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Dtsch Med Wochenschr 2015; 140(17): 1272-1277
DOI: 10.1055/s-0041-102916
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Schlafstörungen
© Georg Thieme Verlag KG Stuttgart · New York

Schlafstörungen und Herzerkrankungen

Sleep-disordered breathing and cardiac disease
Dominik Linz
1   Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg / Saar
,
Michael Arzt
2   Schlafmedizinisches Zentrum der Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg
› Author Affiliations
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Publication History

Publication Date:
25 August 2015 (online)

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Zusammenfassung

Die Prävalenz von schlafbezogenen Atmungsstörungen (SBAS) beträgt ca. 30 % bei Patienten mit einer koronaren Herzerkrankung, ca. 30 % bei Patienten mit Hypertonus, ca. 50 % bei Patienten mit Herzinsuffizienz und ca. 60 % bei Patienten mit Vorhofflimmern. Betrachtet man die medikamentös nicht einzustellenden Hypertoniker, lassen sich bei bis zu 80 % relevante SBAS nachweisen. Bei vielen kardiologischen Krankheitsbildern, insbesondere Herzinsuffizienz und Vorhofflimmern, ist der Gebrauch von Fragebögen zum Screening von SBAS nicht sensitiv genug, da das Symptom der Tagesschläfrigkeit bei diesen Patienten häufig fehlt. Zum Screening auf SBAS eignet sich die ambulant durchführbare kardiorespiratorische Polygraphie. Eine effektive Therapie der SBAS kann den Blutdruck reduzieren und Rhythmusstörungen verhindern. Ob eine Therapie schlafbezogener Atmungsstörungen das Überleben von Patienten mit einer koronaren Herzerkankung oder mit Herzinsuffizienz beeinflussen kann wird aktuell in größeren Studien untersucht.

Abstract

The prevalence of sleep-disordered breathing (SDB) is ca. 30 % in patients with coronary heart disease, ca. 30 % in patients with Hypertonus, ca. 50 % in patients with congestive heart failure and ca. 60 % in patients with atrial fibrillarion. In patients with resistent hypertension, prevalence of SDB is about 80 %. However, patients with SDB and associated cardiac disease like atrial fibrillation or congestive heart failure do not report daytime symptoms like excessive daytime sleepiness. Ambulatory cardiorespiratory polygraphy is used to screen for SDB in patients with cardiac disease. An effective treatment of SDB can reduced blood pressure and can avoid arrhythmias. The effect of treatment of SDB in patients with congestive heart failure is currently investigated in clinical randomized trials.

Schlüsselwörter

schlafbezogene Atmungsstörung - obstruktive Schlafapnoe - zentrale Schlafapnoe - Herzinsuffizienz - Vorhofflimmern - Hypertonie

Keywords

sleep-disorderd breathing - obstructive sleep apnea - central sleep apnea - heart failure - atrial fibrillation - hypertension
 

