Pneumologie 2009; 63(3): 144-162
DOI: 10.1055/s-0028-1100822
Fort- und Weiterbildung
© Georg Thieme Verlag KG Stuttgart · New York

Zentrale Schlafapnoe[1]

Central Sleep ApneaT.  Schäfer1 , M.  E.  Schläfke2 , M.  Westhoff3 , H.-W.  Duchna4 , T.  Penzel5 , S.  Scholle6 , M.  Orth7 in Zusammenarbeit mit der Arbeitsgruppe Pathophysiologie von Schlaf und Atmung der Deutschen Gesellschaft für Schlafforschung und Schlafmedizin, DGSM
  • 1Ruhr-Universität Bochum, Medizinische Fakultät, Bochum
  • 2Klinik Ambrock, Zentrum für Schlaf- und Rehaforschung, Hagen
  • 3Lungenklinik Hemer, Klinik für Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin, Hemer
  • 4Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Medizinische Klinik III, Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin, Bochum
  • 5Charité Campus Mitte, Schlafmedizinisches Zentrum, Berlin
  • 6Robert Koch-Krankenhaus Apolda, Apolda
  • 7Theresienkrankenhaus, Pneumologie, Mannheim
Further Information

Publication History

Publication Date:
03 March 2009 (online)

Einleitung

Hinter der Bezeichnung „zentrale Schlafapnoe” verbergen sich verschiedene Syndrome unterschiedlicher Genese und damit auch unterschiedlicher klinischer Wertigkeit und Therapiebedürftigkeit. Diese CME-Fortbildung zur zentralen Schlafapnoe basiert auf einem Übersichtsartikel der Arbeitsgruppe Pathophysiologie Schlaf/Atmung der Deutschen Gesellschaft für Schlafforschung und Schlafmedizin (DGSM) [1]. Sie erklärt das aktuelle Klassifikationsschema, zeigt die pathophysiologischen Hintergründe auf, nimmt Stellung zur klinischen Relevanz der Syndrome und gibt einen Überblick über die differenzialdiagnostischen und therapeutischen Möglichkeiten beim Erwachsenen und bei Kindern und Jugendlichen.

