Subscribe to RSS
DOI: 10.1055/s-0033-1336823
Kardiovaskuläre Folgeerkrankungen bei obstruktiver Schlafapnoe – Pathomechanismen der Assoziation von OSA und Herz-Kreislauferkrankungen
Cardio-vascular Sequelae in obstructive sleep apnea – Pathomechanisms in association of OSA and cardio-vascular diseasesPublication History
Publication Date:
08 February 2013 (online)
![](https://www.thieme-connect.de/media/klinikarzt/201301/lookinside/thumbnails/10.1055-s-0033-1336823-1.jpg)
Die obstruktive Schlafapnoe ist häufig mit verschiedenen, vor allem internistischen Erkrankungen assoziiert. Hierbei stehen Herz-Kreislauferkrankungen wie arterielle Hypertonie, koronare Herzkrankheit, Herzinsuffizienz, Herzrhythmusstörungen, pulmonale Hypertonie, Schlaganfall und auch metabolische Störungen wie der Diabetes mellitus ganz im Vordergrund. Hierdurch ist die Mortalität von Schlafapnoe-Patienten gesteigert, andererseits sind Patienten mit Herz-Kreislauf-Erkrankungen und zusätzlicher Schlafapnoe besonders gefährdet. In der internistischen Diagnostik und Therapie muss daher diese eng, z. T. kausal verknüpfte Assoziation und Komorbidität von Herz-Kreislauferkrankungen mit der Schlafapnoe unbedingt berücksichtigt werden, um die Prognose der Patienten zu verbessern.
Obstructive sleep apnea is often associated with several diseases, especially with cardio-vascular diseases such as hypertension, coronary heart disease, heart insufficiency, cardiac arrhythmia, pulmonary hypertension, and stroke. Also metabolic diseases like diabetes mellitus are involved. Because of this cardio-vascular comorbidity mortality of sleep apnea patients is increased. On the other hand patients with cardio-vascular diseases and sleep apnea are in special hazard. Thus, in the physician's diagnostic and therapeutic management this close relationship between cardio-vascular diseases and sleep apnea has to be taken into consideration to improve patient's outcome.
-
Literatur
- 1 Sanner B, Büchner N, Randerath WJ, Rasche K. Hypertonie und Schlafapnoe. Bremen: UNI-MED Verlag; 2011. 1.
- 2 Young T, Finn L, Peppard PE et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008; 31: 1071-1078
- 3 Cano-Pumarega I, Durán-Cantolla J, Aizpuru F et al. Obstructive sleep apnea and systemic hyertension. Am J Respir Crit Care Med 2011; 184: 1299-1304
- 4 Duchna H-W, Grote L, Andreas S et al. Sleep disordered breathing and cardio- and cerebrovascular diseases: Update 2003 of clinical significance and future perspectives. Somnologie 2003; 7: 101-121
- 5 Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2008; 5: 136-143
- 6 Kapur VK, Resnick HE, Gottlieb DJ. Sleep Heart Health Study Group. Sleep disordered breathing and hypertension: does self-reported sleepiness modify the association?. Sleep 2008; 31: 1127-1132
- 7 Becker HF, Jerrentrup A, Ploch T et al. Effect of nasal contiuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 2003; 107: 68-73
- 8 Sanner B, Tepel M, Markmann A, Zidek W. Effect of CPAP therapy on 24-hour blood pressure in patients with obstructive sleep apnea syndrome. Am J Hypertens 2002; 15: 251-257
- 9 Peker Y, Carlson J, Hedner J. Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J 2006; 28: 596-602
- 10 Sorajja D, Gami AS, Somers VK et al. Independent association between obstructive sleep apnea and subclinical coronary artery disease. Chest 2008; 133: 927-933
- 11 Kuniyoshi FH, Garcia-Touchard A, Gami AS et al. Day-night variation of acute myocardial infarction in obstructive sleep apnea. J Am Coll Cardiol 2008; 52: 343-346
- 12 Peker Y, Hedner Kraiczi H, Löth S. Respiratory disturbance index: an independent predictor of mortality in coronary artery disease. Am J Respir Crit Care Med 2000; 162: 81-86
- 13 Shahar E, Whithney CW, Redline S et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001; 163: 19-25
- 14 Lindberg E. Epidemiology of OSA. Eur Respir Mon 2010; 50: 51-68
- 15 Steiner S, Willinghöfer R. Kardiale Auswirkungen der obstruktiven Schlafapnoe. Somnologie 2011; 15: 233-238
- 16 Lopez M, Almenar L, Fernandez-Fabrella E et al. Analysis of echocardiographic alterations observed in sleep apnea hypopnea syndrome and how they are influenced by hypertension. Rev Esp Cardiol 2009; 61: 49-57