  • Literatur

  • 1 Berry RB, Budhiraja R, Gottlieb DJ et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012; 8: 597-619
    Search in Google Scholar
  • 2 Tkacova R, Niroumand M, Lorenzi-Filho G et al. Overnight shift from obstructive to central apneas in patients with heart failure: role of PCO2 and circulatory delay. Circulation 2001; 103: 238-243
    CrossrefPubMedSearch in Google Scholar
  • 3 Peppard PE, Young T, Barnet JH et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013; 177: 1006-1014
    CrossrefPubMedSearch in Google Scholar
  • 4 Schäfer H, Koehler U, Ewig S et al. Obstructive sleep apnea as a risk marker in coronary artery disease. Cardiology 1999; 92: 79-84
    CrossrefPubMedSearch in Google Scholar
  • 5 Becker HF, Jerrentrup A, Ploch T et al. Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 2003; 107: 68-73
    CrossrefPubMedSearch in Google Scholar
  • 6 Javaheri S, Parker TJ, Liming JD et al. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation 1998; 97: 2154-2159
    CrossrefPubMedSearch in Google Scholar
  • 7 Stevenson IH, Teichtahl H, Cunnington D et al. Prevalence of sleep disordered breathing in paroxysmal and persistent atrial fibrillation patients with normal left ventricular function. Eur Heart J 2008; 29: 1662-1669
    PubMedSearch in Google Scholar
  • 8 Logan AG, Perlikowski SM, Mente A et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001; 19: 2271-2277
    CrossrefPubMedSearch in Google Scholar
  • 9 Mayer G, Fietze I, Fischer J et al. S3-Leitlinie Nicht erholsamer Schlaf / Schlafstörungen. Somnologie 2009; 13: 4-160
    CrossrefPubMedSearch in Google Scholar
  • 10 Arzt M, Young T, Finn L et al. Sleepiness and sleep in patients with both systolic heart failure and obstructive sleep apnea. Arch Intern Med 2006; 166: 1716-1722
    CrossrefPubMedSearch in Google Scholar
  • 11 Albuquerque FN, Calvin AD, Sert Kuniyoshi FH et al. Sleep-disordered breathing and excessive daytime sleepiness in patients with atrial fibrillation. Chest 2012; 141: 967-973
    CrossrefPubMedSearch in Google Scholar
  • 12 Geib T, Plappert N, Roth T et al. Prevalence of sleep-disordered breathing related symptoms in patients with chronic heart failure and reduced ejection fraction. Canad J Cardiol 2015; 31: 839-845
    PubMedSearch in Google Scholar
  • 13 Penzel T, Blau A, Garcia C et al. Diagnostik schlafbezogener Atmungsstörungen mittels portabler Verfahren. Pneumologie 2013; 67: 112-117
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Randerath WJ, Hein H, Arzt M et al. Konsensuspapier zur Diagnostik und Therapie schlafbezogener Atmungsstörungen bei Erwachsenen. Pneumologie 2014; 68: 106-123
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Oldenburg O, Arzt M, Bitter T et al. Positionspapier „Schlafmedizin in der Kardiologie“ Update 2014. Kardiologe 2015; 9: 140-158
    CrossrefPubMedSearch in Google Scholar
  • 16 Kasai T, Bradley TD. Obstructive sleep apnea and heart failure: pathophysiologic and therapeutic implications. J Am Coll Cardiol 2011; 57: 119-127
    CrossrefPubMedSearch in Google Scholar
  • 17 Arzt M, Harth M, Luchner A et al. Enhanced ventilatory response to exercise in patients with chronic heart failure and central sleep apnea. Circulation 2003; 107: 1998-2003
    CrossrefPubMedSearch in Google Scholar
  • 18 Linz D, Woehrle H, Bitter T et al. The importance of sleep-disordered breathing in cardiovascular disease. Clin Res Cardiol 2015;
    PubMedSearch in Google Scholar
  • 19 Engleman HM, Martin SE, Deary IJ et al. Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea / hypopnoea syndrome. Lancet 1994; 343: 572-575
    CrossrefPubMedSearch in Google Scholar
  • 20 Marin JM, Agusti A, Villar I et al. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA 2012; 307: 2169-2176
    CrossrefPubMedSearch in Google Scholar
  • 21 Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH / ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34: 2159-2219
    PubMedSearch in Google Scholar
  • 22 Davies CW, Crosby JH, Mullins RL et al. Case-control study of 24 hour ambulatory blood pressure in patients with obstructive sleep apnoea and normal matched control subjects. Thorax 2000; 55: 736-740
    CrossrefPubMedSearch in Google Scholar
  • 23 Narkiewicz K, Kato M, Phillips BG et al. Nocturnal continuous positive airway pressure decreases daytime sympathetic traffic in obstructive sleep apnea. Circulation 1999; 100: 2332-2335
    CrossrefPubMedSearch in Google Scholar
  • 24 Varounis C, Katsi V, Kallikazaros IE et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: a systematic review and meta-analysis. Int J Cardiol 2014; 175: 195-198
    CrossrefPubMedSearch in Google Scholar
  • 25 Gottlieb DJ, Punjabi NM, Mehra R et al. CPAP versus oxygen in obstructive sleep apnea. N Engl J Med 2014; 370: 2276-2285
    PubMedSearch in Google Scholar
  • 26 Linz D, Mahfoud F, Linz B et al. Effect of obstructive respiratory events on blood pressure and renal perfusion in a pig model for sleep apnea. Am J Hypertens 2014; 27: 1293-1300
