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Nervenheilkunde 2017; 36(07): 541-549
DOI: 10.1055/s-0038-1627499
Übersichtsartikel
Schattauer GmbH

Schlafstörungen bei der Parkinson-Krankheit

Pathogenese, Diagnostik und TherapieSleep disturbance in Parkinson’s disease
M. Hahne
1   Neurologische Klinik Bad Neustadt, Akademisches Lehrkrankenhaus der Philipps Universität Marburg
,
W. H. Jost
2   Zentrum für Bewegungsstörungen, Parkinsonklinik Ortenau
,
D. Hartmann
1   Neurologische Klinik Bad Neustadt, Akademisches Lehrkrankenhaus der Philipps Universität Marburg
,
B. Griewing
1   Neurologische Klinik Bad Neustadt, Akademisches Lehrkrankenhaus der Philipps Universität Marburg
,
M. Keidel
1   Neurologische Klinik Bad Neustadt, Akademisches Lehrkrankenhaus der Philipps Universität Marburg
› Author Affiliations
Further Information

Publication History

eingegangen am: 30 March 2017

angenommen am: 12 April 2017

Publication Date:
22 January 2018 (online)

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Zusammenfassung

Schlafstörungen gehören zu den häufigsten nicht motorischen Symptomen bei der Parkinson- Krankheit. In zahlreichen Fällen ist auch die Vigilanz am Tag mit verstärkter Einschlafneigung und Tageschläfrigkeit gestört. Pathophysiologisch liegen überwiegend nondopaminerg vermittelte Störungen und Fehlsteuerungen von im Hirnstamm lokalisierten Neurotransmitterneuronen und den nachgeschalteten Regelkreisen vor. Die Ursachen sind multifaktoriell und überlappen sich nicht selten. Im Vordergrund stehen primäre krankheitsimmanente Ursachen einschließlich psychiatrischer und urologischer nicht motorischer Symptome, hypo- oder hyperdopaminerge Phasen meist im Rahmen der Medikation, nächtliche Schmerzen unterschiedlicher Genese sowie Komorbiditäten wie Restlesslegs- Syndrom, REM-Schlaf-Verhaltensstörung oder ein Schlafapnoe-Syndrom. Entsprechend den vielfältigen und häufig gegenseitig überlappenden Ursachen ist die Therapie auszurichten. Die ursachenbezogene Differenzialdiagnostik und damit die richtige Therapie stellen für den Arzt eine besondere Herausforderung dar. Idealerweise kann die Abklärung durch Patientenselbstbeurteilungsbögen und durch apparative Messverfahren wie Schlafapnoe- Screening oder Polysomnografie ergänzt werden. Schlafstörungen nachts oder ausgeprägte Tageschläfrigkeit beeinflussen die Lebensqualität von Patient und/oder Betreuer in zum Teil beträchtlichem Ausmaß.

Summary

Problems with sleeping belong to the most frequent non-motor symptoms in Parkinson’s disease. In numerous cases vigilance is impaired during daytime coupled with increased drowsiness and sleepiness. Pathophysiologically, this involves primarily nondopaminergic problems and deficient control from neurons, localized in the brain stem, and control circuits downstream. The causes are multifactorial and often overlap considerably. The primary causes include: immanent, specific disease-related causes, psychiatric and urological symptoms, non-motor symptoms during hypo- or hyper-dopaminergic phases usually involving the medication, nocturnal pains of various origins as well as comorbidities such as the restless legs syndrome, rapid eye movement sleep behavior disorder, restless legs syndrome or sleep apnea. The appropriate therapy will be as many-faceted and overlapping as are their causes. Differential diagnostics and the corresponding appropriate therapy are indeed challenges for all physicians. Ideally, clarification will also depend on using self-description inventories as well as instrument-based measurements such as in sleep apnea screening or polysomnography. Nocturnal sleep disturbances or extensive daytime drowsiness detract essentially from life quality, and not only for the patients but just as well for their loved ones or caretakers.

Schlüsselwörter

Parkinson-Krankheit - Schlafstörung - nicht motorische Symptome - Insomnie - exzessive Tagesmüdigkeit - REM-Schlaf-Verhaltensstörung - Restless-legs-Syndrom - Schlafapnoe- Syndrom

Keywords

Parkinson’ disease - sleep disturbance - non motor symptoms - insomnia - excessive daytime sleepiness - REM sleep behavior disorder - restless legs syndrome - sleep apnoea syndrome
 

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