Herz und Schlaf

Abstract

Heart and sleep are not independent from each other, in contrast there is enormous mutual relationship between both. Thus, especially sleep related breathing disorders like obstructive sleep apnea syndrome (OSAS) have enormous sequelae for the cardiovascular system. Contrary severe diseases of the heart, especially those leading to left heart insufficiency cause serious alterations of ventilation during sleep. The present paper deals with the sequelae of OSAS on the cardiovascular system. Furthermore the effects of cardial diseases on sleep are presented.

Kernaussagen

Schlafstörungen und kardiale Erkrankungen finden nicht unabhängig voneinander und nur in der Nacht bzw. am Tag statt, sondern 24 Stunden lang und in enger Wechselwirkung.

Auswirkungen von Schlafstörungen auf das kardiovaskuläre System

• Schlafstörungen, insbesondere Atmungsstörungen im Schlaf, haben z. T. schwere Auswirkungen auf das kardiovaskuläre System. Dies ist vor allem beim obstruktiven Schlafapnoe-Syndrom (OSAS), der häufigsten Atmungsstörung im Schlaf, der Fall.

• Beim OSAS liegen anatomische Besonderheiten vor (kurzer, dicker Hals, große Zunge), die im Schlaf regelmäßig zur Verlegung der oberen Atemwege führen und nachfolgend Weckreaktionen, sog. „Arousals“, und Sauerstoffentsättigungen hervorrufen. Über verschiedene pathophysiologische Mechanismen kann es dadurch zu arterieller Hypertonie (bis zu 60 % der OSAS-Patienten haben eine Hypertonie, > 30 % der Hypertoniker haben ein OSAS), Schlaganfall, linksventrikulärer Hypertrophie, KHK, Vorhofflimmern und letztlich zum plötzlichen Herztod kommen.

• Bei der arteriellen Hypertonie ist eine Senkung des Blutdrucks mittels CPAP-Therapie nur bei ausreichender Nutzungsdauer möglich.

Auswirkungen von Herzerkrankungen auf den Schlaf

• Herzerkrankungen, insbesondere die Linksherzinsuffizienz unterschiedlicher Provenienz, können zu schweren schlafbezogenen Atmungsstörungen führen. Bei 28 und 37 % aller leitliniengerechten behandelten Patienten mit einer linksventrikulären Ejektionsfraktion ≤ 40 % treten zentrale Apnoen und/oder eine Cheyne-Stokes-Atmung auf.

• ZSA und CSA können nicht medikamentös mit CPAP, Bilevel-Therapie und adaptiver Servoventilation sowie über eine Resynchronisationstherapie und zukünftig vielleicht eine einseitige transvenöse Phrenikusstimulation behandelt werden.

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