Abstract
Sleep-disordered breathing is recognized as an increasing public health burden. Obstructive
sleep apnea (OSA), characterized by repetitive obstructions of the upper airway associated
with respiratory efforts and disturbance of normal sleep. Besides the neurocognitive
impairment with daytime sleepiness there are mounting data suggesting an important
causative role of OSA in cardiovascular disease, especially systemic hypertension.
The proposed mechanisms are increased reactive oxygen species and inflammation resulting
in endothelial dysfunction. In addition, longitudinal studies highlightened the associations
of OSA with increased mortality from cardiac events. Central sleep apnea, especially
Cheyne-Stokes-respiration, is frequently found in patients with heart failure and
may be of pathophysiologic significance in heart failure outcomes. Diagnostic workup
of patients at risk is warranted and effective treatment may improve long-term-outcome.
Literatur
- 1 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
- 2
Malhotra A, White D P.
Obstructive sleep apnoea.
Lancet.
2002;
360
237-245
- 3
Young T, Shahar E, Nieto F J. et al .
Predictors of sleep-disordered breathing in community-dwelling adults.
Arch Intern Med.
2002;
162
893-900
- 4
Schäfer H, Pauleit D, Sudhop T. et al .
Body fat distribution, serum leptin, and cardiovascular risk factors in men with obstructive
sleep apnea.
Chest.
2002;
122
829-839
- 5
Barceló A, Barbé F, Llompart E. et al .
Neuropeptide Y and Leptin in patients with obstructive sleep apnea syndrome: role
of obesity.
Am J Respir Crit Care Med.
2005;
171
183-187
- 6
Bradley T D.
Right and left ventricular functional impairment and sleep apnea.
Clin Chest Med.
1992;
13
459-479
- 7
Narkiewicz K, van der Bourne P, Pasek C. et al .
Selective potentiation of peripheral chemoreflex sensitivity in obstructive sleep
apnea.
Circulation.
1999;
99
1183-1189
- 8
Gozal D, Kheirandish-Gozal L.
Cardiovascular morbidity in obstructive sleep apnea. Oxidative stress, inflammation,
and much more.
Am J Respir Crit Care Med.
2008;
177
369-375
- 9
Schulz R, Mahmoudi S, Hattar K. et al .
Enhanced release of superoxid from polymorphnuclear neutrophils in obstructive sleep
apnea. Impact of continuous positive airway pressure therapy.
Am J Respir Crit Care Med.
2000;
162
566-570
- 10
Phillips B G, Narkiewicz K, Pesek C A. et al .
Effects of obstructive sleep apnea on endothelin-1 and blood pressure.
J Hypertens.
1999;
17
61-66
- 11
McNicholas W T, Bonsignore M R.
Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence,
basic mechanisms and research priorities.
Eur Respir J.
2007;
29
156-178
- 12
Koehler U, Becker H F, Grimm W. et al .
Relations among hypoxemia sleep stage, and bradyarrhythmia during sleep.
Am Heart J.
2000;
139
142-148
- 13
Mehra R, Benjamin E J, Shahar E. et al .
Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart
Health Study.
Am J Respir Crit Care Med.
2006;
173
910-916
- 14
Gami A S, Howard D E, Olson E J, Somers V K.
Day-night pattern of sudden death in obstructive sleep apnea.
N Engl J Med.
2005;
352
1206-1214
- 15
Gami A S, Pressman G, Caples S M.
Association of atrial fibrillation and obstructive sleep apnea.
Circulation.
2004;
110
364-367
- 16
Garrigue S, Pepin J L, Defaye P. et al .
High prevalence of sleep apnea syndrome in patients with long-term pacing. The European
multicenter polysomnographic study.
Circulation.
2007;
115
1703-1709
- 17
Nieto F J, Young T B, Lind B K. et al .
Association of sleep-disordered breathing, sleep apnea, and hypertension in a large
community-based study.
JAMA.
2000;
283
1829-1836
- 18
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
- 19
Bazzano L A, Khan Z, Reynolds K, He J.
Effect of nocturnal continuous positive airway pressure on blood pressure in obstructive
sleep apnea.
Hypertension.
2007;
50
417-423
- 20
Peker Y, Hedner J, Norum J. et al .
Increased incidence of cardiovascular disease in middle-aged men with obstructive
sleep apnea.
Am J Respir Crit Care Med.
2002;
166
159-165
- 21
Marin J M, Carrizo S J, Vicente E, Agustini A GN.
Long-term cardiovascular outcomes in men with obstructive sleep apnoea.hypopnoea with
or without treatment with continuous positive airway pressure: an observational study.
Lancet.
2005;
365
1046-1053
- 22
Kuniyoshi F HS, Garcia-Touchard A, Gami A S. et al .
Day-night variation of acute myocardial infarction in obstructive sleep apnea.
J Am Coll Cardiol.
2008;
52
343-346
- 23
Oldenburg O, Lamp B, Faber L. et al .
Sleep disordered breathing in symptomatic patients with heart failure.
Eur J Heart failure.
2007;
9
251-257
- 24
Schulz R, Blau A, Börgel J. et al .
Sleep apnoea in heart failure.
Eur Respir J.
2007;
29
1201-1205
- 25
Wang H, Parker J D, Newton G E. et al .
Influence of obstructive sleep apnea on mortality in patients with heart failure.
J Am Coll Cardiol.
2007;
49
1625-1631
- 26
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
- 27
Arias M A, Garcia-Rio F, Alonso-Fernandez A. et al .
Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects
of nasal continuous positive pressure ventilation in men.
Circulation.
2005;
112
375-383
- 28
Kushida C A, Littner M R, Hirshkowitz M. et al .
Practice parameters for the indication for polysomnography and related procedures.
An update for 2005.
Sleep.
2005;
28
499-519
- 29
Peppard P E, Young T, Palta M. et al .
Longitudinal study of moderate weight change and sleep-disordered breathing.
JAMA.
2000;
284
3015-3021
- 30
Young T, Peppard P E, Gottlieb D J.
Epidemiology of obstructive sleep apnea.
Am J Respir Crit Care Med.
2002;
165
1217-1239
Prof. Dr. med. Harald H. Schäfer
SHG Kliniken Völklingen
Innere Medizin II-Pneumologie
Lungenzentrum Saar
Richardstr. 5 – 9
66333 Völklingen
Email: h.schaefer.vk@shg-kliniken.de
