Zusammenfassung
Ein- und Durchschlafstörungen treten mit einer großen Häufigkeit in der Bevölkerung
auf. Die Auswirkungen auf die psychische und physische Lebensqualität sind erheblich.
Die Ursachen sind vielschichtig, doch in letzter Zeit mehren sich die Belege, dass
ein kausaler Zusammenhang zwischen gastroösophagealer Refluxkrankheit (GERD) und Schlafstörungen
bei einem Teil der Patienten besteht. Ein Großteil der Patienten mit GERD berichtet
auch über Refluxsymptome in der Nacht, und gerade der nächtliche Reflux zeichnet sich
durch eine längere ösophageale Säureexposition aus. Aktuelle Studienergebnisse zeigen,
dass sich die beobachteten Schlafstörungen durch eine effektive antisekretorische
Therapie deutlich verbessern lassen. Insbesondere sollte auch bei Patienten mit Schlafstörungen
ohne bislang diagnostizierte GERD gezielt nach einer solchen gefahndet und diese effizient
therapiert werden.
Andere schwerwiegende schlafassoziierte Erkrankungen, wie das obstruktive Schlafapnoesyndrom
(OSAS), zeigen eine Assoziation mit der ösophagealen Säureexposition. Vermutlich ist
der schlafapnoe-assoziierte Reflux multifaktoriell bedingt: Liegen weitere prädisponierende
Bedingungen vor, so begünstigt OSAS die Entstehung des Reflux. Auch hier konnte gezeigt
werden, dass eine antisekretorische Therapie das OSAS verbessert.
In dieser Übersicht werden die aktuelle Literatur über die GERD-assoziierten Schlafstörungen
und die möglichen pathophysiologischen Zusammenhänge diskutiert.
Summary
Difficulties of initiating or maintaining sleep are very common in the general population.
Individuals with clinical sleep disorders have a greatly impaired quality of life.
The causes for sleeping disorders are complex, but evidence has recently come from
different trials supporting a causal relationship between gastro-esophageal reflux
disease (GERD) and sleep disorders in some patients. The majority of patients with
GERD report reflux symptoms during the night. It is well known that especially at
night reflux is characterized by prolonged esophageal acid exposure. Recent data have
indicated that sleep disorders significantly improve while on efficacious antisecretory
treatment. In particular in patients with sleep disorders but no previously known
GERD, the search for it is recommended and should be followed by adequate antisecretory
treatment.
In other severe diseases associated with sleep, like the obstructive sleep apnoea
syndrome (OSAS), an association with esophageal acid exposure has been proven. The
sleep apnea-associated reflux has probably a multifactorial etiology: in cases with
other predisposing conditions for gastro-esophageal reflux, OSAS promotes the development
of reflux. Antisecretory treatment has been able to improve the severity of OSAS.
The purpose of this review has been to survey of recent publications in GERD-associated
sleep disorders, as well as the possible pathophysiological basis of the observed
phenomena.
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Prof. Dr. med. D. Jaspersen
Klinikum Fulda gAG
Pacelliallee 2-4
36043 Fulda
Phone: 0661/845420
Fax: 0661/845422
Email: d.jaspersen.medII@klinikum-fulda.de
