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Nervenheilkunde 2011; 30(09): 683-690
DOI: 10.1055/s-0038-1628412
Update Neurologie
Schattauer GmbH

Update Schlafmedizin 2010

Update sleep medicine 2010
G. Mayer
1   Neurologie, Schlafmedizin, Hephata Klinik, Schwalmstadt-Treysa
2   Klinik für Neurologie, Philipps-Universität Marburg
,
S. Javidi
1   Neurologie, Schlafmedizin, Hephata Klinik, Schwalmstadt-Treysa
› Institutsangaben
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Publikationsverlauf

Eingegangen am: 30. März 2011

Angenommen am: 04. April 2011

Publikationsdatum:
23. Januar 2018 (online)

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Zusammenfassung

Schlafmedizinische Diagnostik kann gemäßder Leitlinie S3 der Deutschen Gesellschaft für Schlafforschung und Schlafmedizin „Nicht erholsamerSchlaf/Schlafstörungen” durchgeführtwerden. Die Auswertung der Polysomnografien (PSG) erfolgt seit 2007 nach neuenRichtlinien. Sie erfordern frontale und okzipitaleAbleitungen, um Grafoelemente, die dasSchlafstadium charakterisieren am Ort dermaximalen Ausprägung zu identifizieren. Tiefschlafwird auf ein Stadium N3 reduziert. DieIndikation für die ambulante Polygrafie zur Diagnostikschlafbezogener Atmungsstörungenwird mittels der Prätestwahrscheinlichkeit optimiert.Bei hoher Prätestwahrscheinlichkeit und geringer Apnoezahl in der Polygrafie sowiebei Verdacht auf eine alveoläre Hypoventilation,z. B. bei neuromuskulären Erkrankungen,ist immer eine PSG indiziert. SchlafbezogeneAtmungsstörungen und kurzer Schlafgehen mit hohem kardiovaskulärem-, metabolischem- und Mortalitätsrisiko einher. Ob die Insomnie ein Risikofaktor ist konnte nichteindeutig geklärt werden. Dafür finden sich zunehmend Belege für das zugrunde liegende Hyperarousal-Modell. Neue Therapien für die Insomnien bieten die Melatoninagonisten. In der Narkolepsie konnten mittels genomweiter Analysen mehrere Assoziationen gefunden werden, die eine Autoimmunhypothese stützen. Bei Narkolepsien ohne Kataplexie konnte inpostmortalen Untersuchungen eine quantitativgeringe Destruktion hypocretinerger Neuronefestgestellt werden. Das HLA-Allel DQB1*0602ist fast ausschließlich mit einem niedrigen Liquor Hypocretin assoziiert, sodass sich bei Vorliegendes Allels die diagnostische Liquorpunktionerübrigt. Die REM-Schlafverhaltensstörunghat sich als Prädiktor für neurodegenerativeErkrankungen etabliert. Ihre Diagnostikumfasst Fragebögen, Riechtests, transkraniellenUltraschall der Stammganglien, zerebralerBildgebung und Muskeltonusanalyse des REMSchlafes.

Summary

Diagnosis of sleep disorders can be performed according to the evidence based guideline“ nonrestorative sleep/sleep disorders” of the German Sleep Society. PSG scoring is performed according to a new system since 2007. Frontal and occipital derivations allow scoringof graphoelements that characterize sleep stages at their maximal representation. Deep sleep stages are reduced to one stage N3. Indication for ambulatory polygraphy for diagnosis of sleep related breathing disorders is optimized by introducing a “pretest probability”. PSG is indicated if it is high and polygraphy displays only little apneas, and when alveolar hypoventilation is probable. Sleep related breathing disorders and short sleep are associated with high cardiovascular, metabolic and mortality risk. If insomnia is a risk factor itself is unclear. However, many proofs for the hyperarousal model of insomnia have been discovered. New therapeutic options for insomnia are given by the introduction of melatonina gonists. Genome-wide analysis has found several associations with gene loci that support the autoimmune hypothesis of narcolepsy. Post mortem investigations displayed aminor loss of hypocretinergic cells in humans.The allele DQB1*0602 is almost always associated with a low CSF hypocretin, and.therefore does not require a diagnostic lumbarpuncture. REM sleep behaviour disorderhas become an established predictor for neurodegenerative diseases. The diagnostic procedures comprise specific questionnaires, olfactory tests, transcranial ultrasound of basal ganglia, cerebral imaging and muscle tone analysis of REM sleep.

Schlüsselwörter

Polysomnografie - Polygrafie - kardiovaskuläreund metabolische Risiken - Hyperarousal-Modell,genomweite Analysen - Narkolepsie,REM-Schlafverhaltensstörung

Keywords

Polysomnography - polygraphy - cardiovascularand metabolic risk factors - hyperaraousalmodel - genome-wide analysis - narcolepsy - REMsleep behaviour disorder
 

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