    PubMedSearch in Google Scholar
  • 27 Gami AS, Hodge DO, Herges RM et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol 2007; 49: 565-571
    CrossrefPubMedSearch in Google Scholar
  • 28 Kanagala R, Murali NS, Friedman PA et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 2003; 107: 2589-2594
    CrossrefPubMedSearch in Google Scholar
  • 29 Linz D, Hohl M, Ukena C et al. Obstructive respiratory events and premature atrial contractions after cardioversion. Eur Respir J 2015; pii ERJ-01757–2014
    PubMedSearch in Google Scholar
  • 30 Ng CY, Liu T, Shehata M et al. Meta-analysis of obstructive sleep apnea as predictor of atrial fibrillation recurrence after catheter ablation. Am J Cardiol 2011; 108: 47-51
    PubMedSearch in Google Scholar
  • 31 Monahan K, Brewster J, Wang L et al. Relation of the severity of obstructive sleep apnea in response to anti-arrhythmic drugs in patients with atrial fibrillation or atrial flutter. Am J Cardiol 2012; 110: 369-372
    CrossrefPubMedSearch in Google Scholar
  • 32 Fein AS, Shvilkin A, Shah D et al. Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation. J Am Coll Cardiol 2013; 62: 300-305
    PubMedSearch in Google Scholar
  • 33 Gami AS, Olson EJ, Shen WK et al. Obstructive sleep apnea and the risk of sudden cardiac death: A longitudinal study of 10, 701 adults. J Am Coll Cardiol 2013; 62: 610-616
    CrossrefPubMedSearch in Google Scholar
  • 34 Zeidan-Shwiri T, Aronson D, Atalla K et al. Circadian pattern of life-threatening ventricular arrhythmia in patients with sleep-disordered breathing and implantable cardioverter-defibrillators. Heart Rhythm 2011; 8: 657-662
    CrossrefPubMedSearch in Google Scholar
  • 35 Ryan CM, Usui K, Floras JS et al. Effect of continuous positive airway pressure on ventricular ectopy in heart failure patients with obstructive sleep apnoea. Thorax 2005; 60: 781-785
    CrossrefPubMedSearch in Google Scholar
  • 36 Bitter T, Gutleben KJ, Nölker G et al. Treatment of Cheyne-Stokes respiration reduces arrhythmic events in chronic heart failure. J Cardiovasc Electrophysiol 2013; 24: 1132-1140
    PubMedSearch in Google Scholar
  • 37 Linz D, Linz B, Hohl M et al. Atrial arrhythmogenesis in obstructive sleep apnea: Therapeutic implications. Sleep Med Rev
    PubMed
  • 38 Linz D, Hohl M, Nickel A et al. Effect of renal denervation on neurohumoral activation triggering atrial fibrillation in obstructive sleep apnea. Hypertension 2013; 62: 767-774
    CrossrefPubMedSearch in Google Scholar
  • 39 Buchner S, Greimel T, Hetzenecker A et al. Natural course of sleep-disordered breathing after acute myocardial infarction. Eur Respir J 2012; 40: 1173-1179
    CrossrefPubMedSearch in Google Scholar
  • 40 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
    CrossrefPubMedSearch in Google Scholar
  • 41 Buchner S, Satzl A, Debl K et al. Impact of sleep-disordered breathing on myocardial salvage and infarct size in patients with acute myocardial infarction. Eur Heart J 2014; 35: 192-199
    CrossrefPubMedSearch in Google Scholar
  • 42 Oldenburg O, Lamp B, Faber L et al. Sleep-disordered breathing in patients with symptomatic heart failure: a contemporary study of prevalence in and characteristics of 700 patients. Eur J Heart Fail 2007; 9: 251-257
    CrossrefPubMedSearch in Google Scholar
  • 43 Jilek C, Krenn M, Sebah D et al. Prognostic impact of sleep disordered breathing and its treatment in heart failure: an observational study. Eur J Heart Fail 2011; 13: 68-75
    CrossrefPubMedSearch in Google Scholar
  • 44 Damy T, Margarit L, Noroc A et al. Prognostic impact of sleep-disordered breathing and its treatment with nocturnal ventilation for chronic heart failure. Eur J Heart Fail 2012; 14: 1009-1019
    CrossrefPubMedSearch in Google Scholar
  • 45 Bradley TD, Logan AG, Kimoff RJ et al. Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med 2005; 353: 2025-2033
    CrossrefPubMedSearch in Google Scholar
  • 46 Arzt M, Floras JS, Logan AG et al. Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure: a posthoc analysis of the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure Trial (CANPAP). Circulation 2007; 115: 3173-3180
    CrossrefPubMedSearch in Google Scholar
  • 47 Cowie MR, Woehrle H, Wegscheider K et al. Rationale and design of the SERVE-HF study: treatment of sleep-disordered breathing with predominant central sleep apnoea with adaptive servo-ventilation in patients with chronic heart failure. Eur J Heart Fail 2013; 15: 937-943
    CrossrefPubMedSearch in Google Scholar
  • 48 Deutsche Gesellschaft für Kardiologie. Stellungnahme der Deutschen Gesellschaft für Kardiologie zur wichtigen Sicherheitsinformation über ein erhöhtes kardiovaskuläres Todesrisiko bei ASV-Therapie. http://dgk.org/daten/ErhoehtesMortalitaetsriskikobeiASV-Therapie_Stellungnahme_DGK.pdf (letzter Zugriff 23.7.2015)
    Crossref