1 Erstveröffentlichung in Somnologie 2008; 12: 109 – 204

Literatur

  • 1 Schäfer T, Schläfke M E, Westhoff M. et al . Zentrale Schlafapnoe – Pathophysiologie, Relevanz, Diagnostik und Therapie.  Somnologie. 2008;  12 190-204
  • 2 American Academy of Sleep Medicine .ICSD-2 – International classification of sleep disorders, 2nd ed.: Diagnostic and coding manual. Westchester, Illinois: American Academy of Sleep Medicine 2005
  • 3 Duchna H W. Schlafbezogene Atmungsstörungen – Neuauflage der Internationalen Klassifikation von Schlafstörungen (ICSD-2) der American Academy of Sleep Medicine (AASM).  Pneumologie. 2006;  60 568-575
  • 4 Eckert D J, Jordan A S, Merchia P. et al . Central sleep apnea: Pathophysiology and treatment.  Chest. 2007;  131 595-607
  • 5 Schläfke M E, Schäfer C, Schäfer T. Das Undine-Syndrom als kongenitales zentrales Hypoventilationssyndrom (CCHS).  Somnologie. 1999;  3 128-133
  • 6 Khoo M CK, Berry R B. Modeling the interaction between arousal and chemical drive in sleep-disordered breathing.  Sleep. 1996;  19 S167-S169
  • 7 Xie A L, Rutherford R, Rankin F. et al . Hypocapnia and increased ventilatory responsiveness in patients with idiopathic central sleep apnea.  Am J Respir Crit Care Med. 1995;  152 1950-1955
  • 8 Javaheri S. Central sleep apnea-hypopnea syndrome in heart failure: prevalence, impact, and treatment.  Sleep. 1996;  19 S229-S231
  • 9 Hanly P, Zuberi N, Gray R. Pathogenesis of cheyne-stokes respiration in patients with congestive heart failure.  Chest. 1996;  104 1079-1084
  • 10 Badr M S, Toiber F, Skatrud J B. et al . Pharyngeal narrowing/occlusion during central sleep apnea.  J Appl Physiol. 195;  78 1806-1815
  • 11 Penzel T, Brandenburg U, Grote L. et al . Atmungsfunktionsdiagnostik im Schlaf: Möglichkeiten und Grenzen.  Pneumologie. 1997;  51 444-449
  • 12 American Academy of Sleep Medicine Task Force . Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force.  Sleep. 1999;  22 667-689
  • 13 Penzel T, Brandenburg U, Fischer J. et al . Empfehlungen zur computergestützten Aufzeichnung und Auswertung von Polygraphien.  Somnologie. 1998;  2 42-48
  • 14 de Backer W A, Verbraecken J, Willemen M. et al . Central apnea index decreases after prolonged treatment with acetazolamide.  Am J Respir Crit Care Med. 1995;  151 87-91
  • 15 Ancoli-Israel S, Kripke D F, Mason W. Characteristics of obstructive and central sleep apnea in the elderly: an interim report.  Biol Psychiatry. 1987;  22 741-750
  • 16 Bradley T D, Phillipson E A. Central sleep apnea.  Clin Chest Med. 1992;  13 493-505
  • 17 Westhoff M. Häufigkeit zentraler Apnoen und prädiktive Faktoren für ihr Auftreten sowie die Persistenz unter CPAP-Therapie.  Pneumologie. 2006;  60 326-327
  • 18 Bradley T D, McNicholas W T, Rutherford R. et al . Clinical and physiologic heterogeneity of the central sleep apnea syndrome.  Am Rev Respir Dis. 1986;  134 217-221
  • 19 Verbraecken J, Willemen M, Wittesaele W. et al . Short-term CPAP does not influence the increased CO2 drive in idipathic central sleep apnea.  Monaldi Arch Chest Dis. 2002;  57 10-18
  • 20 White D P, Zwillich C W, Pickett C K. et al . Central sleep apnea. Improvement with acetazolamide therapy.  Arch Intern Med. 1982;  142 1816-1819
  • 21 Xie A L, Wong B, Phillipson E A. et al . Interaction of hyperventilation and arousal in the pathogenesis of idiopathic central sleep apnea.  Am J Respir Crit Care Med. 1994;  150 489-495
  • 22 Schulz R, Blau A, Börger J. et al . Prävalenz schlafbezogener Atemstörungen bei Patienten mit schwerer Linksherzinsuffizienz – aktuelle Daten einer deutschen Multizenterstudie.  Pneumologie. 2005;  59 279
  • 23 Hall M J, Xie A L, Rutherford R. et al . Cycle length of periodic breathing in patients with and without heart failure.  Am J Respir Crit Care Med. 1996;  154 376-381
  • 24 Sullivan C E, Berthon-Jones M, Issa F G. et al . Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nose.  The Lancet. 1981;  1 862-865