- 17 Duchna HW, Myslinski W, Dichmann M et al. Kardiale Funktion bei Patienten mit obstruktivem Schlafapnoe-Syndrom und behandelter arterieller Hypertonie. Vorteile durch CPAP-Therapie?. Med Klin 2006; 101: 1-8
- 18 Javaheri S, Caref EB, Chen E et al. Sleep apnea testing and outcomes in a large cohort of Medicare beneficiaries with newly diagnosed heart failure. Am J Respir Crit Care Med 2011; 183: 539-546
- 19 Garrigue S, Pépin JL, Defaye P et al. High prevalence of sleep apnea syndrome in patients with long-term pacing: The European Multicenter Polysomnographic Study. Circulation 2007; 115: 1703-1709
- 20 Gami AS, Howard DE, Olson EJ et al. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med 2005; 352: 1206-1214
- 21 Mehra R, Stone KL, Varosy PD et al. Nocturnal arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study. Arch Intern Med 2009; 169: 1147-1155
- 22 Abe H, Takahashi M, Yaegashi H et al. Efficacy of continuous positive airway pressure on arrhythmias in obstructive sleep apnea patients. Heart Vessels 2010; 25: 1703-1709
- 23 Kanagala R, Murali NS, Friedmann PA et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 2003; 107: 2589-2594
- 24 Atwood CW, McCrory D, Garcia JGN et al. Pulmonary artery hypertension and sleep-disordered breathing. Chest 2004; 126
- 25 Sajkov D, Wang T, Saunders NA et al. Continuous positive airway pressure treatment improves pulmonary hemodynamics in patients with obstructive sleep apnea. Am J Respir Crit Care Med 2002; 165: 152-158
- 26 Chaouat A, Weitzenblum E, Krieger J et al. Pulmonary hemodynamics in the obstructive sleep apnea syndrome. Results in 220 consecutive patients. Chest 1996; 109: 380-386
- 27 Rasche K, Orth M, Kutscha A, Duchna HW. Lungenerkrankungen und Herzfunktion. Internist 2007; 48: 276-283
- 28 Schäfer D. Schlaganfall durch schlafbezogene Atmungsstörungen oder schlafbezogene Atmungsstörungen durch Schlaganfall. Atemw-Lungenkrkh 2008; 34: 212-218
- 29 Arzt M, Youg T, Finn L et al. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 2005; 172: 1447-1451
- 30 Valham F, Mooe T, Rabben T et al. Increased risk of stroke in patients with coronary artery disease and sleep apnea: a 10-year follow-up. Circulation 2008; 118: 955-960
- 31 Martinez-Garcia MA, Soler-Cataluňa JJ, Ejarque-Martinez L et al. Continous positive air way pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med 2009; 180: 36-41
- 32 Adams HP, del Zoppo G, Alberts MJ et al. Guidelines for early management of adults with ischemic stroke. Stroke 2007; 38: 1655-1711
- 33 Rasche K, Keller T, Tautz B et al. Obstructive sleep apnea and type 2 diabetes. Eur J Med Res 2010; 15 (Suppl. 02) 152-156
- 34 Marshall NS, Wong KKH, Phillips CL et al. Is sleep apnea an independent risk factor for prevalent and incident diabetes in the Busselton Health Study?. J Clin Sleep Med 2009; 5: 15-20
- 35 Tasali E, Ip MSM. Obstructive sleep apnea and metabolic syndrome. Proc Am Thor Soc 2008; 5: 207-217
- 36 Harsch IA, Schahin SP, Radespiel-Tröger M et al. Continuous positive airway pressure treatment rapidly improves insulin sensitivity in patients with OSAS. Am J Respir Crit Care Med 2004; 169
- 37 Onat A, Hergenç G, Uyarei H, Yazici M, Tuncer M, Dogan Y, Can G, Rasche K. OSAS is associated with metabolic syndrome rather than insulin resistance. Sleep Breath 2007; 11: 23-30
- 38 Doherty LS, Kiely JL, Swan V, McNicholas WT. Long-term effects of nasal continuous positive pressure therapy on cardiovascular outcomes in sleep apnea syndromes. Chest 2005; 127: 2076-2084
- 39 Martίnez-Garcίa MA, Campos-Rodrίguez F, Catalán-Serra P et al. Cardiovascular mortality in obstructive sleep apnea in the elderly: role of long-term contiuous positive airway pressure treatment. Am J Respir Crit Care Med 2012; 186: 909-916
- 40 Somers VK, White DP, Amin R et al. Sleep apnea and cardiovascular disease. J Am Coll Cardiol 2008; 52: 686-717
- 41 Mant A, King M, Saunders NA et al. Four-year follow-up of mortality and sleep-related respiratory disturbance in non-demented seniors. Sleep 1995; 18: 433-438
- 42 Lavie P, Herer P, Peled R et al. Mortality in sleep apnea patients: a multivariate analysis of risk factors. Sleep 1995; 18: 149-157
- 43 Mayer G, Fietze I, Fischer J et al. S3-Leitlinie „Nicht erholsamer Schlaf/Schlafstörungen der Deutschen Gesellschaft für Schlafforschung und Schlafmedizin (DGSM). Somnologie 2009; 13 (Suppl. 01) 1-160