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Pneumologie 2012; 66(11): 650-657
DOI: 10.1055/s-0032-1325788
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Mechanismen der kardiovaskulären Komorbidität bei Patienten mit obstruktivem Schlafapnoesyndrom

Mechanisms of Cardiovascular Co-Morbidity in Patients with Obstructive Sleep Apnoea Syndrome
M. Meier
1   Lungenfachklinik Immenhausen/Krs. Kassel
,
S. Andreas
1   Lungenfachklinik Immenhausen/Krs. Kassel
2   Abtl. Kardiologie und Pneumologie, Universitätsmedizin Göttingen
› Author Affiliations
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Publication History

eingereicht 14 September 2012

akzeptiert nach Revision 19 September 2012

Publication Date:
06 November 2012 (online)

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Zusammenfassung

Die bei obstruktiver Schlafapnoe repetitiv auftretende intermittierende Hypoxie, zentralnervöse Weckreaktion und intrathorakale Druckschwankung sind als wesentliche pathophysiologische Mechanismen für die kardiovaskuläre Komorbidität verantwortlich. Diese Phänomene führen zu vermehrtem oxidativen Stress, systemischer Inflammation, Störungen der Vasomotorik, Steigerung sympathischer Aktivität und Arteriosklerose der Blutgefäße. Die CPAP-Therapie senkt den arteriellen Blutdruck und hat einen positiven Effekt auf wesentliche Einzelaspekte der kardiovaskulären Komorbidität. Vor der Veröffentlichung bereits laufender randomisierter Studien werden wir im klinischen Alltag im Einzelfall entscheiden müssen, ob allein die kardiovaskuläre Situation eine CPAP-Therapie rechtfertigt. Dies wird insbesondere dann der Fall sein, wenn eine schwere OSA vorliegt, eine Tagesmüdigkeit besteht, eine gute Compliance gegeben ist und die Patienten jünger sind. Auf jeden Fall sinnvoll sind Maßnahmen, die das kardiovaskuläre Risiko senken und dabei gleichzeitig einen positiven Einfluss auf die OSA haben, d. h. Gewichtsreduktion, körperliches Training und Tabakentwöhnung.

Abstract

The repetitive intermittent hypoxic episodes, central nervous arousal and intrathoracic pressure fluctuations that occur together with obstructive sleep apnoea are the primary pathophysiological mechanisms responsible for the cardiovascular co-morbidity. These phenomena lead to increased oxidative stress, systemic inflammation, disrupted vasomotor function, increased sympathetic activity and the development of arteriosclerosis in blood vessels. CPAP therapy lowers arterial blood pressure and has a positive effect on relevant specific aspects of cardiovascular co-morbidity. Until the results of current randomised studies have been published, it has to be decided on an individual basis whether the cardiovascular situation alone justifies CPAP therapy. This will usually be the case in severe OSA with daytime sleepiness, in young patients and patients with good compliance. Interventions that reduce cardiovascular risk and also have a positive effect on OSA, i. e., weight reduction, physical exercise and smoking cessation are always appropriate.

 

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