Zusammenfassung
Ca. 1,9 % der Bevölkerung haben ein obstruktives Schlafapnoesyndrom (OSAS). Im Alter
zwischen 30 und 60 Jahren beträgt die Häufigkeit etwa 3 %. Bei Patienten mit OSAS
werden gehäuft Herz-Kreislauferkrankungen wie ischämische Herzerkrankungen, Arrhythmien
und ein arterieller Hypertonus diagnostiziert. Pathophysiologisch ist eine Vielzahl
von Veränderungen nachweisbar. Die erhöhte Aktivität des Sympathikus, rezidivierende
Hypoxämien, Scherstress, Störungen der mikrovaskulären Milieus, eine endotheliale
Dysfunktion, erhöhte oxidative Kapazität sowie eine verminderte vaskuläre Reagibilität
werden mit der Folgeerkrankung der Arteriosklerose in Verbindung gebracht. Verschiedene
biochemische Marker, die als Risikofaktoren bzw. Marker kardiovaskulärer Erkrankungen
angesehen werden, sind bei Patienten mit OSAS verändert (hochsensitives CRP, Interleukin(IL)-6,
IL-8, IL-10, TNF-α, VGEF, ICAM-1, VCAM-1 und L-Selectin) und es bestehen Zeichen einer
Insulinresistenz. Außerdem sind Störungen der Mikrozirkulation nachweisbar. Patienten
mit obstruktivem Schlafapnoesyndrom haben verglichen mit Personen ohne Schlafapnoe
auch unter Berücksichtigung anderer Risikofaktoren erhöhte Blutdruckwerte. Die Inzidenz
einer koronaren Herzkrankheit bei Patienten mit OSAS ist erhöht. Verschiedene Untersuchungen
zeigen eine erhöhte Morbidität und Mortalität von Patienten mit obstruktiven Schlafapnoesyndromen.
Viele der pathologisch veränderten Werte bessern sich unter einer CPAP-Therapie.
Abstract
About 1.9 % of the population suffer from an obstructive sleep apnea syndrome (OSAS).
At the age of between 30 and 60 years it occurs in 3 %. Patients with OSAS develop
more frequently such disorders as arteriosclerosis, cardiac arrhythmias and arterial
hypertension. A host of pathophysiological changes can be diagnosed. The elevated
sympathic activity, recurrent hypoxemias, stress, disturbances in the microvascular
milieu, endothelial dysfunction, elevated oxidative capacity as well as a reduced
vascular reagibility are deemed to be factors connected to arteriosclerosis. Different
biochemical markers, which are seen as risk factors or as markers of cardiovascular
diseases, are altered in patients with OSAS (high-sensitive CRP, Interleukin(IL)-6,
IL-8, IL-10, TNF-α, VGEF, ICAM-1, VCAM-1 and L-Selectin). Patients with OSAS exhibit
signs of an impaired insulin sensitivity. Disturbances in microcirculation are also
evident. Patients with OSAS have, compared to patients without sleep apnea, elevated
blood pressure measurements, even given other common risk factors. The incidence of
coronary heart diseases is increased in patients with OSAS. Morbidity and mortality,
especially of arteriosclerotic diseases are elevated. Many of the aforementioned disturbances
can be improved by a CPAP-therapy.
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Holger Hein
Krankenhaus Großhansdorf · Zentrum für Pneumologie und Thoraxchirurgie
Wöhrendamm 80
22927 Großhansdorf
Email: Holger.Hein@t-online.de
