Pathophysiologie der Schlafapnoe

Zusammenfassung

Obstruktiven Schlafapnoen liegen meist mechanische Ursachen zugrunde. Zumeist handelt es sich um Fettablagerungen in den oberen Atemwegen sowie um eine Verringerung des Lungenvolumens, was zu einem Verlust der kaudalen Traktion der oberen Atemwege führt. Aufgrund des Umstands, dass 60–80% der Betroffenen eine Ernährungsstörung im Sinne einer Adipositas aufweisen, rücken adipöse und darmgestörte Patienten in den Vordergrund. Auch wenn die gesamten Zusammenhänge noch nicht vollständig erforscht sind, zeigt sich, dass der bei Adipösen stark vergrößerte Anteil an viszeralem Fett als endokrines Organ zur Pathogenese der obstruktiven Schlafapnoe beiträgt. Weitere Ursachen der obstruktiven Schlafapnoe können ein meist unbemerkter nächtlicher laryngopharyngealer Reflux sowie intestinale Intoxikationen sein. Der Beitrag beleuchtet die Pathophysiologie der Schlafapnoen unter ernährungs- und darmspezifischen Aspekten und beschreibt davon ausgehende Therapieansätze außerhalb der bekannten konventionellen Verfahren.

Abstract

Obstructive sleep apnea is usually due to mechanical causes. In most cases, fat deposits in the upper airways as well as a reduction in lung volume are present, resulting in a loss of caudal traction of the upper airways. Due to the fact that 60–80 % of the people affected suffer from a nutritional disorder in the sense of obesity, obese patients and patients with bowel disorder come into focus. Although not all relationships have been fully explored yet, it is apparent that the significantly increased proportion of visceral fat in obese individuals contributes to the pathogenesis of obstructive sleep apnea as an endocrine organ. Other causes of obstructive sleep apnea may include nocturnal laryngopharyngeal reflux, which is usually unnoticed, as well as intestinal intoxications. The article highlights the pathophysiology of sleep apnea under nutritional and intestine-specific aspects and describes therapeutic approaches based on these aspects outside the known conventional methods.

Schlüsselwörter

Schlafapnoe - Schlafhypopnoe - obstruktive Apnoe - zentrale Apnoe - Ernährung - Adipositas

Keywords

Sleep apnea - sleep hypopnea - obstructive apnea - central apnea - nutrition - obesity

