Publikationsserver der Universitätsbibliothek Marburg
Titel:Exzessive Tagesschläfrigkeit bei Patienten mit zerebrovaskulären Erkrankungen und obstruktiver Schlafapnoe
Autor:Waßmuth-Langanke, Johann Peter Wenzel
Weitere Beteiligte: Köhler, Ulrich (Prof. Dr.)
Veröffentlicht:2015
URI:https://archiv.ub.uni-marburg.de/diss/z2015/0168
DOI: https://doi.org/10.17192/z2015.0168
URN: urn:nbn:de:hebis:04-z2015-01680
DDC: Medizin
Titel (trans.):Excessive daytime sleepiness in patients with cerebrovascular disease and obstructive sleep apnea
Publikationsdatum:2015-03-24
Lizenz:https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
stroke, Epworth Sleepiness Scale, habituelle Schlafdauer, exzessive Tagesschläfrigkeit, Schlaganfall, exzessive Tagesschläfrigkeit, Epworth Sleepiness Scale, habitual sleep duration, obstruktive Schlafapnoe, habituelle Schlafdauer, Schlaganfall, obstructive sleep apnea, Epworth Sleepiness Scale, excessive daytime sleepiness, obstruktive Schlafapnoe

Zusammenfassung:
Hintergrund: Zerebrovaskuläre Ereignisse zählen zu den führenden Todesursachen und bedingen häufig lebenslange Behinderung und Invalidität. Bisher noch weitgehend unbekannt oder noch nicht ausreichend erhoben, ist der Einfluss der obstruktiven Schlafapnoe auf zerebrovaskuläre Ereignisse und umgekehrt. Gesteigerte Tagesschläfrigkeit gilt als ein Kardinalsymptom der obstruktiven Schlafapnoe. Patienten werden meist deshalb einer Diagnostik und Therapie zugeführt. Vorrausgegangene Arbeiten legen nahe, dass Patienten nach einem zerebrovaskulären Ereignis mit begleitender obstruktiver Schlafapnoe keine gesteigerte Tagesschläfrigkeit beklagen. Vor diesem Hintergrund wollen wir prüfen, ob Patienten nach einem zerebrovaskulären Ereignis mit obstruktiver Schlafapnoe im Vergleich zu Patienten mit ausschließlich obstruktiver Schlafapnoe, ebenfalls keine vermehrte Tagesschläfrigkeit beklagen, ob dies mit einer veränderten nächtlichen Ruhezeit einhergeht und ob sie sich bezüglich ihres Schlafes in der diagnostischen Polysomnographie und unter CPAP-Therapie unterscheiden. Methode: Dazu führten wir eine retrospektive Fall-Kontroll-Studie an 675 Patienten mit obstruktiver Schlafapnoe durch, untersuchten 26 Patienten nach einem zerebrovaskulären Ereignis und weitere 26, nach Alter, Geschlecht, Größe, Gewicht, Beschäftigungsstatus und Apnoe-Hypopnoe-Index, parallelisierte Patienten als Kontrollgruppe. Wir verwendeten dazu Daten aus der klinischen Anamnese, sowie aus der diagnostischen Polysomnographie und der anschließenden CPAP-Therapie unter polysomnographischer Kontrolle. Ergebnisse: Verglichen mit den Kontrollpatienten zeigen Patienten nach einem zerebrovaskulären Ereignis einen signifikant niedrigeren Epworth Sleepiness Scale Score (8.5±3.3 vs. 13.1±4.8; p<,001). Nach der aktuell gültigen Definition exzessiver Tagesschläfrigkeit (ESS ≥11) gelten 6 von 26 Patienten 51 mit einem zerebrovaskulären Ereignis und 16 von 26 Kontrollpatienten als exzessiv tagesschläfrig (p=,004). Ferner berichten Patienten nach einem zerebrovaskulären Ereignis von einer höheren habituellen Schlafzeit unter der Woche von 521.9±91,0 vs. 461.0±66.9 Minuten (p<,001). Die schlafbezogene Atmungsstörung in der chronischen Phase des zerebrovaskulären Ereignisses unterscheidet sich nicht bedeutsam in den Variablen der diagnostischen Polysomnographie und unter CPAP. Schlussfolgerung: Patienten mit zerebrovaskulären Erkrankungen und obstruktiver Schlafapnoe berichten eine geringere Tagesschläfrigkeit als gepaarte Patienten ohne zerebrovaskuläre Erkrankungen. Für dieses bereits von anderen Autoren beobachtete Phänomen kann in dieser Arbeit durch die deutlich längere berichtete Schlafzeit der Patienten mit zerebrovaskulärer Erkrankung erstmals ein Erklärungsansatz vorgestellt werden. Offen bleibt allerdings, ob der durchaus plausible Zusammenhang „längere Schlafzeit – geringere Tagesschläfrigkeit“ kausal ist oder ob die zerebrovaskuläre Erkrankung z.B. sowohl auf Schlafwahrnehmung als auch auf Wachheitserleben Einfluss hat. Die schlafbezogene Atmungsstörung bei Patienten in der chronischen Phase des zerebrovaskulären Ereignisses unterscheidet sich dagegen nicht bedeutsam in den Variablen der diagnostischen Polysomnographie und der Therapie mit CPAP.

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