Pathophysiologie der Atmung unter besonderer Berücksichtigung   schlafbezogener Atmungsstörungen

T. Schäfer

doi:10.1055/s-2006-925105

Laryngo-Rhino-Otologie, Inhaltsverzeichnis

Laryngorhinootologie 2006; 85: 1-10
DOI: 10.1055/s-2006-925105

Schlafmedizin

Pathophysiologie der Atmung unter besonderer Berücksichtigung schlafbezogener Atmungsstörungen

T. Schäfer¹

¹Institut für Physiologie, Ruhr-Universität Bochum, Bochum

Abstract

Zusammenfassung

Die regelmäßige Ein- und Ausatmung wird durch ein verzweigtes Netzwerk respiratorischer Neurone im Hirnstamm gesteuert, das auf unspezifische und spezifische Atmungsantriebe wie Sauerstoffmangel- und CO₂-Empfindlichkeit angewiesen ist. Das respiratorische Netzwerk und die Atmungsantriebe mit ihrer Wirkung auf die Atmung unterliegen charakteristischen Veränderungen beim Übergang vom Wachen zum Schlafen und in den verschiedenen Schlafstadien, die eine Destabilisierung der Atmung im Schlaf begünstigen. Vom Hirnstamm geht auch die atemsynchrone Innervation der dilatierenden und versteifenden Rachenmuskeln aus. Auch diese Aktivität wie der durch lokal-reflektorische Mechanismen gesteuerte basale Tonus der Pharyngealmuskulatur unterliegt typischen Schwankungen in den verschiedenen Wach- und Schlafphasen, die zu einer Widerstandserhöhung der oberen Atemwege im Schlaf führen. Während bei Gesunden diese schlafbezogenen Besonderheiten kompensiert werden und der Gasaustausch im Schlaf kaum behindert ist, kommt es im Krankheitsfall zu erheblichen Störungen der Ventilation und damit der Blutgase und des Schlafes, der dadurch seinen Erholungseffekt einbüßt. Hierzu zählen die zentrale Hypoventilation, das zentrale Apnoe-Hypopnoe-Syndrom sowie das obstruktive Apnoe-Hypopnoe-Syndrom. Dank der intensiven Ursachensuche liegt mittlerweile ein detailliertes Bild über die pathophysiologischen Mechanismen der Entstehung und Aufrechterhaltung der schlafbezogenen Atmungsstörungen vor.

Schlüsselwörter

Atmungsregulation - Atmungsantriebe - Schlaf - Obstruktion der oberen Atemwege - Hypoventilation - zentrale Schlafapnoe

Volltext

Referenzen

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Priv.-Doz. Dr. med. Thorsten Schäfer

Ruhr-Universität Bochum, Institut für Physiologie

Geb. UHW 10/1013 · Stiepeler Straße 129 · 44780 Bochum

eMail: Thorsten.Schaefer@rub.de