Subscribe to RSS
DOI: 10.1055/s-2002-34208
Kardiologische Diagnostik bei Patienten mit obstruktiver Schlafapnoe
Cardiological diagnosis in patients with obstructive sleep apneaPublication History
eingereicht: 27.2.2002
akzeptiert: 17.6.2002
Publication Date:
19 September 2002 (online)

Mit einer Prävalenz von etwa 2-4 % in der erwachsenen Bevölkerung stellen schlafbezogene Atmungsstörungen ein häufiges Krankheitsbild mit erheblichen sozio-ökonomischen Auswirkungen dar [52], wobei bei etwa jedem zweiten dieser Patienten kardiale Erkrankungen als direkte Folge der nächtlichen Atemstörungen oder infolge eines ungünstigen kardiovaskulären Risikoprofils vorliegen. Ältere Untersuchungen konnten eine Übersterblichkeit bei Schlafapnoepatienten in Abhängigkeit des Schweregrades der Atmungsstörung belegen [19]. Mutmaßlich ist zumindest ein Teil dieser Todesfälle durch kardiovaskuläre Ereignisse bedingt [31], wobei die Schlafapnoe mittlerweile als eigenständiger Risikofaktor angesehen wird [38]. Somit wird der Stellenwert der kardialen Diagnostik in diesem Patientenkollektiv deutlich.
Literatur
- 1
Bonsignore M R, Marrone O, Insalaco G, Bonsignore G.
The
cardiovascular effects of obstructive sleep anoeas: analysis of
pathogenic mechanisms.
Eur Respir J.
1994;
7
786-805
Reference Ris Wihthout Link
- 2
Carlson J T, Hedner J, Elam M, Ejnell H, Sellgren J, Wallin B G.
Augmented resting
sympathetic activity in awake patients with obstructive sleep apnea.
Chest.
1993;
103
1763-1768
Reference Ris Wihthout Link
- 3
Carlson J T, Hedner J A, Ejnell H, Peterson L E.
High prevalence
of hypertension in sleep apnea patients independent of obesity.
Am
J Respir Crit Care Med.
1994;
150
72-77
Reference Ris Wihthout Link
- 4
Chaouat A, Weitzenblum E, Krieger J, Oswald M, Kessler R.
Pulmonary hemodynamics
in the obstructive sleep apnea syndrome. Results in 220 consecutive
patients.
Chest.
1996;
109
380-386
Reference Ris Wihthout Link
- 5 Colucci W, Braunwald E. Pathophysiology in
heart failure. Saunders Philadelphia In:
Braunwald E (Hrsg). Heart disease. A textbook of cardiovascular
medicine, Band 1. 5th Auflage 1997: 394-420
Reference Ris Wihthout Link
- 6
Deutsche Gesellschaft für
Pneumologie .
Empfehlungen zur Diagnostik und Therapie
nächtlicher Atmungs- und Kreislaufsregulationsstörungen.
Pneumologie.
1991;
45
45-48
Reference Ris Wihthout Link
- 7
Devereux R, Reichek N.
Echocardiographic determination
of left ventricular mass in man: anatomic validation of the method.
Circulation.
1977;
55
613-618
Reference Ris Wihthout Link
- 8
Dimsdale J, Loredo J, Profant J.
Effect
of continuous positive airway pressure on blood pressure. A placebo
trial.
Hypertension.
2000;
35
144-147
Reference Ris Wihthout Link
- 9
Duchna H, Guilleminault C, Stoohs R. et al .
Vascular reactivity in obstructive sleep
apnea syndrome.
Am J Respir Crit Care Med.
2000;
161
187-191
Reference Ris Wihthout Link
- 10
Fletcher E C.
Sympathic
activity and blood pressure in the sleep apnea syndrome.
Respiration.
1997;
64
22-28
Reference Ris Wihthout Link
- 11
Fletcher E C.
The
relationship between systemic hypertension and obstructive sleep
apnea: Facts and theory.
Am J Med.
1998;
98
118-128
Reference Ris Wihthout Link
- 12
Fung J W, Li T S, Choy D K. et al .
Severe obstructive sleep apnea is associated
with left ventricular diastolic dysfunction.
Chest.
2002;
121
422-429
Reference Ris Wihthout Link
- 13
Garcia-Rio F, Racionero M, Pino J. et al .
Sleep and hypertension. The role of the
peripheral chemoreceptors and the sympatic system.
Chest.
2000;
117
1417-1425
Reference Ris Wihthout Link
- 14
Grote L, Hedner J, Peter J.
Sleep-related
breathing disorder is an independent risk factor for uncontrolled
hypertension.
J Hypertens.
