Subscribe to RSS
DOI: 10.1055/s-2005-863079
© Georg Thieme Verlag Stuttgart · New York
Schlafapnoe: Bedeutung bei Patienten mit Herzinsuffizienz
Pathophysiologie, Diagnostik und TherapieSleep apnea in patients with chronic heart failurePathophysiology, diagnosis and treatmentPublication History
eingereicht: 24.8.2004
akzeptiert: 18.2.2005
Publication Date:
24 February 2005 (online)

Während der letzten 50 Jahre konnte die Prognose der Patienten mit Herzinsuffizienz sowohl durch neue medikamentöse Therapiekonzepte [17] als auch durch interventionelle und chirurgische Revaskularisationsverfahren bei koronarer Herzkrankheit (KHK) sowie in neuerer Zeit durch spezielle antibradykarde und antitachykarde Schrittmachersysteme gebessert werden. Dennoch ist die Letalität der Herzinsuffizienz hoch [25], so dass die Weiterentwicklung neuer Therapieoptionen wünschenswert ist.
Bei der Herzinsuffizienz handelt es sich um ein komplexes Syndrom mit Veränderungen des Sauerstoffaustausches durch eine pulmonalvenöse Stauung oder sowohl restriktive als auch obstruktive Lungenfunktionsstörungen, sowie eine vermehrte Beanspruchung der Atemmuskulatur bei Hyperventilation. Deshalb kommt einem integrativen kardio-pulmonalen Therapiekonzept, das neben der kardiologischen Therapie auch pneumologische Verfahren - wie beispielsweise die atemunterstützende Therapie - umfasst, zunehmende Bedeutung zu.
Literatur
- 1
American Sleep Disorders Association .
Practice parameters for the treatment of snoring and obstructive sleep apnea.
Sleep.
1995;
18
511-513
Reference Ris Wihthout Link
- 2
Andreas S, Clemens C, Sandholzer H, Figulla H, Kreuzer H.
Improvement of exercise capacity with the treatment of cheyne-stokes respiration in
patients with congestive heart failure.
J Am Coll Cardiol.
1996;
27
1486-1490
Reference Ris Wihthout Link
- 3
Andreas S, Hagenah G, Möller C, Werner G, Kreuzer H.
Cheyne-Stokes respiration and prognosis in congestive heart failure.
Am J Cardiol.
1996;
78
1260-1264
Reference Ris Wihthout Link
- 4
Arzt M, Harth M, Luchner A. et al .
Enhanced ventilatory responses to exercise in patients with chronic heart failure
and central sleep apnea.
Circulation.
2003;
107
1998-2003
Reference Ris Wihthout Link
- 5
Becker H F, Jerrentrup A, Ploch T. et al .
Effect of nasal continuous positive airway pressure treatment on blood pressure in
patients with obstructive sleep apnea.
Circulation.
2003;
107
68-73
Reference Ris Wihthout Link
- 6
Bradley T D, Floras J S.
Sleep apnea and heart failure. Part I: obstructive sleep apnea.
Circulation.
2003;
107
1671-1678
Reference Ris Wihthout Link
- 7
Bradley T D, Logan A G, Floras J S.
Rationale and design of the Canadian continuous positive airway pressure trial for
congestive heart failure patients with central sleep apnea.
Can J Cardiol.
2001;
17
677-684
Reference Ris Wihthout Link
- 8
Douglas N J, Polo O.
Pathogenesis of obstructive sleep apnea/hypopnea syndrome.
Lancet.
1994;
344
653-655
Reference Ris Wihthout Link
- 9
Duchna H -W, Guilleminault C, Stoohs R A. et al .
Vascular reactivity in obstructive sleep apnea syndrome.
Am J Respir Crit Care Med.
2000;
161
187-191
Reference Ris Wihthout Link
- 10
Duchna H -W, Guilleminault C, Stoohs R A, Orth M. et al .
Das obstruktive Schlafapnoe-Syndrom: Ein kardiovaskulärer Risikofaktor?.
Z Kardiol.
2001;
90
568-575
Reference Ris Wihthout Link
- 11
Duchna H -W, Grote L, Andreas S. et al .
