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Schlafapnoe als Komorbidität bei Herzinsuffizienz

Comorbidities of heart failure: sleep apnea

  • Schwerpunkt: Komorbiditäten bei Herzinsuffizienz
  • Published:
Der Internist Aims and scope Submit manuscript

An Erratum to this article was published on 04 June 2018

This article has been updated

Zusammenfassung

Hintergrund

Da schlafbezogene Atmungsstörungen (SBAS) bei Herzinsuffizienz häufig auftreten, ergibt sich regelmäßig die Notwendigkeit zu entscheiden, inwiefern eine diesbezügliche Diagnostik und/oder Therapie erforderlich ist.

Fragestellung

Welche SBAS treten auf? Wann sind sie behandlungsbedürftig? Welche Behandlungsmaßnahmen und Therapieziele sind geeignet?

Material und Methoden

Diskussion von klinischen Studien und Leitlinien. Darstellung der praktischen Umsetzung.

Ergebnisse

Bei mindestens 40 % der Patienten mit Herzinsuffizienz, sowohl mit eingeschränkter (HFrEF) als auch mit erhaltener (HFpEF) linksventrikulärer Ejektionsfraktion, liegt eine relevante SBAS als Komorbidität vor. Die obstruktive Schlafapnoe wie auch die zentrale Schlafapnoe und insbesondere die damit verbundenen Sauerstoffentsättigungen sind bei Herzinsuffizienz mit einer erhöhten Mortalität assoziiert. Während sowohl bei Patienten mit HFrEF als auch bei Patienten mit HFpEF die Behandlung der obstruktiven Schlafapnoe mittels „continuous positive airway pressure“ (CPAP) symptomatische und funktionelle Verbesserungen herbeiführt, ist derzeit unklar, ob und wie eine zentrale Schlafapnoe zu behandeln ist. Bei Patienten mit HFpEF könnte die Behandlung der zentralen Schlafapnoe mittels Positivdruckverfahren von Nutzen sein. Bei Patienten mit einer Ejektionsfraktion ≤45 % ist die Therapie einer zentralen Schlafapnoe mit adaptiver Servoventilation kontraindiziert.

Schlussfolgerung

Schlafbezogene Atmungsstörungen sind bei Patienten mit Herzinsuffizienz häufig und von prognostischer Bedeutung. In spezifischen Patientengruppen lassen sich durch eine Behandlung symptomatische und funktionelle Verbesserungen erzielen. Deshalb sollten Patienten mit Herzinsuffizienz hinsichtlich schlafbezogener Atmungsstörungen untersucht werden.

Abstract

Background

Since sleep apnea often occurs in heart failure, physicians regularly need to decide whether further diagnostic procedures and/or treatment are required.

Objectives

Which types of sleep apnea occur in heart failure patients? When is treatment needed? Which treatments and treatment goals are appropriate?

Materials and methods

Clinical trials and guidelines as well as their implementation in clinical practice are discussed.

Results

At least 40% of patients with heart failure, both with reduced and preserved left ventricular ejection fraction (HFrEF and HFpEF, respectively), suffer from relevant sleep apnea. In heart failure patients both obstructive and central sleep apnea are associated with increased mortality. In HFrEF as well as in HFpEF patients with obstructive sleep apnea, treatment with continuous positive airway pressure (CPAP) achieves symptomatic and functional improvements. In patients with HFpEF, positive airway pressure treatment of central sleep apnea may be beneficial. In patients with HFrEF and left ventricular ejection fraction ≤45%, adaptive servoventilation is contraindicated.

Conclusions

Sleep apnea is highly prevalent in heart failure patients and its treatment in specific patient groups can improve symptoms and functional outcomes. Thus, testing for sleep apnea is recommended.

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Change history

  • 04 June 2018

    Erratum zu:

    Internist 2018

    https://doi.org/10.1007/s00108-018-0412-7

    In diesem Beitrag ist ein Fehler in Abb. 1 aufgetreten. In Teilabbildung b wurde die Beschriftung der verschiedenen Kanäle vertauscht. Die Redaktion bittet den Fehler zu entschuldigen und um die Beachtung der korrekten …

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Authors and Affiliations

  1. Schlaf- und Beatmungszentrum Blaubeuren, Lungenzentrum Ulm, Ulm, Deutschland

    H. Woehrle

  2. Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland

    O. Oldenburg

  3. Ludgerus-Kliniken, Clemenshospital, Lehrkrankenhaus der Westfälischen Wilhelms-Universität, Münster, Deutschland

    O. Oldenburg

  4. Schlafmedizinisches Zentrum, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    S. Stadler &  M. Arzt

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Interessenkonflikt

H. Woehrle erhielt Beraterhonorare und Vortragshonorare von ResMed, Inspire, Boehringer Ingelheim und VitalAire. O. Oldenburg erhielt Beraterhonorare von ResMed, LivaNova, Novartis und Boehringer Ingelheim, Forschungsunterstützung von ResMed und Vortragshonorare von ResMed, Respicardia, LivaNova, Novartis, und Boehringer Ingelheim. M. Arzt erhält Forschungsunterstützung von ResMed, der ResMed Foundation und Philips Respironics sowie Vortragshonorare von Philips Respironics und ResMed. S. Stadler gibt an, dass kein Interessenkonflikt besteht.

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Woehrle, H., Oldenburg, O., Stadler, S. et al. Schlafapnoe als Komorbidität bei Herzinsuffizienz. Internist 59, 428–438 (2018). https://doi.org/10.1007/s00108-018-0412-7

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