as a consequence of intermittent hypoxemia and pulmonary hypertension. Right ventricular hemodynamics differ essentially from left ventricular hemodynamics. Right ventricular function is substantially influenced by right ventricular afterload, which is mainly determined by pulmonary vascular resistance, and slightly influenced by preload. Application of continuous positive airway pressure (CPAP) via a nose mask normalizes nocturnal breathing disorders and reduces pre- and afterload, especially in patients with cardiomegaly. Therefore, CPAP generates positive effects on the myocardium.

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  1. Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf

    S. Steiner & B. E. Strauer

  2. Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225 , Düsseldorf

    S. Steiner

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Steiner, S., Strauer, B.E. Funktionelle Dynamik des rechten Ventrikels und des Lungenkreislaufes bei obstruktiver Schlafapnoe. Internist 45, 1101–1107 (2004). https://doi.org/10.1007/s00108-004-1266-8

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  • DOI: https://doi.org/10.1007/s00108-004-1266-8

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