Der obere Atemweg bei OSA-Patienten ist auch im Wachzustand pathologisch

Zusammenfassung

Die obstruktive Schlafapnoe (OSA) ist charakterisiert durch eine partielle bzw. komplette Obstruktion des pharyngealen Atemwegs. Prinzipiell kann man anatomische von nicht-anatomischen Faktoren unterscheiden. Alter und Adipositas stellen die Hauptrisikofaktoren für OSA dar, dennoch sind etwa 50% der Patienten nicht adipös. Im höheren Alter (>60 Jahre) nimmt der Stellenwert der Adipositas ab, es werden vermehrt normgewichtige Patienten mit OSA gefunden. Durch Effekte der chronisch intermittierenden Hypoxämie, der Low-grade-Inflammation, des erhöhten Sympathikotonus sowie der mechanischen Beanspruchung kommt es zu einer Muskelfasertransformation im oberen Atemweg mit verminderter Muskelmasse und -kraft. Seltener auftretende nicht-anatomische Faktoren sind ein reduzierter muskulärer Tonus, eine erhöhte Arousalschwelle sowie eine veränderte Sensibilität der Chemorezeptoren auf CO₂.

Abstract

Obstructive sleep apnea (OSA) is characterized by partial or complete obstruction of the pharyngeal airway. Anatomical factors can be distinguished from non-anatomical factors. Age and obesity are the main risk factors for OSA; however, approximately 50% of patients are not obese. In older patients (>60 years), the importance of obesity decreases. There is an increased prevalence of OSA among patients with normal weight. The effects of chronic intermittent hypoxemia, low-grade inflammation, increased sympathetic tone and mechanical stress contribute to a transformation of muscle fibers in the upper airway, resulting in reduced muscle mass and strength. Less frequently encountered non-anatomical factors include decreased muscle tone, increased arousal threshold, and altered sensitivity of CO₂ chemoreceptors.

Schlüsselwörter

obstruktive Schlafapnoe - pharyngealer Atemweg - chronisch intermittierende Hypoxie - Atemwegsmuskulatur - Chemorezeption

Keywords

obstructive sleep apnea - pharyngeal airway - chronic intermittent hypoxia - airway muscles - chemoreception

Publication History

Received: 26 May 2023

Accepted after revision: 10 July 2023

Article published online:
30 August 2023

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