Schlafbezogene Atmungsstörungen und Arrhythmien Mechanismen, Interaktionen und klinische Relevanz

 

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Zusammenfassung

In jüngster Zeit erfahren schlafbezogene Atmungsstörungen (SBAS) bei kardialen Erkrankungen zunehmende Aufmerksamkeit. Sowohl die obstruktive schlafbezogene Atmungsstörung als auch die Cheyne-Stokes-Atmung konnten als Komorbiditäten von hoher Prävalenz und prognostischer Relevanz bei verschiedenen kardiovaskulären Krankheitsbildern identifiziert werden. Speziell kardiale Arrhythmien sind seit vielen Jahren als Konsequenz der SBAS bekannt; Hypoxämien und vermehrte Aktivierungen des sympathischen Nervensystems gelten als Triggerfaktoren. Folglich konnten verschiedene klinische Studien eine Assoziation der SBAS vor allem mit tachykarden, atrialen oder ventrikulären Herzrhythmusstörungen aufzeigen. Auch wenn insbesondere für die Cheyne-Stokes-Atmung Daten aus größeren, randomisierten Studien ausstehen, so scheint eine suffiziente Therapie der nächtlichen Atemaussetzer mit einem positiven Effekt auf Arrhythmien einherzugehen.

Abstract

In patients with cardiac disease growing interests have been centered on concomitant co-morbidities such as sleep disordered breathing (SDB). Obstructive sleep apnoea (OSA) as well as Cheyne-Stokes Respiration (CSR) have been recognized as relevant co-morbidities that are highly prevalent and associated with an impaired prognosis. As a known consequence from recurrent hypoxaemias and an increased sympathetic activity, SDB promotes structural myocardial changes and potentially triggers cardiac arrhythmias. Several investigations thus reported an increasing frequency of cardiac arrhythmias among patients with either OSA or CSR. Sufficiently suppressing SDB by adequate therapies seems to ameliorate its arrhythmogenic impact. However, especially for CSR data from randomized, controlled trial are urgently awaited to definitely answer this question.

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Dr. med. Thomas Bitter

Klinik für Kardiologie
Herz- und Diabeteszentrum Nordrhein Westfalen
Ruhr-Universität Bochum

Georgstraße 11

32545 Bad Oeynhausen

Phone: 05731/97-1258

Fax: 05731/97-2194

Email: akleemeyer@hdz-nrw.de