State of the art article: Sleep-disordered breathing and cardio- and cerebrovascular
diseases: update 2003 of clinical significance and future perspectives.
Somnologie.
2003;
7
101-121
Reference Ris Wihthout Link
- 12
Dunai J, Kleiman J, Trinder J.
Ventilatory instability during sleep onset in individuals with high peripheral chemosensitivity.
J Appl Physiol.
1999;
87
661-672
Reference Ris Wihthout Link
- 13 Fischer J. Schlafbezogene Atmungsstörungen (Apnoe-Syndrom). Auflage 1 Deisenhofen: Dustri-Verlag In: Nolte D, editor. Manuale Pneumologicum 1992: 1-19
Reference Ris Wihthout Link
- 14
Freimark D, Adler Y, Sheffy J. et al .
Oscillations in peripheral arterial tone in congestive heart failure patients: a new
marker for Cheyne-Stokes breathing.
Cardiology.
2002;
98
21-24
Reference Ris Wihthout Link
- 15 Guilleminault C. Clinical features and evaluation of obstructive sleep apnea. W.B. Saunders Company, London, Toronto, montreal, Sydney, Tokyo In: Kryger MH, Roth T, Dement WC, editors: Principles and practice of sleep medicine 1994: 667-677
Reference Ris Wihthout Link
- 16
Hanley P, Zuberi N, Gray R.
Pathogenesis of cheyne-stokes respiration in patients with congestive heart failure.
Relationship to PCO2.
Chest.
1999;
104
1079-1084
Reference Ris Wihthout Link
- 17
Hoppe U C, Erdmann E.
Leitlinien zur Therapie der chronischen Herzinsuffizienz.
Z Kardiol.
2001;
90
218-237
Reference Ris Wihthout Link
- 18
Jahaveri S, Corbett W.
Association of low PaO2 with central sleep apnea and ventricular arrhythmias in ambulatory
patients with stable heart failure.
Ann Intern Med.
1998;
128
204-297
Reference Ris Wihthout Link
- 19
Javaheri S, Parker T J, Liming J. et al .
Sleep apnea in 81 ambulatory male patients with stable heart failure: types and their
prevalences, consequences, and presentations.
Circulation.
1998;
97
2154-2159
Reference Ris Wihthout Link
- 20
Javerheri S.
A mechanism of central sleep apnea in patients with heart failure.
N Engl J Med.
1999;
341
949-954
Reference Ris Wihthout Link
- 21
Kaneko Y, Floras J S, Usui K. et al .
Cardiovascular effects of continuous positive airway pressure in patients with heart
failure and obstructive sleep apnea.
N Engl J Med.
2003;
348
1233-1241
Reference Ris Wihthout Link
- 22
Kelm M, Strauer B E.
Endotheliale Dysfunktion - Therapeutische und prognostische Relevanz.
Internist.
1999;
40
1300-1307
Reference Ris Wihthout Link
- 23
Lanfranchi P, Braghioli A, Bosimini E. et al .
Prognostic value of nocturnal cheyne -stokes respiration in chronic heart failure.
Circulation.
1999;
99
1435-1440
Reference Ris Wihthout Link
- 24
Lanfranchi P, Somers V, Braghiroli A. et al .
Central sleep apnea in left ventricular dysfunction. Prevalence and implications for
arrythmic risk.
Circulation.
2003;
107
727-732
Reference Ris Wihthout Link
- 25
Levy D, Kenchaiah S, Larson M G. et al .
Long-term trends in the incidence of and survival with heart failure.
N Engl J Med.
2002;
347
1397-1402
Reference Ris Wihthout Link
- 26
Libby P, Ridker P M, Maseri A.
Inflammation and Atherosclerosis.
Circulation.
2002;
105
1135-1143
Reference Ris Wihthout Link
- 27
Lipkin D.
Sleep disordered breating in chronic stable heart failure.
Lancet.
1999;
354
531-532
Reference Ris Wihthout Link
- 28
Mansfield D R, Gollogly N C, Kaye D M, Richardson M, Bergin P, Naughton M T.
Controlled trial of continuous positive airway pressure in obstructive sleep apnea
and heart failure.