2000;
18
679-685
Reference Ris Wihthout Link
- 15
Grunstein R.
Obstructive
sleep apnea as a risk factor for arterial hypertension.
J
Sleep Res.
2001;
4
166-170
Reference Ris Wihthout Link
- 16
Guidry U C, Mendes L A, Evans J C. et al .
Echocardiographic features
of the Right Heart in Sleep-Disordered Breathing: The Framingham
Heart Study.
Am J Respir Crit Care Med.
2001;
164
933-938
Reference Ris Wihthout Link
- 17
Hanly P, Sasson Z, Zuberi N, Lunn K.
ST-Segment depression during
sleep in obstructive sleep apnea.
Am J Cardiol.
1993;
71
1341-1345
Reference Ris Wihthout Link
- 18
Harbison J, O`Reilly P, McNicholas W.
Cardiac rhythm disturbances in the obstructive
sleep apnea syndrome.
Chest.
2000;
118
591-595
Reference Ris Wihthout Link
- 19
He J, Kryger M H, Zorick F J, Conway W, Roth T.
Mortality
and apnea index in obstructive sleep apnea.
Chest.
1988;
94
9-14
Reference Ris Wihthout Link
- 20
Hedner J, Ejnell H, Caidahl K.
Left
ventricular hypertrophy independent of hypertension in patients
with obstructive sleep apnea.
J Hypertension.
1990;
8
941-946
Reference Ris Wihthout Link
- 21
Heidland U, Strauer B.
Left ventricular muscle
mass and elevated heart rate are associated with coronary plaque
disruption.
Circulation.
2001;
104
1477-1482
Reference Ris Wihthout Link
- 22
Khalil M M, Rifaie O A.
Electrocardiographic
changes in obstructive sleep apnoea syndrome.
Respir Med.
1998;
92
25-27
Reference Ris Wihthout Link
- 23
Kraiczi H, Caidahl K, Samuelsson A, Peker Y, Hedner J.
Impairment
of vascular endothelial function and left ventricular filling: Association
with severity of apnea-induced hypoxemia during sleep.
Chest.
2001;
119
1085-1091
Reference Ris Wihthout Link
- 24
Lavie P, Herer P, Hoffstein V.
Obstructive
sleep apnea syndrome as a risk factor for hypertension: population
study.
BMJ.
2000;
320
479-482
Reference Ris Wihthout Link
- 25
Nieto F Y, Lind B, Shahar E. et
al .
Association of sleep-disordered breathing , sleep
apnea, and hypertension in a large community-based study.
JAMA.
2000;
283
1829-1836
Reference Ris Wihthout Link
- 26
Niroumand M, Kuperstein R, Sasson Z, Hanley P.
Impact of obstructive sleep
apnea on left ventricular mass and diastolic function.
Am
J Respir Crit Care Med.
2001;
163
1632-1636
Reference Ris Wihthout Link
- 27
Noda A, Okada T, Yasuma F, Nakashima N, Yokota M.
Cardiac
hypertrophy in obstructive sleep apnea syndrome.
Chest.
1995;
197
1538-1544
Reference Ris Wihthout Link
- 28
Pankow W, Nabe B, Lies A, Kohl F, Lohmann F.
Influence
of obstructive sleep apnoea on circadian blood pressure profile.
J
Sleep Res.
1995;
4
102-106
Reference Ris Wihthout Link
- 29
Pankow W, Nabe B, Lies A, Becker H, Köhler U, Kohl F V, Lohmann F W.
Influence of sleep apnea on 24-hour blood
pressure.
Chest.
1997;
112
1253-1258
Reference Ris Wihthout Link
- 30
Parish J M, Shepard J W.
Cardiovascular
effects of sleep disorders.
Chest.
1990;
97
1220-1226
Reference Ris Wihthout Link
- 31
Partinen M, Guilleminault C.
Daytime sleepiness
and vascular morbidity at seven-year follow-up in obstructive sleep
apnea patients.
Chest.
1990;
97
27-32
Reference Ris Wihthout Link
- 32
Peker Y, Hedner J, Kraiczi, Löth S.
Respiratory disturbance index. An independent
predictor of mortality in coronary artery disease.
Am
J Respir Crit Care Med.
2000;
162
81-86
Reference Ris Wihthout Link
- 33
Pelttari L, Hietanen E, Salo T, Kataja M, Kantola I.
Little
effect of ordinary antihypertensive therapy on nocturnal high blood
pressure in patients with sleep disordered breathing.
AJH.
1998;
11
272-279
Reference Ris Wihthout Link
- 34
Peppard P, 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
- 35
Perings C, Steiner S, Perings St.
