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Aktuelle Rheumatologie 2018; 43(04): 277-288
DOI: 10.1055/s-0044-100490
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Rheumatologische Erkrankungen und Schlaf – Schlafmedizinische Aspekte der Diagnostik und Therapie – Eine literaturbasierte Übersicht

Rheumatological Diseases and Sleep: Somnological Aspects of Diagnostics and Therapy
Lennart Knaack
1   Zentrum für Schlafmedizin und Schlafforschung, Intersom Köln, Köln
,
Jaroslaw Janicki
1   Zentrum für Schlafmedizin und Schlafforschung, Intersom Köln, Köln
› Author Affiliations
Further Information

Publication History

Publication Date:
06 March 2018 (online)

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Zusammenfassung

Ziel des auf einer PubMed-Recherche basierenden Übersichtsartikels ist es, die Schlafphysiologie und die pathophysiologischen Zusammenhänge von rheumatologischen Erkrankungen und primären sowie sekundären Schlafstörungen darzustellen. Dabei werden die somnologische Diagnostik und Therapie als ergänzende Verfahren in die rheumatologische Behandlungsstrategie eingebunden.

Epidemiologie 70% aller Rheumapatienten berichten über einen verkürzten, oberflächlichen und wenig erholsamen Schlaf. Zudem treten bei über 20% der Erkrankungen primäre Schlafstörungen, z. B. das Schlafapnoe- und Restless Legs Syndrom, auf.

Pathogenese Primäre und sekundäre Schlafstörungen können rheumaassoziierte Symptome wie Tagesschläfrigkeit, Fatigue und Depressivität, aber auch die Schmerzintensität und Krankheitsaktivität verstärken. Umgekehrt verschlechtern Schmerzintensität und inflammatorische Marker die Schlafqualität regelhaft. Bei rheumatischen Erkrankungen können neben einer Adipositas auch krankheitsspezifische skelettale Faktoren für ein Obstruktives Schlafapnoesyndrom (OSAS) prädisponieren. Das rheumatologisch komorbide auftretende Restless Legs Syndrom (RLS) mindert die Schlafqualität durch eine sensorisch bedingte Schlafstörung, sowie schlaffragmentierende periodische Beinbewegungen.

Messverfahren Die somnologische Diagnostik umfasst introspektive Fragebögen und objektive Tests zu Reaktionsvermögen und Vigilanz. Komorbide auftretende Schlafbezogene Atmungs- und Bewegungsstörungen werden im Sinne eines apparativen und polygrafischen Screenings identifiziert. Mittels Polysomnografie im Schlaflabor erfolgt die spezifische Diagnosestellung und Therapieeinleitung sowie deren Kontrolle.

Therapie Primäre und sekundäre Schlafstörungen bei RA-Erkrankungen werden verhaltenstherapeutisch, medikamentös (Insomnie und RLS) und apparativ (OSAS) behandelt. Eine suffiziente Diagnostik und Behandlung von Schlafstörungen bei rheumatologischen Erkrankungen beinhaltet eine koordinierte und interdisziplinäre Zusammenarbeit der einzelnen medizinischen Fachgebiete.

Abstract

This PubMed-based review discusses primary and secondary sleep disorders associated with rheumatological diseases. It presents the pathophysiological interaction of sleep-related diseases and rheumatological disorders and summarises clinical symptoms, diagnostic investigation and therapies from a somnological perspective.

Epidemiology 70 % of patients suffering from rheumatological diseases report poor sleep quality, numerous awakenings at night and non-restorative sleep. More than 20 % of these patients are found to have primary sleep disorders such as obstructive sleep apnoea (OSA) and the restless legs syndrome (RLS).

Pathogenesis Primary and secondary sleep disorders may increase symptoms associated with rheumatological diseases, e. g. excessive daytime sleepiness, fatigue, depression, pain intensity, and disease activity. Vice versa, pain intensity and inflammatory markers worsen sleep quality. In patients with rheumatic diseases, obesity as well as disease-related skeletal characteristics may be predisposing factors for obstructive sleep apnoea. The restless legs syndrome, which frequently occurs in rheumatological diseases, lowers sleep quality due to a sensory stimulus and periodic leg movements causing sleep fragmentation.

Diagnostic investigation Somnological diagnostic investigation consists of sleep-related questionnaires and scales. Objective tests are used to measure reaction time and vigilance. Sleep-related breathing and movement disorders can be identified with screening devices and polygrafic monitoring. A final polysomnografic sleep study is necessary to make the diagnosis and to initiate a specific treatment and follow-up examinations.

Treatment Sleep disorders associated with rheumatological diseases may be treated with behavioural and drug therapies. Drug therapy is commonly used in the management of insomnia and RLS. Most cases of OSAS can be treated with CPAP or UPS devices. Interdisciplinary cooperation in the fields of somnology and rheumatology may improve treatment in RA patients.

Schlüsselwörter

Rheumatologie - Schlafstörungen - Schlafapnoe - RLS - Insomnie

Key words

rheumatology - sleep disorders - sleep apnoea - RLS - insomnia
 

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