Am J Respir Crit Care Med.
2004;
169
361-366
Reference Ris Wihthout Link
- 29
Mansfield D, Kaye D, Brunner L RH, Solin P, Esler M, Naughton M.
Raised sympathetic nerve activity in heart failure and central sleep apnea is due
to heart failure severity.
Circulation.
2003;
107
1396-1400
Reference Ris Wihthout Link
- 30
Marti S, Sampol G, Munoz X. et al .
Mortality in severe sleep apnoea/hypopnoea syndrome patients: impact of treatment.
Eur Respir J.
2002;
20
1511-1518
Reference Ris Wihthout Link
- 31
Metha S, Liu P, Fitzgerald F, Allinda Y, Bradley T.
Effects of continuous positive airway pressure on cardiac volumes in patients with
ischemic and dilated cardiomyopathy.
Am J Respir Crit Care Med.
2000;
161
128-134
Reference Ris Wihthout Link
- 32
Narkiewicz K, van de Borne P, Cooley R L, Dyken M E, Somers V K.
Sympathetic activity in obese subjects with and without obstructive sleep apnea.
Circulation.
1998;
98
772-776
Reference Ris Wihthout Link
- 33
Narkiewicz K, Kato M, Phillips B G, Pesek C A, Davison D E, Somers V K.
Nocturnal continuous positive airway pressure decreases daytime sympathetic traffic
in obstructive sleep apnea.
Circulation.
1999;
100
2332-2335
Reference Ris Wihthout Link
- 34
Naughton M T, Benard D, Liu P, Rutherford R, Rankin F, Bradley D.
Effects of nasal CPAP on sympathetic activity in patients with heart failure and central
sleep apnea.
Am J Respir Crit Care Med.
1995;
152
473-479
Reference Ris Wihthout Link
- 35
Nieto F J, Herrington D M, Redline S, Benjamin E J, Robbins J A.
Sleep apnea and markers of vascular endothelial dysfunction in a large community sample
of older adults.
Am J Respir Crit Care Med.
2004;
169
354-360
Reference Ris Wihthout Link
- 36 Orth M, Rasche K, Duchna H -W. Konservative Therapie. Blackwell, Berlin, Wien In: Rasche K, Sanner B, Schäfer T, Schläfke ME, Sturm A, Zidek W (HRSG): Schlafbezogene
Atmungsstörungen in Klinik und Praxis 1999: 212-221
Reference Ris Wihthout Link
- 37
Peperell J C, Ramdassingh-Dow S, Crosthwaite N. et al .
Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive
airway pressure for obstructive sleep apnoea: a randomised parallel trial.
Lancet.
2001;
359
204-210
Reference Ris Wihthout Link
- 38
Peppard P E, Young T, Palta M, Skatrud J.
Prospective study of the association between sleep-disordered breathing and hypertension.
N Engl J Med.
2000;
342
1378-1384
Reference Ris Wihthout Link
- 39
Quan S F, Gersh B J.
Cardiovascular consequences of sleep-disordered breathing: past, present and future
- report of a workshop from the national center on sleep disorders research and the
national heart, lung, and blood institute.
Circulation.
2004;
109
951-957
Reference Ris Wihthout Link
- 40
Sanner B, Hader C, Rasche K.
Das obstruktive Schlafapnoe-Syndrom - Therapie.
Dtsch Med Wochenschr.
2004;
129
570-572
Reference Ris Wihthout Link
- 41
Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S.
Oral applicances for the treatment of snoring and obstructive sleep apnea: a review.
Sleep.
1995;
18
501-510
Reference Ris Wihthout Link
- 42
Schulz R, Schmidt D, Blum A. et al .
Decreased plasma levels of nitric oxide derivates in obstructive sleep apnea: response
to CPAP-Therapy.
Thorax.
2000;
55
1046-1051
Reference Ris Wihthout Link
- 43
Shahar E, Whitney C W, Redline S. et al .
Sleep-disordered breathing and cardiovascular disease - Cross-sectional results of
the Sleep Heart Health Study.
Am J Respir Crit Care Med.
