Schlafbezogene Atmungsstörungen und Arrhythmien Mechanismen, Interaktionen und klinische Relevanz

Zusammenfassung

In jüngster Zeit erfahren schlafbezogene Atmungsstörungen (SBAS) bei kardialen Erkrankungen zunehmende Aufmerksamkeit. Sowohl die obstruktive schlafbezogene Atmungsstörung als auch die Cheyne-Stokes-Atmung konnten als Komorbiditäten von hoher Prävalenz und prognostischer Relevanz bei verschiedenen kardiovaskulären Krankheitsbildern identifiziert werden. Speziell kardiale Arrhythmien sind seit vielen Jahren als Konsequenz der SBAS bekannt; Hypoxämien und vermehrte Aktivierungen des sympathischen Nervensystems gelten als Triggerfaktoren. Folglich konnten verschiedene klinische Studien eine Assoziation der SBAS vor allem mit tachykarden, atrialen oder ventrikulären Herzrhythmusstörungen aufzeigen. Auch wenn insbesondere für die Cheyne-Stokes-Atmung Daten aus größeren, randomisierten Studien ausstehen, so scheint eine suffiziente Therapie der nächtlichen Atemaussetzer mit einem positiven Effekt auf Arrhythmien einherzugehen.

Abstract

In patients with cardiac disease growing interests have been centered on concomitant co-morbidities such as sleep disordered breathing (SDB). Obstructive sleep apnoea (OSA) as well as Cheyne-Stokes Respiration (CSR) have been recognized as relevant co-morbidities that are highly prevalent and associated with an impaired prognosis. As a known consequence from recurrent hypoxaemias and an increased sympathetic activity, SDB promotes structural myocardial changes and potentially triggers cardiac arrhythmias. Several investigations thus reported an increasing frequency of cardiac arrhythmias among patients with either OSA or CSR. Sufficiently suppressing SDB by adequate therapies seems to ameliorate its arrhythmogenic impact. However, especially for CSR data from randomized, controlled trial are urgently awaited to definitely answer this question.

Schlüsselwörter

Schlafbezogene Atmungsstörungen - Arrhythmien - Vorhofflimmern - ventrikuläre Tachykardien - obstruktive Schlafapnoe - Cheyne-Stokes-Atmung

Keywords

sleep disordered breathing - arrhythmias - atrial fibrillation - ventricular tachycardias - obstructive sleep apnea - Cheyne-strokes respiration