  • 25 Issa F G, Sullivan C E. Reversal of central sleep apnea using nasal CPAP.  Chest. 1986;  90 165-171
  • 26 Solin P, Roebuck T, Swieca J. et al . Effects of cardiac dysfunction on nonhypercapnic central sleep apnea.  Chest. 1998;  113 104-110
  • 27 Solin P, Roebuck T, Johns D P. et al . Peripheral and central ventilatory responses in central sleep apnea with and without congestive heart failure.  Am J Respir Crit Care Med. 2000;  162 2194-2200
  • 28 Mansfield D R, Solin P, Roebuck T. et al . The effect of successful heart transplant treatment of heart failure on central sleep apnea.  Chest. 2003;  124 1675-1681
  • 29 Leung R S, Huber M A, Rogge T. et al . Association between atrial fibrillation and central sleep apnea.  Sleep. 2005;  28 1543-1546
  • 30 Lanfranchi P A, Braghiroli A, Bosimi E. Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure.  Circulation. 1999;  99 1435-1440
  • 31 Hanly P J, Zuberi-Khokhar N. Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure.  Am Rev Respir Dis. 1996;  153 272-276
  • 32 Lanfranchi P A, Somers V K, Braghiroli A. et al . Central sleep apnea in left ventricular dysfunction: prevalence and implications for arrhythmic risk.  Circulation. 2003;  107 727-732
  • 33 Sin D D, Logan A G, Fitzgerald F S. et al . Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration.  Circulation. 2000;  102 61-66
  • 34 Brack T, Thuer I, Clarenbach C F. et al . Daytime Cheyne-Stokes respiration in ambulatory patients with severe congestive heart failure is associated with increased mortality.  Chest. 2007;  132 1463-1471
  • 35 Bradley T D, Logan A G, Kimoff R J. et al . Continuous positive airway pressure for central sleep apnea and heart failure.  N Engl J Med. 2005;  353 2025-2033
  • 36 Arzt M, Floras J S, Logan A G. et al . Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure: a post hoc analysis of the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure Trial (CANPAP).  Circulation. 2007;  115 3173-3180
  • 37 Schulz R, Baseler G, Ghofrani H A. et al . Nocturnal periodic breathing in primary pulmonary hypertension.  Eur Respir J. 2002;  19 658-663
  • 38 Oksenberg A, Arons E, Snir D. et al . Cheyne-Stokes respiration during sleep: a possible effect of body position.  Med Sci Monit. 2002;  8 CS61-65
  • 39 Sahlin C, Svanborg E, Stenlund H. et al . Cheyne-Stokes respiration and supine dependency.  Eur Resp J. 2005;  25 829-833
  • 40 Tkacova R, Niroumand M, Lorenzi-Filho G. et al . Overnight shift from obstructive to central apneas.  Circulation. 2001;  103 238-243
  • 41 Bassetti C, Aldrich M S, Quint D. Sleep-disordered breathing in patients with acute supra- and infratentorial strokes: A prospective study of 39 patients.  Stroke. 1997;  28 1765-1772
  • 42 Botelho R V, Bittencourt L R, Rotta J M. et al . A prospective controlled study of sleep respiratory events in patients with craniovertebral junction malformation.  J Neurosurg. 2003;  99 1004-1009
  • 43 Gagnadoux F, Meslier N, Svab I. et al . Sleep-disordered breathing in patients with Chiari malformation: improvement after surgery.  Neurology. 2006;  66 136-138
  • 44 Lam B, Ryan C F. Arnold-Chiari malformation presenting as sleep apnea syndrome.  Sleep Med. 2000;  1 139-144
  • 45 Zolty P, Sanders M H, Pollack I F. Chiari malformation and sleep-disordered breathing: a review of diagnostic and management issues.  Sleep. 2000;  23 637-643
  • 46 Lopez-Esteban P, Peraita-Adrados R. Sleep and respiratory disorders in myotonic dystrophy of Steinert.  Neurologia. 2000;  15 102-108
  • 47 Tagasugi T, Ishihara T, Kawamura J. et al . Respiratory failure: respiratory disorders during sleep in patients with myotonic dystrophy.  Rinsho Shinkeigaku. 1995;  35 1468-1486
  • 48 Grunstein R R, Ho K Y, Berthon-Jones M. et al . Central sleep apnea is associated with increased ventilatory response to carbon dioxide and hypersecretion of growth hormone in patients with acromegaly.  Am J Respir Crit Care Med. 1994;  150 496-502
