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Obstruktive Schlafapnoe bei neurologischen Erkrankungen

Speziell als Risikofaktor für Schlaganfall

Obstructive sleep apnea in neurological diseases

Specially as a risk factor for stroke

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Zusammenfassung

Patienten mit neurologischen Erkrankungen haben häufig schlafbezogene Atmungsstörungen als Begleiterkrankungen. Umgekehrt werden bei Patienten mit obstruktiver Schlafapnoe (OSA) gehäuft Erkrankungen des zerebro- und kardiovaskulären Systems gefunden. Epidemiologische Studien haben gezeigt, dass die unbehandelte OSA ein unabhängiger Risikofaktor für das Auftreten eines Schlaganfalls, einer arteriellen Hypertonie oder einer kardiovaskulären Erkrankung ist. Pathogenetisch bedeutsam sind apnoeassoziierte Faktoren wie die arterielle Hypertonie, das Auftreten von Vorhofflimmern, ein erhöhter Sympathikotonus, die intermittierende Hypoxie sowie eine vaskuläre Dysfunktion. Frühzeitige Diagnosestellung und Therapieeinleitung der schlafbezogenen Atmungsstörungen bei neurologischen Erkrankungen führen zu einem verbesserten Behandlungsergebnis der neurologischen Erkrankung und zu einer Reduktion zerebro- und kardiovaskulärer Folgeerkrankungen.

Summary

Neurological diseases are frequently associated with sleep-related breathing disorders. In contrast patients with obstructive sleep apnea (OSA) suffer more often from cerebrovascular and cardiovascular diseases. Epidemiological studies have shown that OSA is common among patients with stroke, arterial hypertension or cardiovascular disease. In particular apnea-associated arterial hypertension, atrial fibrillation, activation of the sympathetic nervous system, recurrent hypoxemia and vascular inflammatory response should be considered as risk factors for the vascular system. Early diagnosis and treatment of sleep-related breathing disorders in neurological diseases are required to reduce the risk of subsequent cerebrovascular and cardiovascular diseases.

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Abbreviations

AHI:

Apnoe-Hypopnoe-Index

ANF:

atrialer natriuretischer Faktor

CPAP:

continuous positive airway pressure

OSA:

obstruktive Schlafapnoe

RAAS:

Renin-Angiotensin-Aldosteron-System

SBAS:

schlafbezogene Atmungsstörung

Literatur

  1. Arzt M, Young T, Finn L et al (2005) Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 172:1447–1451

    Article  PubMed  Google Scholar 

  2. Arzt M, Young T, Peppard PE et al (2010) Dissociation of obstructive sleep apnea from hypersomnolence and obesity in patients with stroke. Stroke 41:129–134

    Article  Google Scholar 

  3. Barone DA, Krieger AC (2013) Stroke and obstructive sleep apnea: a review. Curr Atheroscler Rep 15:334–340

    Article  PubMed  Google Scholar 

  4. Dong JY, Zhang YH, Qin LQ (2013) Obstructive sleep apnea and cardiovascular risk: meta-analysis of prospective cohort studies. Atherosclerosis 229:489–495

    Article  CAS  PubMed  Google Scholar 

  5. Dumitrascu R, Tiede H, Rosengarten B et al (2012) Obstruktive Schlaf-Apnoe und Schlaganfall. Pneumologie 66:476–499

    Article  CAS  PubMed  Google Scholar 

  6. Gainer JL (1987) Hypoxia and atherosclerosis: re-evaluation of an old hypothesis. Atherosclerosis 68:263–266

    Article  CAS  PubMed  Google Scholar 

  7. Grimm W, Hoffmann J, Koehler U et al (1996) Electrophysiological evaluation of sinus node function and atrioventricular conduction in patients with prolonged ventricular asystole during obstructive sleep apnea. Am J Cardiol 77:1310–1314