Diagnostik
des chronischen Cor Pulmonale.
Internist.
2001;
40
729-738
Reference Ris Wihthout Link
- 36
Peters A J, Perings Ch, Schwalen A. et al .
Prognostisch relevante Parameter bei Patienten
mit koronarer Herzkrankheit, arterieller Hypertonie und schlafbezogenen
Atmungsstörungen.
Pneumologie.
1997;
51
580-585
Reference Ris Wihthout Link
- 37
Sanner B, Haske M, Büchner N, Zidek W.
Bluthochdruck und schlafbezogene
Atemstörungen.
Nieren- und Hochdruckkrankheiten.
2000;
29
321-325
Reference Ris Wihthout Link
- 38
Sanner B, Konermann M, Hörstenmeyer D, Kreuzer I, Burmann-Urbanek M.
Clinical significance of ventricular late
potentials with obstructive sleep apnea.
J Sleep Res.
1995;
4
190-193
Reference Ris Wihthout Link
- 39
Sanner B, Konermann M, Müller H J, Grötz J, Laschewski F, Kreuzer I.
Rechtsventrikuläre
Funktion bei Patienten mit einer obstruktiven Schlafapnoe.
Wien
Med Wochenschr.
1995;
145
518-520
Reference Ris Wihthout Link
- 40
Schäfer H, Koehler U, Ploch T, Peter J H.
Sleep-related
myocardial ischemia and sleep structure in patients with obstructive
sleep apnea and coronary heart disease.
Chest.
1997;
111
387-393
Reference Ris Wihthout Link
- 41
Schannwell C, Schoebel F, Badiian M. et al .
Diastolische Funktionsparameter und atriale
Rhythmusstörungen bei Patienten mit arterieller Hypertonie.
Dtsch
Med Wochenschr.
1998;
123
957-964
Reference Ris Wihthout Link
- 42
Schulz R, Olschewski H, Grimminger F, Seeger W.
Obstruktive Schlaf-Apnoe
und kardiovaskuläre Erkrankungen- Hypothese pathophysiologischer
Zusammenhänge.
Pneumologie.
2001;
55
295-310
Reference Ris Wihthout Link
- 43
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
- 44
Shanoudy H, Soliman A, Raggi P, Liu J W, Russell D C, Jarmukli N F.
Prevalence
of patent foramen ovale and its contribution to hypoxemia in patients
with obstructive sleep apnea.
Chest.
1998;
113
91-96
Reference Ris Wihthout Link
- 45
Steiner St, Hennersdorf M, Schwalen A, Strauer B.
Right ventricular performance
in patients with sleep apnea and cardiovascular disease.
Am
J Respir Crit Care Med.
2001;
163
400
Reference Ris Wihthout Link
- 46
Steiner St, Perings C.
Pulmonalarterielle Hypertonie
und Cor pulmonale bei obstruktiver Schlafapnoe. Pathophysiologie
und klinische Relevanz.
Internist.
1999;
40
739-746
Reference Ris Wihthout Link
- 47 Strauer B E. Das
Hochdruckherz. Pathophysiologie-Diagnostik-Differentialtherapie. Berlin,
Heidelberg, New York, Springer 1991 3.
Auflage: 210-218
Reference Ris Wihthout Link
- 48
Sturm A, Sanner B.
Schlafmedizin. Ein neues
Querschnittsfach der inneren Medizin.
Dtsch Med Wochenschr.
1999;
124
1573-1576
Reference Ris Wihthout Link
- 49
Sturm A.
Gibt
es ein charakteristisches Schlafapnoe-Cor?.
Dtsch Med Wochenschr.
1994;
119
531-534
Reference Ris Wihthout Link
- 50
Vaile J, Stallard T, Al-Ani M, Jordan P, Townend J, Litter W.
Sleep and blood pressure:
spontaneous baroreflex sensitivity in dippers and non-dippers.
J
Hypertension.
1996;
14
1427-1432
Reference Ris Wihthout Link
- 51
Wessendorf T E, Thilmann A F, Wang Y M, Schreiber A, Konietzko N, Teschler H.
Fibrinogen
levels and obstructive sleep apnea in ischemic stroke.
Am
J Respir Crit Care Med.
2000;
162
2039-2042
Reference Ris Wihthout Link
- 52
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S.
The occurence of sleep-disordered
breathing among middle-aged adults.
N Engl J Med.
1993;
328
1230-1235
Reference Ris Wihthout Link
Dr. med. Stephan Steiner
Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum
Düsseldorf
Moorenstraße 5
40225 Düsseldorf
Phone: 0211/8118800
Fax: 0211/8118800
Email: steinest@uni-duesseldorf.de