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Regulation der Atmung im Schlaf

Control of breathing during sleep

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Somnologie - Schlafforschung und Schlafmedizin Aims and scope Submit manuscript

Zusammenfassung

Die Atmung ist ein Teil eines Transportsystems im Dienst des Gasaustauschs. Rhythmische Atembewegungen werden von einem neuronalen Netzwerk in der Medulla oblongata gesteuert, das auf tonische Afferenzen angewiesen ist. Diese bilden teils geschlossene Regelkreise zur Homöostase der Blutgase und des pH-Werts und sind zum Teil nicht rückgekoppelte „Wachheitsantriebe“. Orexinerge Neurone des Hypothalamus scheinen hier eine wichtige Rolle zu spielen. Mit dem Einschlafen reduzieren sich diese tonischen Afferenzen, die Empfindlichkeit für Sauerstoffmangel und Hyperkapnie nimmt ab, die Arousalschwellen steigen an. Schlaf demaskiert die Apnoeschwelle. Fällt der arterielle Kohlendioxidpartialdruck infolge kurzer Hyperpnoe unter diesen Wert, kommt es zu einem Atemstillstand. Eine unruhige Einschlafphase und häufige Schlafstadienwechsel destabilisieren das Atmungsmuster. Der Tonusverlust der Muskulatur insbesondere im REM-Schlaf betrifft auch die Atemwege und die Interkostalmuskulatur. Folglich nimmt der Atemwegswiderstand zu, das Zwerchfell muss zur Kompensation erhöhte Arbeit leisten. Dennoch weichen beim Gesunden die Blutgase im Schlaf nur wenig von den Werten im Wachsein ab.

Abstract

Breathing is part of a transport system that serves gas exchange of the body. Rhythmic breathing movements are controlled by the neuronal respiratory network in the medulla oblongata, which is dependent on tonic afferents. These are partly closed feedback loops to guarantee the homeostasis of blood gases and acid–base balance, and partly non-feedback stimuli as the so-called “wakefulness drives.” Orexinergic neurons in the hypothalamus seem to play an important role in the tonic drive of respiration during wakefulness. Sleep onset markedly reduces tonic afferents, decreases the sensitivity to hypoxia and hypercapnia, and elevates arousal thresholds. Sleep unmasks the apnea threshold. If the arterial carbon dioxide partial pressure drops below this threshold due to short hyperpneic episodes, the respiratory rhythm arrests. Restless sleep with frequent changes in sleep states destabilizes the breathing pattern. The muscle atonia especially during REM sleep also affects the upper airway muscles and the intercostal muscles. Consequently, there is an increase in airway resistance. The diaphragm has to compensate these challenges by increased work. Nevertheless, in healthy subjects the blood gases only slightly change from wakefulness to sleep.

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  1. Medizinische Fakultät, Ruhr-Universität Bochum, Universitätsstr. 150, 44780, Bochum, Deutschland

    T. Schäfer & M.E. Schläfke

  2. Institut für Klinische Physiologie, HELIOS Klinik Hagen-Ambrock, Hagen-Ambrock, Deutschland

    T. Schäfer & M.E. Schläfke

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Schäfer, T., Schläfke, M. Regulation der Atmung im Schlaf. Somnologie 15, 84–91 (2011). https://doi.org/10.1007/s11818-011-0515-z

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