  • 49 Blanco Perez J J, Blanco-Ramos M A, Zamarron Sanz C. et al . Acromegaly and sleep apnea.  Arch Bronchopneumol. 2004;  40 355-359
  • 50 Wessendorf T E. Schlafapnoe bei Akromegalie.  Somnologie. 2003;  7 Suppl. 1 31
  • 51 Resnick H E, Redline S, Shahar E. et al . Diabetes and sleep disturbances: findings from the Sleep Heart Health Study.  Diabetes Care. 2003;  26 702-709
  • 52 Famey R J, Walker J M, Cloward T V. et al . Sleep-disordered breathing associated with long-term opioid therapy.  Chest. 2003;  123 632-639
  • 53 Teichtahl H, Prodromidis A, Miller B. et al . Sleep-disordered breathing in stable methadone programme patients: a pilot study.  Addiction. 2001;  96 395-403
  • 54 Wang D, Teichtahl H, Drummer O. et al . Central sleep apnea in stable methadone maintenance treatment patients.  Chest. 2005;  128 1348-1356
  • 55 Westhoff M, Litterst P, Richling F. et al . Schlafbezogene Atemstörung und Morphinpumpentherapie.  Somnologie. 2004;  8 Suppl. 1 27-28
  • 56 Trinder J, Whitworth F, Kay A. et al . Respiratory instability during sleep onset.  J Appl Physiol. 1992;  73 2462-2469
  • 57 Zwillich C W, Pickett C, Hanson F N. et al . Disturbed sleep and prolonged apnea during nasal obstruction in normal men.  Am Rev Respir Dis. 1981;  124 158-160
  • 58 Javaheri S, Parker T J, Liming J D. 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
  • 59 Hommura F, Nishimura M, Oguri M. et al . Continuous versus bilevel positive airway pressure in a patient with idiopathic central sleep apnea.  Am J Respir Crit Care Med. 1997;  155 1482-1485
  • 60 Ayappa I, Norman R G, Rapoport D M. Cardiogenic oscillations on the airflow signal during continuous positive airway pressure as a marker of central apnea.  Chest. 1999;  116 660-666
  • 61 Thomas R J, Terzano M G, Parrino L. et al . Obstructive sleep-disordered breathing with a dominant cyclic alternating pattern – a recognizable polysomnographic variant with practical clinical implications.  Sleep. 2004;  27 229-234
  • 62 Gilmartin G S, Daly R W, Thomas R J. Recognition and management of complex sleep-disordered breathing.  Curr Opin Pulm Med. 2005;  11 485-493
  • 63 Kuzniar T J, Pusalavidyasagar S, Gay P C. et al . Natural course of complex sleep apnea – a retrospective study.  Sleep Breath. 2007; 
  • 64 Remme W J, Swedberg K. Task Force for the Diagnosis and Treatment of Chronic Heart Failure, European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure.  Eur Heart J. 2001;  22 1527-1560
  • 65 Gabor J Y, Newman D A, Bernard-Roberts V. et al . Improvement in Cheyne-Stokes respiration following cardiac resynchronisation therapy.  Eur Respir J. 2005;  26 95-100
  • 66 Javaheri S, Parker T J, Wexler L. et al . Effect of theophylline on sleep-disordered breathing in heart failure [see comments].  N Engl J Med. 1996;  335 562-567
  • 67 Sutton J R, Houston C S, Mansell A L. et al . Effect of azetazolamide on hypoxemia during sleep at high altitude.  N Engl J Med. 1979;  301 1329-1331
  • 68 Javaheri S. Azetazolamide improves central sleep apnea in heart failure.  Am J Respir Crit Care Med. 2006;  173 234-237
  • 69 Javaheri S, Ahmed M, Parker T. et al . Effects of nasal O2 on sleep-related disordered breathing in amubulatory patients with stable heart failure.  Sleep. 1999;  22 1101-1106
  • 70 Staniforth A D, Kinneart W JM, Starling R. et al . Effect of oxygen on sleep quality, cognitive function and sympathetic activity in patients with chronic heart failure and Cheyne-Stokes respiration.  Eur Heart J. 1998;  19 922-928
  • 71 Hanly P J, Milar T W, Steljes D G. et al . The effects of oxygen on respiration and sleep in patients with congestive heart failure.  Ann Intern Med. 1989;  111 777-782
  • 72 Andreas S, Weidel K, Hagenah G. et al . Treatment of Cheyne-Stokes respiration with nasal oxygen and carbon dioxide.  Eur Respir J. 1998;  12 414-419
  • 73 Javaheri S. Effects of continuous positive airway pressure on sleep apnea and ventricular irritability in patients with heart failure.  Circulation. 2000;  101 392-397