Literatur

• 1 Abe H, Takahashi M, Yaegashi H. et al . Efficacy of continuous positive airway pressure on arrhythmias in obstructive sleep apnea patients.  Heart Vessels. 2010;  25 63-69
• 2 Al Lawati N, Mulgrew A, Cheema R. et al . Pro-artherogenic cytokine profile of patients with suspected obstructive sleep apnea.  Sleep Breath. 2009;  13 277-283
• 3 Ashikaga H, Sasano T, Dong J. et al . Magnetic resonance-based anatomical analysis of scar-related ventricular tachycardia: implications for catheter ablation.  Circ Res. 2007;  101 939-947
• 4 Barbe F, Duran-Cantolla J, Capote F. et al . Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea.  Am J Respir Crit Care Med. 2010;  181 718-726
• 5 Bitter T, Langer C, Vogt J. et al . Sleep-disordered breathing in patients with atrial fibrillation and normal systolic left ventricular function.  Dtsch Arztebl Int. 2009;  106 164-170
• 6 Bitter T, Westerheide N, Prinz C. et al . Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure.  Eur Heart J. 2011;  32 61-74
• 7 Bradley T D, Logan A G, Kimoff R J. et al . CANPAP Investigators: Continuous positive airway pressure for central sleep apnea and heart failure.  N Engl J Med. 2005;  353 2025-2033
• 8 Brilla C G, Zhou G, Matsubara L, Weber K T. Collagen metabolism in cultured adult rat cardiac fibroblasts: Response to angiotensin II and aldosterone.  J Mol Cell Immunol. 1994;  26 809-820
• 9 Brooks D, Horner L J, Kozar L F, Render-Teixera C L, Philippson E A. Obstructive sleep apnea as a cause of systemic hypertension. Evidences from a canine model.  J Clin Invest. 1997;  99 106-109
• 10 Calhoun D A, Nishizaka M K, Zaman M A, Harding S M. Aldosterone excretion among subjects with resistant hypertension and symptoms of sleep apnea.  Chest. 2004;  125 112-117
• 11 Cassar A, Morgenthaler T I, Lennon R J, Rihal C S, Lerman A. Treatment of obstructive sleep apnea is associated with decreased cardiac death after percutaneous coronary intervention.  J Am Coll Cardiol. 2007;  50 1310-1314
• 12 Chilukuri K, Dalal D, Gadrey S. et al . A prospective study evaluating the role of obesity and obstructive sleep apnea for outcomes after catheter ablation of atrial fibrillation.  J Cardiovasc Electrophysiol. 2010;  21 521-525
• 13 Courtemanche M, Ramirez R J, Nattel S. Ionic mechanisms underlying human atrial action potential properties: insights from a mathematical model.  Am J Physiol. 1998;  275 301-321
• 14 Craig S, Pepperell J C, Kohler M. et al . Continuous positive airway pressure treatment for obstructive sleep apnoea reduces resting heart rate but does not affect dysrhythmias: a randomised controlled trial.  J Sleep Res. 2009;  18 329-336
• 15 Dimsdale J E, Ziegler M G, Ancoli-Israel S, Clausen J. The effect of sleep apnea on plasma and urinary catecholamines.  Sleep. 1995;  18 377-381
• 16 Duchna H W. Sleep-related breathing disorders – a second edition of the International Classification of Sleep Disorders (ICSD-2) of the American Academy of Sleep Medicine (AASM).  Pneumologie. 2006;  60 656-662
• 17 Dyugovskaya L, Lavie P, Lavie L. Increased adhesion molecule expression and production of reactive oxygen species in leucocytes of sleep apnea patients.  Am J Respir Crit Care Med. 2002;  165 934-939
• 18 Dyugovskaya L, Lavie P, Lavie L. Lymphocyte activation as a possible measure of artherosclerotic risk in patients with sleep apnea.  Ann N Y Acad Sci. 2005;  1051 340-350
• 19 Empana J P, Duciemetiere P, Balkau B, Jouven X. Contribution of the metabolic syndrome to sudden death in asymptomatic men: the Paris Prospective Study I.  Eur Heart J. 2007;  28 1149-1154
• 20 Fletcher F C. Effect of hypoxia on sympathetic activity and blood pressure.  Respir Physiol. 2000;  119 189-197
• 21 Gami A S, Hodge D O, Herges R M. et al . Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation.  J Am Coll Cardiol. 2007;  49 565-571
• 22 Gami A S, Howard D E, Olson E J, Somers V K. Day-night pattern of sudden death in obstructive sleep apnoea.  N Engl J Med. 2005;  352 1206-1214
• 23 Gami A S, Pressman G, Caples S M. et al . Association of atrial fibrillation and obstructive sleep apnea.  Circulation. 2004;  110 364-367
