Schlafbezogene Atmungsstörungen bei Patienten mit Herzinsuffizienz: Epiphänomen oder wechselseitige Krankheitsbeeinflussung

Zusammenfassung

Schlafbezogene Atmungsstörungen (SBAS) stellen mit einer Prävalenz von ca. 45 % eine sehr häufige Komorbidität der Herzinsuffizienz (HI) dar. Die beiden Erkrankungen sind wechselseitig voneinander abhängig: Einerseits kann die obstruktive Schlafapnoe zur Entstehung einer HI beitragen. Die Apnoe-assoziierte Erhöhung der kardialen Nachlast, die Entwicklung einer arteriellen Hypertonie und negative intrathorakale Drücke können zu einer Myokardhypertrophie und somit zu einer HI führen. Außerdem erhöht die Schlafapnoe das Herzinfarktrisiko und begünstigt die Entstehung einer HI nach Herzinfarkt. Anderseits kann die HI zur Entstehung sowohl der zentralen als auch der obstruktiven Schlafapnoe beitragen. Die optimale Behandlung einer bestehenden HI ist daher ein wichtiger Teil der Therapie einer SBAS. Die Therapie einer SBAS mittels positivem Atemwegsdruck reduziert effektiv Apnoen und Hypopnoen, verbessert den Schlaf und kann sich positiv auf das Befinden, die Lebensqualität und die Herzfunktion der Betroffenen auswirken. Die hohe Koinzidenz der SBAS und der HI rechtfertigt daher eine schlafmedizinische Diagnostik und Evaluation der Therapieindikation der SBAS in einem spezialisierten Zentrum.

Abstract

Sleep-disordered breathing (SDB) constitutes a highly prevalent comorbidity in patients with chronic heart failure (HF, approximately 45 %). Both diseases are related in a bidirectional way: Obstructive sleep apnoea (OSA) can contribute to the development of HF via multiple mechanisms. Apnoea-related acute rise of cardiac afterload as well as manifest hypertension may contribute to the development of myocardial hypertrophy and thus HF. In addition, OSA increases the risk for myocardial infarction and impaired recovery of cardiac function after the event. Impaired cardiac function itself may contribute to the development of obstructive and central sleep apnoea (SA). Therefore, optimal medical management of HF is part of the therapy of SDB in such patients. Treatment of SDB with different modes of positive airway pressure suppresses apnoeas and hypopnoeas, improves sleep and may improve related symptoms and cardiac function of affected patients. Considering the high coincidence of SDB and HF, the adequate diagnosis of SDB and evaluation of indication for therapy of SDB performed in a specialised centre is advised.

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