Herz-Kreislauferkrankungen und schlafbezogene obstruktive Atmungsstörungen

Zusammenfassung

Ca. 1,9 % der Bevölkerung haben ein obstruktives Schlafapnoesyndrom (OSAS). Im Alter zwischen 30 und 60 Jahren beträgt die Häufigkeit etwa 3 %. Bei Patienten mit OSAS werden gehäuft Herz-Kreislauferkrankungen wie ischämische Herzerkrankungen, Arrhythmien und ein arterieller Hypertonus diagnostiziert. Pathophysiologisch ist eine Vielzahl von Veränderungen nachweisbar. Die erhöhte Aktivität des Sympathikus, rezidivierende Hypoxämien, Scherstress, Störungen der mikrovaskulären Milieus, eine endotheliale Dysfunktion, erhöhte oxidative Kapazität sowie eine verminderte vaskuläre Reagibilität werden mit der Folgeerkrankung der Arteriosklerose in Verbindung gebracht. Verschiedene biochemische Marker, die als Risikofaktoren bzw. Marker kardiovaskulärer Erkrankungen angesehen werden, sind bei Patienten mit OSAS verändert (hochsensitives CRP, Interleukin(IL)-6, IL-8, IL-10, TNF-α, VGEF, ICAM-1, VCAM-1 und L-Selectin) und es bestehen Zeichen einer Insulinresistenz. Außerdem sind Störungen der Mikrozirkulation nachweisbar. Patienten mit obstruktivem Schlafapnoesyndrom haben verglichen mit Personen ohne Schlafapnoe auch unter Berücksichtigung anderer Risikofaktoren erhöhte Blutdruckwerte. Die Inzidenz einer koronaren Herzkrankheit bei Patienten mit OSAS ist erhöht. Verschiedene Untersuchungen zeigen eine erhöhte Morbidität und Mortalität von Patienten mit obstruktiven Schlafapnoesyndromen. Viele der pathologisch veränderten Werte bessern sich unter einer CPAP-Therapie.

Abstract

About 1.9 % of the population suffer from an obstructive sleep apnea syndrome (OSAS). At the age of between 30 and 60 years it occurs in 3 %. Patients with OSAS develop more frequently such disorders as arteriosclerosis, cardiac arrhythmias and arterial hypertension. A host of pathophysiological changes can be diagnosed. The elevated sympathic activity, recurrent hypoxemias, stress, disturbances in the microvascular milieu, endothelial dysfunction, elevated oxidative capacity as well as a reduced vascular reagibility are deemed to be factors connected to arteriosclerosis. Different biochemical markers, which are seen as risk factors or as markers of cardiovascular diseases, are altered in patients with OSAS (high-sensitive CRP, Interleukin(IL)-6, IL-8, IL-10, TNF-α, VGEF, ICAM-1, VCAM-1 and L-Selectin). Patients with OSAS exhibit signs of an impaired insulin sensitivity. Disturbances in microcirculation are also evident. Patients with OSAS have, compared to patients without sleep apnea, elevated blood pressure measurements, even given other common risk factors. The incidence of coronary heart diseases is increased in patients with OSAS. Morbidity and mortality, especially of arteriosclerotic diseases are elevated. Many of the aforementioned disturbances can be improved by a CPAP-therapy.

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