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Schlafbezogene Atmungsstörungen im Kindes- und Jugendalter

Sleep-related breathing disorders in childhood and adolescence

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Zusammenfassung

Die anatomischen Strukturen für die Schlaf-Wach-Regulation und die Atemregulation sind topografisch eng benachbart und beeinflussen sich gegenseitig funktionell durch zahlreiche neuronale Verbindungen. Der Schlaf stellt daher einen besonders „sensiblen“ Zustand für das Auftreten von Atmungsstörungen dar. Da Kinder und Jugendliche 30–70 % der Zeit schlafend verbringen, sind derartige Störungen besonders relevant. Schlafbezogene Atmungsstörungen präsentieren sich klinisch in verschiedenen Lebensaltern recht unterschiedlich. Abhängig von der die Störung bedingenden Ursache bzw. Grunderkrankung werden Atempausen, Hypoventilation, erschwerte Atmung bzw. Dyspnoe (v. a. bei Obstruktion), Zyanose oder auch Herzfrequenzveränderungen beobachtet. Mitunter führen die Atmungsstörungen zu lebensbedrohlichen Ereignissen. Bei anamnestischem oder klinischem Verdacht auf schlafbezogene Atmungsstörungen sollte umgehend eine diagnostische Abklärung in einem pädiatrischen Schlaflabor erfolgen. Je nach Diagnose muss anschließend eine adäquate Therapie (Adenotonsillektomie/-otomie, „continuous positive airway pressure“ [CPAP], Heimbeatmung u. a.) eingeleitet werden. Jegliche Therapieverzögerung kann zu Sekundärveränderungen führen (Schädigung des Zentralnervensystems, anatomische Fehlentwicklungen, Trichterbrust, Rechtsherzbelastung, Cor pulmonale, mangelndes Gedeihen, Einschränkung der Lebensqualität etc.) und ist daher unbedingt zu vermeiden. Das Bewusstsein für schlafbezogene Atmungsstörungen im Kindesalter ist allerdings auch beim medizinischen Personal noch nicht optimal, sodass Aufklärung und Bewusstseinsbildung zwei der wesentlichen Aufgaben pädiatrischer Somnologen darstellen.

Abstract

The anatomical structures for sleep-wake and respiratory regulation are topographically closely situated and mutually influence each other functionally due to many neuronal connections; therefore, sleep represents a very sensitive state for the occurrence of breathing disorders. As children and adolescents spend 30–70 % of overall time asleep, they are especially prone to sleep-related breathing disorders (SBD), which are clinically manifested differently at different ages. Depending on the cause or disease underlying the disorder, SBD may present as apneas, hypoventilation, dyspnea (especially by obstructions) or cyanosis and is occasionally associated with heart rate alterations. If there is an anamnestic or clinical suspicion of SBD, diagnostic investigations should immediately be carried out in a pediatric sleep laboratory. Depending on the diagnosis, adequate therapy, e.g. adenotonsillectomy, adenotonsillotomy, continuous positive airway pressure (CPAP) and home ventilation, has to be subsequently initiated. Any delay in therapy onset may cause adverse secondary alterations, e.g. central nervous system (CNS) alterations, anatomical aberrations, funnel chest, right heart failure, cor pulmonale, failure to thrive and reduced quality of life and must therefore be avoided. Awareness of SBD in childhood is, however, suboptimal even among medical personnel. To increase knowledge and awareness are two of the major tasks of pediatric somnologists.

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Authors and Affiliations

  1. Abteilung für Kinder und Jugendliche, LKH Hochsteiermark/Leoben, Vordernbergerstr. 42, 8700, Leoben, Österreich

    R. Kerbl & I. Grigorow

  2. Amt für Jugend und Familie, Stadt Graz, Graz, Österreich

    W. Sauseng

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  1. R. Kerbl
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Correspondence to R. Kerbl.

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R. Kerbl, I. Grigorow und W. Sauseng geben an, dass kein Interessenkonflikt besteht.

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Kerbl, R., Grigorow, I. & Sauseng, W. Schlafbezogene Atmungsstörungen im Kindes- und Jugendalter. Monatsschr Kinderheilkd 164, 1085–1095 (2016). https://doi.org/10.1007/s00112-016-0176-x

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