• 24 Guilleminault C, Connolly S, Winkle R. et al . Cyclical variation of the heart rate in sleep apnoea syndrome. Mechanisms, and usefulness of 24 helectrocardiography as a screening technique.  Lancet. 1984;  1 126-131
• 25 Haissaguerre M, Jais P, Shah D C. et al . Spontaneuous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.  N Engl J Med. 1998;  339 659-666
• 26 Imadojemu V A, Mawji Z, Kunselman A. et al . Sympathetic chemoreflex responses in obstructive sleep apnea and effects of continuous positive airway pressure therapy.  Chest. 2007;  131 1406-1413
• 27 Javaheri S. A mechanism of central sleep apnoea in patients with heart failure.  N Engl J Med. 1999;  341 949-954
• 28 Javaheri S, Shukla R, Zeigler H, Wexler L. Central sleep apnoea, right ventricular dysfunction, and low diastolic blood pressure are predictors of mortality in systolic heart failure.  J Am Coll Cardiol. 2007;  49 2028-2034
• 29 Kanagala R, Murali N S, Friedman P A. et al . Obstructive sleep apnea and the recurrence of atrial fibrillation.  Circulation. 2003;  107 2589-2594
• 30 Kannel W B, Wolf P A, Benjamin E J, Levy D. Prevalence, incidence, prognosis and predisposing conditions for atrial fibrillation: population-based estimates.  Am J Cardiol. 1998;  82 2N-9N
• 31 Kasai T, Narui K, Dohi T. et al . Prognosis of patients with heart failure and obstructive sleep apnea treated with continuous positive airway pressure.  Chest. 2008;  133 690-696
• 32 Koshino Y, Satoh M, Katayose Y. et al . Association of sleep-disordered breathing and ventricular arrhythmias in patients without heart failure.  Am J Cardiol. 2008;  101 882-886
• 33 Kraiczi H, Hedner J, Peker Y, Carlson J. Increased vasoconstrictor sensitivity in obstructive sleep apnea.  J Appl Physiol. 2000;  89 493-498
• 34 Lai L P, Su M J, Lin J L. et al . Down-regulation of L-type calcium channel and sarcoplasmic reticular Ca(2+)-ATPase mRNA in human atrial fibrillation without significant change in the mRNA of ryanodine receptor, calsequestrin and phospholamban: an insight into the mechanism of atrial electrical remodelling.  J Am Coll Cardiol. 1999;  33 1231-1237
• 35 Lavie L, Lavie P. Molecular mechanisms of cardiovascular disease OSAHS: the oxidative stess link.  Eur Respir J. 2009;  33 1467-1484
• 36 Leung R S, Floras J S, Bradley T D. Respiratory modulation of the autonomic nervous system during Cheyne-Stokes respiration.  Can J Physiol Pharmacol. 2006;  84 61-66
• 37 Leung R S, Huber M A, Rogge T. et al . Association between atrial fibrillation and central sleep apnea.  Sleep. 2005;  28 1543-1546
• 38 Lown B, Tykocinski M, Garfein A, Brooks P. Sleep and ventricular premature beats.  Circulation. 1973;  48 691-701
• 39 Matiello M, Nadal M, Tamborero D. et al . Low efficacy of atrial fibrillation ablation in severe obstructive sleep apnoea patients.  Europace. 2010. In Press; 
• 40 Mayer G, Fietze I, Fischer J. et al . Nicht erholsamer Schlaf: Leitlinie S3 der Deutschen Gesellschaft für Schlafforschung und Schlafmedizin (DGSM).  Somnologie. 2009;  13 4-160
• 41 Mehra R, Benjamin E J, Shahar E. et al . Sleep Heart Health Study: Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study.  Am J Respir Crit Care Med. 2006;  173 910-916
• 42 Mehra R, Stone K L, Varosy P D. et al . Nocturnal arrhythmias across a sprectrum of obstructive and central sleep disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study.  Arch Intern Med. 2009;  169 1147-1155
• 43 Mills P J, Kennedy B P, Loredo J S, Dimsdale J E, Ziegler M G. Effects of nasal continuous positive airway pressure and oxygen supplementation on norepinephrine kinetics and cardiovascular responses in obstructive sleep apnea.  J Appl Physiol. 2006;  100 343-348
• 44 Moller D S, Lind P, Strunge B, Pedersen E B. Abnormal vasoactive hormones and 24-hour blood pressure in obstructive sleep apnea.  Am J Hypertens. 2003;  16 274-280
• 45 Nakashima H, Kumagai K, Urata H. et al . Angiotensin II antagonist prevents electrical remodelling in atrial fibrillation.  Circulation. 2000;  101 2612-2617
• 46 Nieuwlaat R, Capucci A, Camm J A. et al . Atrial fibrillation management: a prospective survey in ESC member countries. The Euro Heart Survey on Atrial Fibrillation.  Eur Heart J. 2005;  26 2422-2434
