Insomnie bei Demenzen

ZUSAMMENFASSUNG

Schlafstörungen gehen Demenzen häufig voran und können deren Verlauf verschlimmern. Die Interaktion ist bidirektional. Beide Erkrankungen haben gemeinsame Symptome wie kognitive Einschränkungen und Veränderungen von Schlafstruktur und Qualität. Wenn sich die Demenz einmal manifestiert hat, können Schlafstörungen wie obstruktive Schlafapnoe, Restless-legs-Syndrom und Parasomnien die Symptomatik verstärken. Die Schlafstruktur zeigt eine Verminderung von langsamwelligem Schlaf und häufiges nächtliches Erwachen mit längeren Wachzeiten. Schlaf ermöglicht es, mittels Aktivierung des glymphatischen Systems Aß- und Tau-Proteine, die sich im Wachen angesammelt haben, aus dem ZNS auszuschleusen. Wegen der bidirektionalen Interaktionen ist es erforderlich, Schlafstörungen vermehrte Aufmerksamkeit zu schenken und sie früh zu diagnostizieren und zu behandeln, um einer Verschlimmerung einer existierenden oder sich entwickelnden Demenz vorzubeugen. Eine Anzahl von subjektiven Fragebögen und objektiven Instrumenten wie Polysomnografie und Aktigrafie stehen für die Diagnostik zur Verfügung. Begleitende Schlafstörungen sollten immer mit behandelt werden (z. B. nasale Überdrucktherapie bei Schlafapnoe).

Prävention oder Behandlung sollten immer Verhaltenstherapien wie körperliche Aktivierung, soziale Interaktion und ausreichende Exposition gegenüber Tageslicht beinhalten. Einige Antidepressiva, Melatonin, neue duale Orexinrezeptorantagonisten (in Deutschland nicht zugelassen) und wenige Hypnotika können zur Behandlung empfohlen werden. Die Schlafprobleme der betreuenden Personen sollten in den Behandlungsablauf eingeschlossen werden, um die Lebensqualität der Erkrankten zu optimieren.

ABSTRACT

Sleep disorders are frequent precursors of dementias and may worsen their course. The interaction is bidirectional and share some symptoms such as cognitive impairment and changes of sleep structure and sleep quality. Once dementia has developed, sleep disorders such as obstructive sleep apnea, restless legs syndrome and parasomnias are frequent. The changes in sleep structure are reduction of slow wave sleep, frequent awakenings and wake times. Sleep allows the glymphatic clearance of Aß and tau proteins, which may accumulate.

Due to the bidirectional interactions it is necessary to pay attention to sleep disorders and to diagnose and treat them early enough to prevent a deterioration of existing or development of future dementia. An array of subjective instruments i. e. questionnaires and objective measurements i. e. polysomnography and actigraphy are available to assess or diagnose sleep disorders. Associated sleep disorders should always be treated (i. e. CPAP for sleep apnea). Prevention or treatment need to always include behavioral therapies such as physical activity, social interaction and exposure to real light or bright light. A few antidepressants, melatonin, new dual orexin receptor agonists and few hypnotics are recommended for the treatment. The sleep problems of caregivers should be included in the treatment, which is necessary for the optimization of the patient’s quality of life.

Schlüsselwörter

Schlafstörungen - zirkadianer Rhythmus - Polysomnografie - langsamwelliger Schlaf - Melatonin - kognitive Verhaltenstherapie - Echtlicht - Hypnotika

Key words

Sleep disorders - circadian rhythm - polysomnography - slow wave sleep - melatonin - cognitive behavioral therapy - bright light - hypnotics

Publication History

Article published online:
09 July 2021

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