  • 74 Naughton M T, Benard D C, Liu P P. et al . 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
  • 75 Naughton M T, Liu P P, Benard D C. et al . Treatment of congestive heart failure and cheyne-stokes respiration during sleep by continuous positive airway pressure.  Am J Respir Crit Care Med. 1995;  151 92-97
  • 76 Naughton M T, Rahman M A, Hara K. et al . Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure.  Circulation. 1995;  91 1725-1731
  • 77 Teschler H, Döhring J, Wang Y M. et al . Adaptive pressure support servo-ventilation.  Am J Respir Crit Care Med. 2001;  164 614-619
  • 78 Töpfer V, El-Sebai M, Wessendorf T E. et al . Adaptive Servoventilation bei chronischer Herzinsuffizienz: Wirkung auf Cheyne-Stokes-Atmung und Lebensqualität.  Pneumologie. 2004;  58 28-32
  • 79 Marcus C L. Clinical and pathophysiological aspects of obstructive sleep apnoea in children.  Pediatr Pulmonol. 1997;  16 123-124
  • 80 Iber C, Ancoli-Israel S, Chesson A. et al .The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specification. Westchester IL: American Academy of Sleep Medicine 2007
  • 81 Niewerth H J, Wiater A. Polysomnographische Untersuchungen für Säuglinge und Kinder – Anleitung für die Laborarbeit.  Somnologie. 2000;  4 43-52
  • 82 Katz-Salamon M. Delayed chemoreceptor responses in infants with apnoea.  Arch Dis Child. 2004;  89 261-266
  • 83 Lopes J M, Muller N L, Bryan M H. et al . Synergistic behavior of inspiratory muscles after diaphragmatic fatigue in the newborn.  J Appl Physiol. 1981;  51 547-551
  • 84 Niewerth H J, Wiater A, Scholle S. et al . Wertigkeit periodischer Atmung im Säuglingsalter.  Somnologie. 1998;  2 140-147
  • 85 Vielle B, Cauvet G. Mathematical study of periodic breathing as an instability of the respiratory system.  Math Biosci. 1993;  114 149-172
  • 86 Scholle S, Poley M, Glaser S. et al . Periodische Atmung im ersten Lebensjahr in Abhängigkeit von den Schlafstadien.  Somnologie. 1998;  2 14-20
  • 87 Wilkinson M H, Cranage S, Berger P J. et al . Changes in the temporal structure of periodic breathing with postnatal development in preterm infants.  Pediatr Res. 1995;  38 533-538
  • 88 Scholle S. Theophyllin in der Therapie schlafbezogener Atmungsstörungen.  Z ärztl Qual Sich. 2001;  92 35-38
  • 89 Philippi H, Bieber I, Reitter B. Acetazolamide treatment for infantile central sleep apnoea.  J Child Neurol. 2001;  16 600-603
  • 90 Marcus C L. Sleep-disordered breathing in children.  Am J Respir Crit Care Med. 2001;  164 16-30
  • 91 Marcus C L, Omlin K J, Basinski D J. et al . Normal polysomnographic values for children and adolescents.  Am Rev Respir Dis. 1992;  146 1235-1239
  • 92 McNamara F, Issa F G, Sullivan C E. Arousal pattern following central and obstructive breathing abnormalities in infants and children.  J Appl Physiol. 1996;  81 2651-2657
  • 93 Li A M, Wing Y K, Cheung A. et al . Is a 2-night polysomnographic study necessary in childhood sleep-related disordered breathing?.  Chest. 2004;  126 1467-1472
  • 94 Uliel S, Tauman R, Greenfeld M. et al . Normal polysomnographic respiratory values in children and adolescents.  Chest. 2004;  125 872-878
  • 95 Moss D, Urschitz M S, Bodman A von. et al . Reference values for nocturnal home polysomnography in primary schoolchildren.  Pediatr Res. 2005;  58 958-965
  • 96 Traeger N, Schultz B, Pollock A N. et al . Polysomnographic values in children 2 – 9 years old: additional data and review of the literature.  Pediatr Pulmonol. 2005;  40 22-30
  • 97 Montgomery-Downs H E, O'Brian L M, Gulliver T E. et al . Polysomnographic characteristics in normal preschool and early school-aged children.  Pediatrics. 2006;  117 741-753

1 Erstveröffentlichung in Somnologie 2008; 12: 109 – 204

Priv.-Doz. Dr. med. 
Thorsten Schäfer, MME

Ruhr-Universität Bochum, Medizinische Fakultät

MA 0/48

44780 Bochum

Email: thorsten.schaefer@rub.de

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