• 47 Owens L M, Fralix T A, Murphy E. et al . Correlation of ischaemia-induced extracellular ion changes to cell-to-cell electrical uncoupling in isolated blood-perfused rabbit hearts. Experimental working group.  Circulation. 1996;  94 10-13
• 48 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
• 49 Pogwizd S M, Corr P B. Mechanisms underlying the development of ventricular fibrillation during early myocardial ischemia.  Circ Res. 1990;  66 672-695
• 50 Roche F, Xuong A N, Court-Fortune I. et al . Relationship among the severity of sleep apnea syndrome, cardiac arrhythmias, and autonomic imbalance.  Pacing Clin Electrophysiol. 2003;  26 669-677
• 51 Ronksley P E, Hemmelgarn B R, Heitman S J. et al . Obstructive sleep apnoea is associated with diabetes in sleepy subjects.  Thorax. 2009;  64 834-839
• 52 Ryan C M, Usui K, Floras J S, Bradley T D. Effect of continuous positive airway pressure on ventricular ectopy in heart failure patients with obstructive sleep apnoea.  Thorax. 2005;  60 781-785
• 53 Sadoshima J, Xu Y, Slayter H S, Izumo S. Autocrine release of angiotensin II mediates stretch-induced hypertrophy of cardiac myocytes in vivo.  Cell. 1993;  75 977-985
• 54 Sanders P, Morton J B, Davidson N C. et al . Electrical remodelling of the atria in congestive heart failure: electrophysiologic and electroanatomic mapping in humans.  Circulation. 2003;  108 1461-1468
• 55 Sato F, Nishimura M, Shinano H, Saito H, Miyamoto K, Kawakami Y. Heart rate during obstructive sleep apnea depends on individual hypoxic chemosensitivity of the carotid body.  Circulation. 1997;  96 274-281
• 56 Serizawa N, Yumino D, Kajimoto K. et al . Impact of sleep-disordered breathing on life-threatening ventricular arrhythmia in heart failure patients with implantable cardioverter-defibrillator.  Am J Cardiol. 2008;  102 1064-1068
• 57 Sheehan J P, Seelig M S. Interactions of magnesium and potassium in the athogenesis of cardiovascular disease.  Magnesium. 1984;  3 301-314
• 58 Staniforth A D, Sporton S C, Early M J. et al . Ventricular arrhythmia, Cheyne-Stokes respiration, and death: observations from patients with defibrillators.  Heart. 2005;  91 1418-1422
• 59 Stevenson I H, Teichtahl H, Cunnington D. et al . Prevalence of sleep disordered breathing in paroxysmal and persistent atrial fibrillation patients with normal left ventricular function.  Eur Heart J. 2008;  29 1662-1669
• 60 Teerlink J R, Jalaluddin M, Anderson S. et al . Ambulatory ventricular arrhythmias in patients with heart failure do not specifically predict an increased risk of sudden death. PROMISE (Prospective Randomized Milrinone Survival Evaluation) Investigators.  Circulation. 2000;  101 40-46
• 61 Teschler H, Döhring J, Wang Y M, Berthon-Jones M. Adaptive pressure support servo-ventilation: a novel treatment for Cheyne-Stokes respiration in heart failure.  Am J Respir Crit Care Med. 2001;  164 614-619
• 62 van Dessel P F, de Bakker J M, van Hemel N M. et al . Pace mapping of postinfarction scar to detect ventricular tachycardia exit sites and zones of slow conduction.  J Cardiovasc Electrophysiol. 2001;  12 662-670
• 63 Vermeulen J T, McGuire M A, Opthof T. et al . Triggered activity and automaticity in ventricular trabeculae of the failing human and rabbit hearts.  Cardiovasc Res. 1994;  28 125-128
• 64 Weber K T, Brilla C G. Pathological hypertrophy and the cardiac interstitium: Fibrosis and the renin-angiotensin-aldosterone system.  Circulation. 1991;  83 1849-1865
• 65 Wolf P A, Dawber T R, Thomas H R, Kannel W B. Epidemiologic assessment of chronic atrial fibrillation and the risk of stroke: the Framingham study.  Neurology. 1978;  28 973-977
• 66 Yokoe T, Minoguchi K, Matsuo H. et al . Elevated levels of C-reaktive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure.  Circulation. 2003;  107 1129-1134
• 67 Young T, Palta M, Dempsey J. et al . The occurrence of sleep-disordered breathing among middle-aged adults.  N Engl J Med. 1993;  328 1230-1235
• 68 Yumino D, Redolfi S, Ruttanaumpawan P et al. Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure.  Circulation. 2010;  13 1598-1605
• 69 Zheng Z J, Croft J B, Giles W H, Mensah G A. Sudden cardiac death in the United States, 1989 to 1998.  Circulation. 2001;  104 2158-2163