Tagesschläfrigkeit bei obstruktiver Schlafapnoe (OSA) – pathogenetische Faktoren

Zusammenfassung

Tagesschläfrigkeit ist eines der führenden klinischen Symptome der obstruktiven Schlafapnoe (OSA). Diese ist mit einer eingeschränkten Lebensqualität sowie einer erhöhten Rate an Unfällen verbunden. Es leiden jedoch nicht alle Patienten mit OSA unter einer vermehrten Tagesschläfrigkeit. Die vorliegende Arbeit soll eine Übersicht über die relevanten Studien zum Thema OSA und Tagesschläfrigkeit vermitteln und Prädiktoren für Tagesschläfrigkeit herausarbeiten. Interessanterweise fand sich eine sehr große Heterogenität der untersuchten Parameter, sodass am ehesten von einer Multikausalität der Tagesschläfrigkeit auszugehen ist. Die Ausprägungen der Adipositas sowie der nächtlichen Atmungsstörungen scheinen pathogenetisch von besonderer Bedeutung zu sein. Die nichtinvasive nasale Beatmungstherapie führt bei Patienten mit OSA und Tagesschläfrigkeit in der Regel zu einer Verbesserung des klinischen Beschwerdebildes.

Abstract

Excessive daytime sleepiness (EDS) is one of the most frequent symptoms in patients with obstructive sleep apnoea (OSA). EDS can lead to substantial impairments in quality of life and is a major cause of fatal accidents. However, not all patients with OSA develop EDS. The aim of this paper is to review the current literature to identify factors having an impact on sleepiness in patients with OSA. Interestingly, a substantial heterogeneity of the results was found. Summarising these results, causes of EDS in patients with OSA are multifactorial. Severity of obesity and breathing disorders (apnoea/hypopnoea index) seem to be the most important predictors. Continuous positive airway pressure therapy significantly reduces sleepiness in patients with OSA.