Publikationsverlauf

Artikel online veröffentlicht:
20. Februar 2023

• Literatur

• 1 Kryger MH. Atlas of Clinical Sleep Medicine. E-Book: Expert Consult-Online. Philadelphia: Elsevier Health Sciences; 2013
• 2 Lyons OD, Bradley TD. Heart failure and sleep apnoea. Can J Cardiol 2015; 31 (07) 898-908
• 3 Dempsey JA, Veasey SC, Morgan BJ. et al. Pathophysiology of sleep apnea. Physiol Rev 2010; 90: 47-112
• 4 Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet 2014; 383: 736-747
• 5 Johns Hopkins Medicine. Obstructive sleep apnea. Im Internet: Zugriff am 26. Januar 2023 unter: https://www.hopkinsmedicine.org/health/conditions-and-diseases/obstructive-sleep-apnea
• 6 S-MED Schlaflabor. Atemaussetzer im Schlaf – so gefährlich sind sie wirklich. Im Internet: Zugriff am 26. Januar 2023 unter: https://smed-schlaflabor.de/atemaussetzer-im-schlaf-so-gefaehrlich-sind-sie-wirklich/
• 7 Johns Hopkins Medicine. 4 signs you might have sleep apnea. Im Internet: Zugriff am 26. Januar 2023 unter: https://www.hopkinsmedicine.org/health/conditions-and-diseases/obstructive-sleep-apnea
• 8 Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2008; 5: 136-143
• 9 Heinzer R, Vat S, Marques-Vidal P. et al. Prevalence of sleep-disordered breathing in the general population: The HypnoLaus study. Lancet Respir Med 2015; 3: 310-318
• 10 Vasu TS, Grewal R, Doghramji K. Obstructive sleep apnea syndrome and perioperative complications: A systematic review of the literature. J Clin Sleep Med 2012; 8: 199-207
• 11 Finkel KJ, Searleman AC, Tymkew H. et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med 2009; 10: 753-758
• 12 Young T, Evans L, Finn L. et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997; 20: 705-706
• 13 Faßbender P, Herbstreit F, Eikermann M. et al. Obstructive sleep apnea – a perioperative risk factor. Dt Arztebl Int 2016; 113: 463-469
• 14 Schwab RJ, Pasirstein M, Pierson R. et al. Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 2003; 168 (05) 522-530
• 15 Mendelson M, Lyons OD, Yadollahi A. et al. Effects of exercise training on sleep apnoea in patients with coronary artery disease: A randomised trial. Eur Respir J 2016; 48: 142-150
• 16 DocCheck Flexikon. Leptin. Im Internet: Zugriff am 26. Januar 2023 unter: https://flexikon.doccheck.com/de/Leptin#Wirkungen
• 17 Phillips BG, Kato M, Narkiewicz K. et al. Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea. Am J Physiol Heart Circ Phys 2000; 279 (01) H234-H237
• 18 Berger S, Polotsky VY. Leptin and leptin resistance in the pathogenesis of obstructive sleep apnea: A possible link to oxidative stress and cardiovascular complications. Oxid Med Cell Longev 2018; 5137947
• 19 DZD. Adipositas – Leptinresistenz verursacht Übergewicht. Info Diabetol 2018; 12: 50
• 20 Lévy P, Kohler M, McNicholas WT. et al. Obstructive sleep apnoea syndrome. Nat Rev Dis Primers 2015; 1: 15015
• 21 Bozkurt NC, Beysel S, Karbek B. et al. Visceral obesity mediates the association between metabolic syndrome and obstructive sleep apnea syndrome. Metab Syndr Relat Disord 2016; 14 (04) 217-221
• 22 Soltanieh S, Aghamiri S, Bawadi H. et al. The influence of fasting and energy-restricted diets on leptin and adiponectin levels in humans: A systematic review and meta-analysis. Clin Nutr 2021; 40 (04) 1811-1821
• 23 Bayon V, Leger D, Gomez-Merino D. et al. Sleep debt and obesity. Ann Med 2014; 46 (05) 264-272
• 24 Tang X, Tang Q, Li S. et al. Changes in laryngopharyngeal reflux after uvulopalatopharyngoplasty for obstructive sleep apnea: An observational study. Laryngosc Investig Otolaryngol 2021; 7 (01) 266-273
• 25 Ing AJ, Ngu MC, Breslin AB. Obstructive sleep apnoea and gastroesophageal reflux. Am J Med 2000; 108: 120-125
• 26 Mahfouz R, Barchuk A, Obeidat AE. et al. The relationship between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD) in inpatient settings: A nationwide study. Cureus 2022; 14: e22810
• 27 Campanholo MAT, Caparroz FA, Vidigal TA. et al. Assessment of laryngopharyngeal reflux and obstructive sleep apnea: A population-based study. Laryngoscope 2022; 132: 1877-1882
• 28 Su J, Fang Y, Meng Y. et al. Effect of continuous positive airway pressure on chronic cough in patients with obstructive sleep apnea and concomitant gastroesophageal reflux. Nat Sci Sleep 2022; 14: 13-23
• 29 Bhutada AM, Broughton WA, Focht Garand KL. Obstructive sleep apnea syndrome (OSAS) and swallowing function – A systematic review. Sleep Breath 2020; 24: 791-799
• 30 Pirlet K. Was sind Stoffwechselschlacken?. Erfahrungsheilkunde; 1989 4.
• 31 Rohlffs K, Rodrian J, Pirlet K. Intestinale Autointoxikation und Kanzerogenese. MMW Munch Med Wochenschr 1976; 118 (41) 1327-1328
• 32 Losurdo G, D’Abramo FS, Indellicati G. et al. The influence of small intestinal bacterial overgrowth in digestive and extraintestinal disorders. Int J Molecul Sci 2020; 21: 3531