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Transvenöse Neurostimulation bei herzinsuffizienzassoziierter zentraler Schlafapnoe

Transvenous neurostimulation in central sleep apnea associated with heart failure

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Zusammenfassung

Schlafbezogene Atemstörungen können als obstruktive (OSA) und zentrale Schlafapnoe (CSA) klassifiziert werden. Während für Pathophysiologie, diagnostisches Vorgehen und Therapie bei OSA heute schon weitreichende Erkenntnisse bzw. Empfehlungen vorliegen, ist die Entstehung der CSA noch nicht vollständig verstanden, die Patientenidentifikation oft schwierig und die Notwendigkeit einer spezifischen Therapie umstritten. Die CSA tritt häufig als Begleitsymptom bei Herzinsuffizienz auf und ist mit einer schlechten Prognose assoziiert. Eine optimale Herzinsuffizienztherapie führt zu einer Reduktion der CSA und ist daher von zentraler Bedeutung in der Therapie. Im Gegensatz zur OSA kann durch eine nichtinvasive Beatmungstherapie die Prognose der Patienten mit CSA nicht verbessert werden; unter ASV-Beatmung (adaptive, druckunterstützte Servoventilation) kam es sogar zu einer erhöhten Sterblichkeit. Als neues Therapieverfahren befindet sich die transvenöse Neurostimulation des N. phrenicus über einen implantierbaren Schrittmacher in der klinischen Erprobung. Erste Ergebnisse weisen auf positive Effekte hinsichtlich der Schlafapnoe-Parameter und der Lebensqualität hin, ohne dass es bisher Hinweise auf eine negative Beeinflussung der Mortalität gibt. Allerdings müssen vor einer breiten klinischen Anwendung weitere Studiendaten an größeren Patientenkollektiven abgewartet werden.

Abstract

Sleep-related breathing disorders can be classified as either obstructive (OSA) or central sleep apnea (CSA). Whereas there is substantial knowledge about the pathophysiology and sound recommendations for the diagnosis and treatment of OSA, the origin of CSA is still incompletely understood, patient identification is difficult and the necessity for specific treatment is under debate. CSA often accompanies heart failure and is associated with an adverse prognosis. Optimized heart failure treatment reduces CSA and is thus the cornerstone of CSA treatment. In contrast to OSA, noninvasive ventilation does not lead to prognostic improvement in CSA and ASV ventilation may even lead to an increase in mortality. Transvenous neurostimuation of the phrenic nerve is currently under clinical investigation as a new therapeutic modality for CSA. Early results demonstrate positive effects on sleep parameters and quality of life without any evidence for a negative impact on mortality. However, these results await confirmation in larger studies before this new approach can be advocated for routine clinical use.

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  1. Klinik für Kardiologie und Internistische Intensivmedizin, Städtische Kliniken Bielefeld, Lehrkrankenhaus der Westfälischen Wilhelms-Universität Münster, Teutoburger Straße 50, 33604, Bielefeld, Deutschland

    Christoph Stellbrink, Bert Hansky, Philipp Baumann & Dennis Lawin

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Correspondence to Christoph Stellbrink.

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Interessenkonflikt

C. Stellbrink hat für Tätigkeiten im Rahmen klinischer Studien und für Beratungstätigkeit Honorare von der Fa. Respicardia erhalten. B. Hansky, P. Baumann und D. Lawin geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Stellbrink, C., Hansky, B., Baumann, P. et al. Transvenöse Neurostimulation bei herzinsuffizienzassoziierter zentraler Schlafapnoe. Herzschr Elektrophys 29, 377–382 (2018). https://doi.org/10.1007/s00399-018-0591-x

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