Kardiologie up2date 2008; 4(4): 347-368
DOI: 10.1055/s-0028-1103470
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© Georg Thieme Verlag KG Stuttgart · New York

Obstruktives Schlafapnoe-Syndrom und Herz-Kreislauf-Krankheiten

Harald  H.  Schäfer
Further Information

Publication History

Publication Date:
30 December 2008 (online)

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

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