2001;
163
19-25
Reference Ris Wihthout Link
- 44
Shamsuzzaman A S, Gersh B J, Somers V K.
Obstructive sleep apnea: implications for cardiac and vascular disease.
JAMA.
2003;
290
1906-1914
Reference Ris Wihthout Link
- 45
Sin D, Fitzgerald F, Parker J D. et al .
Relationship of systolic BP to obstructive sleep apnea in patients with heart failure.
Chest.
2003;
123
1536-1543
Reference Ris Wihthout Link
- 46
Sin D, Logan A, Fitzgerald F, Liu P, Bradley T.
Effects of continuous positive airway pressure on cardiovascular outcomes in heart
failure patients with and without cheyne-stokes respiration.
Circulation.
2000;
102
61-66
Reference Ris Wihthout Link
- 47
Smith R, Ronald J, Delaive K, Walld R, Manfreda J, Kryger M H.
What are obstructive sleep apnea patients being treated for prior to this diagnosis?.
Chest.
2002;
121
164-172
Reference Ris Wihthout Link
- 48
Solin P, Bergin P, Richardson M, Kaye D, Walters E, Naughton M.
Influence of pulmonary capillary wedge pressure on central apnea in heart failure.
Circulation.
1999;
99
1574-1579
Reference Ris Wihthout Link
- 49
Somers V K, Dyken M E, Clary M P, Abboud F M.
Sympathetic neural mechanisms in obstructive sleep apnea.
J Clin Invest.
1995;
96
1897-1904
Reference Ris Wihthout Link
- 50
Steiner S, Perings C.
Pulmonalarterielle Hypertonie und Cor pulmonale bei obstruktiver Schlafapnoe: Pathophysiologie
und klinische Relevanz.
Internist.
1999;
40
739-746
Reference Ris Wihthout Link
- 51
Steiner S, Schwalen A, Strauer B E.
Kardiologische Diagnostik bei Patienten mit obstruktiver Schlafapnoe.
Dtsch Med Wochenschr.
2002;
38
1958-1962
Reference Ris Wihthout Link
- 52
Teschler H, Dohring J, Wang Y M, Berthon-Jones M.
Adaptive pressure support servo-ventilation: a novel treatment for Cheyne-Stokes respiration
in heart failure.
Am J Respir Crit Care Med.
2001;
164
614-619
Reference Ris Wihthout Link
- 53
Thalhofer S A, Kiwus U, Dorow P.
Influence of orthotopic heart transplantation on breathing pattern disorders in patients
with dilated cardiomyopathy.
Sleep Breath.
2000;
4
121-126
Reference Ris Wihthout Link
- 54
Tremel F, Pepin J L, Veale D. et al .
High prevalence and persistance of sleep apnea in patients referred for acute left
ventricular failure and medically treated over 2 months.
Eur Heart J.
1999;
20
1201-1209
Reference Ris Wihthout Link
- 55
Trinder J, Merson R, Rosenberg J I, Fitzgerald F, Kleiman J, Bradley D T.
Pathophysiological interactions of ventilation, arousals, and blood pressure oscillations
during cheyne-stokes respiration in patients with heart failure.
Am J Respir Crit Care Med.
2000;
162
808-813
Reference Ris Wihthout Link
- 56
Yokoe T, Minoguchi K, Matsuo H. et al .
Elevated Levels of C-reactive protein and interleukin-6 in patients with obstructive
sleep apnea syndrome are decreased by nasal continuous positive airway pressure.
Circulation.
2003;
107
1129-1134
Reference Ris Wihthout Link
- 57
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S.
The occurence of sleep-disordered breathing among middle-aged adults.
New Engl J Med.
1993;
328
1230-1235
Reference Ris Wihthout Link
- 58
Hader C, Sanner B, Rasche K.
Das obstruktive Schlafapnoe-Syndrom - Diagnostik.
Dtsch Med Wochenschr.
2004;
129
566-569
Reference Ris Wihthout Link
Dr. med. Stephan Steiner
Universiätsklinikum Düsseldorf, Klinik für Kardiologie, Pneumologie und Angiologie
Moorenstraße 5
40225 Düsseldorf
Email: Steinest@uni-duesseldorf.de