Autonome Dysregulation und kardiale Arrhythmien bei Patienten mit obstruktiver und zentraler Schlafapnoe

 

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Zusammenfassung

Schlafbezogene Atmungsstörungen (SBAS) wie die obstruktive und zentrale Schlafapnoe haben proarrhythmische Effekte. Die durch die Atmungsstörungen induzierten Arrhythmien können zum Auftreten eines akuten Herztodes bzw. einer frühzeitigeren Mortalität führen. Beide Formen der SBAS nehmen Einfluss auf die Regulation des autonomen Nervensystems und das sympathikovagale Gleichgewicht. Während bradykarde Arrhythmien bei obstruktiver Apnoe am ehesten durch einen vagalen kardioinhibitorischen Reflex bedingt sind, treten tachykarde Arrhythmien bei obstruktiver und zentraler Schlafapnoe in Kombination mit einem erhöhten Sympathikotonus und begleitender kardiovaskulärer Morbidität (koronare Herzerkrankung, hypertensiver Herzerkrankung, chronische Herzinsuffizienz) auf. Unter nasaler Beatmungstherapie sind apnoeassoziierte Rhythmusstörungen weitestgehend eliminiert.

Abstract

Obstructive sleep apnea and central sleep apnea with Cheyne-Stokes respiration are associated with an increased risk of cardiac arrhythmia. Apnea- associated arrhythmia may contribute to sudden cardiac death and premature mortality in those patients. Both forms of sleep apnea excert strong modulatory effects on the autonomic system with a special autonomic profile. Profound vagal activity is leading to bradyarrhythmias, and sypathico-excitation to tachyarrhythmias. Atrial fibrillation and ventricular arrhythmias in obstructive and central sleep apnea patients are mainly found in combination with cardiovascular comorbidity (coronary heart disease, hypertensive heart disease, chronic heart failure). Bradyarrhythmias in OSA are induced by a cardioinhibitory vagal reflex due to obstructed airway. CPAP-therapy has been demonstrated to reduce arrhythmias.

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