Literatur

• 1 American Academy of Sleep Medicine .International classification of sleep disorders. Diagnostic and coding manual; 2nd ed.. Westchester, Illinois: American Academy of Sleep Medicine; 2005
• 2 Mayer G, Fietze I, Fischer J et al. S3-Leitlinie Nicht-erholsamer Schlaf/Schlafstörungen.  Somnologie. 2009;  13 4-160, Supplement 1
• 3 Peter H, Penzel T, Peter J H. Enzyklopädie der Schlafmedizin.. Heidelberg: Springer; 2007
• 4 Oksenberg A, Arons E, Nasser K et al. Severe obstructive sleep apnea: sleepy versus nonsleepy patients.  Laryngoscope. 2010;  120 643-648
• 5 Bixler E O, Vgontzas A N, Lin H M et al. Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression.  J Clin Endocrinol Metab. 2005;  90 4510-4515
• 6 Roure N, Gomez S, Mediano O et al. Daytime sleepiness and polysomnography in obstructive sleep apnea patients.  Sleep Med. 2008;  9 727-731
• 7 Gottlieb D J, Whitney C W, Bonekat W H et al. Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study.  Am J Respir Crit Care Med. 1999;  159 502-507
• 8 Chen R, Xiong K P, Lian Y X et al. Daytime sleepiness and its determining factors in Chinese obstructive sleep apnea patients.  Sleep Breath. published online 2010 Feb 20
• 9 Weeß H G, Sauter C, Geisler P et al. Vigilanz, Einschlafneigung, Daueraufmerksamkeit, Müdigkeit, Schläfrigkeit – Diagnostische Instrumentarien zur Messung müdigkeits- und schläfrigkeitsbezogener Prozesse und deren Gütekriterien.  Somnologie. 2000;  4 20-38
• 10 Johns M W. A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale.  Sleep. 1991;  14 540-545
• 11 Johns M W. Daytime sleepiness, snoring, and obstructive sleep apnea: The Epworth Sleepiness Scale.  Chest. 1993;  103 30-36
• 12 Schwarzenberger-Kesper F, Becker H, Penzel T et al. Die exzessive Einschlafneigung am Tage (EDS) beim Apnoe-Patienten: Diagostische Bedeutung und Objektivierung mittels Vigilanztest und synchroner EEG-Registrierung am Tage.  Prax Klein Pneumol. 1987;  41 401-405
• 13 Aarand D, Bonnet M, Hurwitz T et al. Review by the MSLT and MWT Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine.  Sleep. 2005;  28 123-144
• 14 Conradt R, Hochban W, Heitmann J et al. Sleep fragmentation and daytime vigilance in patients with OSA treated by surgical maxillomandibular advancement compared to CPAP therapy.  J Sleep Res. 1998;  7 217-223
• 15 Cassel W, Ploch T, Becker H et al. Risk of traffic accidents in patients with sleep-disordered breathing: reduction with nasal CPAP.  Eur Respir J. 1996;  9 2606-2611
• 16 Sangal R B, Mitler M M, Sangal J M. Subjective sleepiness ratings (Epworth sleepiness scale) do not reflect the same parameter of sleepiness as objective sleepiness (maintenance of wakefulness test) in patients with narcolepsy.  Clinical Neurophysiology. 1999;  110 2131-2135
• 17 Olson L G, Cole M F, Ambrogetti A. Correlations among Epworth Sleepiness Scale scores, multiple latency tests and psychological symptoms.  J Sleep Res. 1998;  7 248-253
• 18 Benbadis S R, Mascha E, Perry M C et al. Association between the Epworth Sleepiness Scale and the multiple sleep latency test in a clinical population.  Annals of Internal Medicine. 1999;  130 289-292
• 19 Mathis J, Hess C W. Sleepiness and vigilance test.  SWISS MED WKLY. 2009;  139 214-219
• 20 Krystal A D, Edinger J E. Measuring sleep quality.  Sleep. Medicine ;  9(1) 10-17
• 21 Levendowski D J, Zack N, Rao S et al. Assessment of the test-retest reliability of laboratory polysomnography.  Sleep Breath. 2009;  13 163-167
• 22 Young T, Palta M, Dempsey J et al. The occurrence of sleep-disordered breathing among middle-aged adults.  N Engl J Med. 1993;  328 230-1235
• 23 Kapur V K, Baldwin C M, Resnick H E et al. Sleepiness in patients with moderate to severe sleep-disordered breathing.  Sleep. 2005;  28 472-477
• 24 Dixon J B, Dixon M E, Anderson M L et al. Daytime sleepiness in the obese: Not as simple as obstructive sleep apnea.  Obesity. 2007;  15 2504-2511
• 25 Mediano O, Barcelo A, de la Pena M et al. Daytime sleepiness and polysomnographic variables in sleep apnoea patients.  Eur Respir J. 2007;  30 110-113
• 26 Tsaoussoglou M, Bixler E O, Calhoun S et al. Sleep-disordered breathing in obese children is associated with prevalent excessive daytime sleepiness, inflammation, and metabolic abnormalities.  J Clin Endocrinol Metab. 2010;  95 43-150
• 27 Gozal D, Kheirandish-Gozal L. Obesity and excessive daytime sleepiness in prepubertal children with obstructive sleep apnea.  Pediatrics. 2010;  123 13-18
• 28 Vgontzas A N, Bixler E O, Tan T L et al. Obesity without sleep apnea is associated with daytime sleepiness.  Arch Intern med. 1998;  158 1333-1337
• 29 Vgontzas A N. Excessive daytime sleepiness in sleep apnea: It is not just apnea hyponea index.  Sleep Medicine. 2008;  9 712-714
• 30 Vgontzas A N, Papanicolaou D A, Bixler E O et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia.  Journal of Clinical Endocrinology and Metabolism. 2000;  85 1151-1158
• 31 Vgontzas A N, Bixler E O, Chrousos G P et al. Obesity and sleep disturbances: Meaningful sub-typing of obesity.  Arch of Physiol and Biochemistry. 2008;  114 224-236
• 32 De la Pena Bravo M, Serpero L D, Barcelo A et al. Inflammatory proteins in patients with obstructive sleep apnea with and without daytime sleepiness.  Sleep Breath. 2007;  11 177-185
• 33 Marshall N S, Bames M, Travier N et al. Continuous positive airway pressure reduces daytime sleepiness in mild to moderate obstructive sleep apnoea: a meta-analysis.  Thorax. 2006;  61 430-434
• 34 Patel S R, White D P, Malhotra A et al. Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea.  Arch Intern Med. 2003;  163 565-571
• 35 Black J. Sleepiness and residual sleepiness in adults with obstructive sleep apnea.  Respiratory Physiology & Neurobiology. 2003;  136 211-220
• 36 Sanders M H, Newmann A B, Haggerty C L et al. Sleep and sleep-disordered breathing in adults with predominantly mild obstructive airway disease.  Am J Respir Crit Care Med. 2003;  167 7-14