Autonome Dysregulation und kardiale Arrhythmien bei Patienten mit obstruktiver und zentraler Schlafapnoe

Abstract

Obstructive sleep apnea and central sleep apnea with Cheyne-Stokes respiration are associated with an increased risk of cardiac arrhythmia. Apnea- associated arrhythmia may contribute to sudden cardiac death and premature mortality in those patients. Both forms of sleep apnea excert strong modulatory effects on the autonomic system with a special autonomic profile. Profound vagal activity is leading to bradyarrhythmias, and sypathico-excitation to tachyarrhythmias. Atrial fibrillation and ventricular arrhythmias in obstructive and central sleep apnea patients are mainly found in combination with cardiovascular comorbidity (coronary heart disease, hypertensive heart disease, chronic heart failure). Bradyarrhythmias in OSA are induced by a cardioinhibitory vagal reflex due to obstructed airway. CPAP-therapy has been demonstrated to reduce arrhythmias.

Laboratory-Instrumental Comparisons of Cardiac Rhythm Variability in Newborns Following Hypoxia

“…Негативну кореляцію мали ЧД (r= -0,61, р=0,001; r= -0,63, р=0,0005; r= -0,6, р=0,02; r= -0,44, р=0,023; r= -0,52, р=0,006 для SDNN, SDANN, індексу SDNN, rMSSD, рNN50 відповідно) та Д ЛП (r= -0,74, р=0,02; r= -0,82, р=0,007; r= -0,73, р=0,024; r= -0,67, р=0,04 для SDNN, індексу SDNN, rMSSD, рNN50 відповідно) з усіма параметрами ВСР.Залежність ВСР від рівня серцевих маркерів та печінкових проб свідчить про поступову зрілість ферментативної системи, що впливає на ступінь активності симпатичного та парасимпатичного відділу ЦНС. Враховуючи незрілість процесів авторегуляції з боку ЦНС, зміна частоти дихання може призводити до вираженої автономної дисфункції з домінуванням впливу парасимпатичної ланки, що, в свою чергу, є фактором ризику розвитку фатальних аритмій [3,30,31]. В групі передчасно народжених без порушень адаптації (рис.…”

Cardiac Arrhythmias and Sleep-Disordered Breathing in Patients with Heart Failure

“…Both prevalence and CSA severity have been associated with increased arrhythmogenic risk synergistic to HF severity with increased neurohumoral activation, higher brain natriuretic peptide (BNP) levels, increased pulmonary capillary wedge pressure, and lower ejection fraction [21,23,25,26] (Figure 2). Heart failure leads to increased left ventricular (LV) wall stress and increased LV filling pressures resulting in pulmonary congestion, which subsequently activates lung irritant vagal receptors.…”

“…Although CSA episodes have a different pathophysiology than OSA without generating an exaggerated negative intrathoracic pressure, both CSA and OSA increase sympathetic nervous system activity in HF patients accompanied by various neurohumoral and hemodynamic responses that together further stress the failing heart. The apneas provoke periodic elevations in sympathetic activity and parasympathetic withdrawal [26], favoring atrial and ventricular irritability due to abnormal automaticity and triggered activity (Figure 2). Increased sympathetic activity may subsequently contribute to tachycardia, peripheral vasoconstriction, and activation of the renin-angiotensin system with increased oxygen demand, blood pressure, blood volume, and myocardial oxygen demand.…”

“…Sleep-disordered breathing and cardiac arrhythmias are both highly prevalent findings in patients with heart failure (HF) [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30]. In contrast to cardiac arrhythmias, which can readily be diagnosed by 12-lead electrocardiogram (ECG) or long-term Holter ECG recordings, screening for sleep-disordered breathing is uncommon in HF patients in the absence of symptoms like excessive daytime sleepiness.…”

“…[16] found a low OSA prevalence of 8% by screening HF patients, after patients with a history of sleep disordered breathing and patients who were referred to the sleep laboratory for symptoms suggestive of sleep disordered breathing had been excluded, whereas Sin et al [1], found a high OSA prevalence of 38% in a retrospective study including 450 HF patients, all of whom were referred to the sleep laboratory because of suspected sleep disordered breathing. The majority of previous studies, however, found a much higher prevalence of central sleep apnea (CSA) compared to OSA in patients with HF ranging from 21% to 82% [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30] (Figure 1). This wide range of CSA frequency in HF patients may be explained by a number of variables including HF severity and etiology, age, gender, and HF medication.…”