    Article  CAS  PubMed  Google Scholar 

  8. Hung J, Whitford EG, Parsons RW, Hillman DR (1990) Association of sleep apnea with myocardial infarction in men. Lancet 336:261–264

    Article  CAS  PubMed  Google Scholar 

  9. Johnson KG, Johnson DC (2010) Frequency of sleep apnea in stroke and TIA-patients: a metaanalysis. J Clin Sleep Med 6:131–137

    PubMed  Google Scholar 

  10. Kanagala R, Murali NS, Friedman PA et al (2003) Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 107:2589–2594

    PubMed  Google Scholar 

  11. Koehler U, Becker HF, Grimm W et al (2000) Relations among hypoxemia, sleep stage, and bradyarrhythmia during obstructive sleep apnea. Am Heart J 139:142–148

    Article  CAS  PubMed  Google Scholar 

  12. Koehler U, Trautmann M, Trautmann R et al (1999) Does sleep apnea increase the risk of myocardial infarct during sleep? Z Kardiol 88:410–417

    Article  CAS  PubMed  Google Scholar 

  13. Lurie A (2011) Obstructive sleep apnea in adults – relationship with cardiovascular and metabolic disorders. Advances in Cardiology. Karger, Basel, S 1–267

  14. Martinez-Garcia MA, Soler-Cataluna JJ, Ejarque-Martinez L et al (2009) Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med 180:36–41

    Article  PubMed  Google Scholar 

  15. Mehra R, Benjamin EJ, Shahar E et al (2006) Association of nocturnal arrhythmias with sleep-disordered breathing: the sleep heart health study. Am J Respir Crit Care Med 173:910–916

    Article  PubMed  Google Scholar 

  16. Mooe T, Franklin KA, Holmström K et al (2001) Sleep-disordered breathing and coronary artery disease – long-term prognosis. Am J Respir Crit Care Med 164:1910–1913

    Article  CAS  PubMed  Google Scholar 

  17. Muller JE, Stone PH, Tur ZG et al (1985) Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med 313:1315–1322

    Article  CAS  PubMed  Google Scholar 

  18. Muller JE, Ludmer PL, Willich SN et al (1987) Circadian variation in the frequency of sudden cardiac death. Circulation 75:131–138

    Article  CAS  PubMed  Google Scholar 

  19. Parra O, Arboix A, Bechich S et al (2000) Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack. Am J Respir Crit Care Med 161:375–378

    Article  CAS  PubMed  Google Scholar 

  20. Parra O, Arboix A, Montserrat JM et al (2004) Sleep-related breathing disorder: impact on mortality of cerebrovascular disease. Eur Respir J 24:267–272

    Article  CAS  PubMed  Google Scholar 

  21. Parra O, Sanchez-Armengol A, Bonnin M et al (2011) Early treatment of obstructive sleep apnoea and stroke outcome: a randomized controlled trial. Eur Respir J 37:1128–1136

    Article  CAS  PubMed  Google Scholar 

  22. Peker Y, Hedner J, Norum J et al (2002) Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea – a 7-year follow-up. Am J Respir Crit Care Med 166:159–165

    Article  PubMed  Google Scholar 

  23. Redline S, Yenokyan G, Gottlieb DJ (2010) Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 182:269–277

    Article  PubMed  Google Scholar 

  24. Ringelstein EB, Knecht S (2006) Bluthochdruck und isolierter systolischer Hypertonus – wichtigste Risikofaktoren des Schlaganfalls. Dtsch Ärztebl 103:1906–1911

    Google Scholar 

  25. Ryan CM, Bavlev M, Green R et al (2011) Influence of continuous positive airway pressure on outcomes of rehabilitation in stroke patients with obstructive sleep apnea. Stroke 42:1062–1067

    Article  PubMed  Google Scholar 

  26. Sahlin C, Sandberg O, Gustafson Y et al (2008) Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. Arch Intern Med 168:297–301

