Cheyne-Stokes-Atmung bei Patienten mit chronischer Herzinsuffizienz: nur diagnostischer „Marker“ oder auch kardialer Risikofaktor?

Zusammenfassung

Schlafbezogene obstruktive und zentrale Atmungsstörungen sind bei Patienten mit chronischer Herzinsuffizienz häufig zu finden, werden jedoch hinsichtlich ihrer klinischen Bedeutung unterschätzt. Mit dem Schweregrad der Herzinsuffizienz geht eine erhöhte Frequenz und Dauer zentraler Atmungsstörungen, insbesondere der Cheyne-Stokes-Atmung (CSA), einher. Die CSA ist gekennzeichnet durch ein wiederholt auftretendes Crescendo-Descrescendo Atemmuster mit konsekutiver zentraler Apnoe. Sie muss als Prädiktor für eine erhöhte Mortalität angesehen werden. Die durch die Atmungsstörung induzierte erhöhte sympathische Aktivität ist sowohl für die Progression der Grunderkrankung als auch deren Prognose bedeutsam.

Abstract

Sleep disordered breathing with predominant obstructive or central apnea is an under-recognized but highly prevalent comorbidity in patients with chronic heart failure. As the severity of heart failure increases the prevalence of central sleep apnea (CSA) and Cheyne-Stokes respiration (CSR) is also much more frequent. Cheyne-Stokes respiration is characterized by alternating periods of crescendo and decrescendo respiration followed by central apnea. Present data indicate that CSA-CSR is not only a compensatory response to severe heart failure but also a predictor of worse prognosis. However the results on long-term mortality are not consistent. The prognostic importance of night- and daytime CSR has to be further elucidated. Increased sympathetic nervous activity has been proposed to play a mayor role concerning progression and outcome of chronic heart failure by CSA-CSR.

Schlüsselwörter

zentrale Schlafapnoe - Cheyne-Stokes-Atmung - chronische Herzinsuffizienz - Mortalität

Keywords

central sleep apnea - Cheyne-Stokes respiration - chronic heart failure - mortality risk

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