    Article  PubMed  Google Scholar 

  27. Schulz R, Seeger W, Fegbeutel C (2005) Changes in extracranial arteries in obstructive sleep apnoea. Eur Respir J 25:69–74

    Article  CAS  PubMed  Google Scholar 

  28. Shahar E, Whitney CW, Redline S et al (2000) Sleep-disordered breathing and cardiovascular disease. Cross-sectional results of the sleep heart health study. Am J Respir Crit Care Med 163:19–25

    Article  Google Scholar 

  29. Shi YF, Wang YP (2009) Sleep-disordered breathing: impact on functional outcome of ischemic stroke patients. Sleep Med 10:717–719

    Article  Google Scholar 

  30. Somers VK, Dyken ME, Clary MP, Abboud FM (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 96:1897–1904

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Valham F, Mooe T, Rabben T et al (2008) Increased risk of stroke in patients with coronary artery disease and sleep apnea: a 10-year follow-up. Circulation 118:955–960

    Article  PubMed  Google Scholar 

  32. Willich SN, Linderer T, Wegscheider K et al (1989) Increased morning incidence of myocardial infarction in the ISAM study: absence with prior β-adrenergic blockade. Circulation 80:853–858

    Article  CAS  PubMed  Google Scholar 

  33. Xie A., Skatrud JB, Puleo DS (2001) Exposure to hypoxia produces long-lasting sympathetic activation in humans. J Appl Physiol 91:1555–1562

    CAS  PubMed  Google Scholar 

  34. Yaggi HK, Concato J, Kernan WN et al (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353:2034–2041

    Article  CAS  PubMed  Google Scholar 

  35. Zehender M, Hohnloser S, Just H (1992) Zirkadiane Rhythmen bei koronarer Herzkrankheit – Pathophysiologie und klinische Bedeutung für myokardiale Ischämie, akuten Myokardinfarkt und plötzlichen Herztod. Dtsch Med Wochenschr 117:629–637

    Article  CAS  PubMed  Google Scholar 

  36. Koehler U et al (2011) Autonome Dysregulation und kardiale Arrhythmien bei Patienten mit obstruktiver und zentraler Schlafapnoe. Dtsch Med Wochenschr 136:2622–2628

    Article  CAS  PubMed  Google Scholar 

  37. Iber C, Ancoli-Israel S, Chesson A, Quan SF for the American Academy of Sleep Medicine (2007) The AASM Manual for the Scoring of Sleep and Associated Events: rules, terminology and technical specifications. 1st edn. American Academy of Sleep Medicine, Westchester, Illinois

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Einhaltung ethischer Richtlinien

Interessenkonflikt. U. Koehler, W. Cassel, O. Hildebrandt, K. Kesper, P. Kianinejad, C. Nell, G. Mayer und G. Ohl geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik Innere Medizin, Schwerpunkt Pneumologie, Intensiv- und Schlafmedizin, Fachbereich Medizin, Philipps Universität Marburg, Baldingerstr. 1, 35033, Marburg, Deutschland

    U. Koehler, W. Cassel, O. Hildebrandt, K. Kesper, P. Kianinejad, C. Nell & G. Ohl

  2. Hephata-Klinik für Neurologische Schlafstörungen, Treysa und Fachbereich Medizin, Philipps Universität Marburg, Marburg, Deutschland

    G. Mayer

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  1. U. Koehler
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  2. W. Cassel
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  3. O. Hildebrandt
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  5. P. Kianinejad
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  6. C. Nell
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  7. G. Mayer
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  8. G. Ohl
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Correspondence to U. Koehler.

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Koehler, U., Cassel, W., Hildebrandt, O. et al. Obstruktive Schlafapnoe bei neurologischen Erkrankungen. Nervenarzt 85, 35–42 (2014). https://doi.org/10.1007/s00115-013-3890-9

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  • DOI: https://doi.org/10.1007/s00115-013-3890-9

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