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Bedeutung des Schlafs bei Patienten mit Lungenerkrankungen

Relevance of sleep for patients with lung diseases

  • Schwerpunkt: Zirkadiane Steuerungsmechanismen in Gesundheit und Krankheit
  • Published:
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Zusammenfassung

Der Schlaf ist bereits beim Gesunden durch eine Verschiebung des Gleichgewichts zwischen Last und Kapazität des Atmungssystems gekennzeichnet. Die Last nimmt zu, da der Widerstand sowohl der oberen Atemwege als auch der Bronchien ansteigt. Die Kapazität sinkt, da Atemantrieb, Muskelaktivität und Ventilation abnehmen. Während beim Gesunden aber lediglich geringe Blutgasveränderungen resultieren und der Schlaf ungestört verläuft, manifestieren sich bei Patienten mit Lungenerkrankungen Symptome während der Nacht schon früh im Krankheitsverlauf.

Als häufigste Erkrankungen, bei denen dem Schlaf eine bedeutende Rolle zukommt, werden hier das Asthma, die COPD, die respiratorische Globalinsuffizienz, schlafbezogene Atmungsstörungen, das Overlap-Syndrom und die Mukoviszidose besprochen.

Die Anamnese sollte Fragen zu nächtlichen Symptomen und zum Schlaf beinhalten. Diagnostisch können beim Asthmatiker nächtliche Peak-flow Messungen erfolgen. Bei allen anderen Erkrankungen stehen ambulante Mehrkanalrecorder zur Messung der Atmung und der Sauerstoffsättigung zur Verfügung, die eine orientierende Beurteilung der nächtlichen Atmung erlauben. Im Schlaflabor erfolgt die Diagnosesicherung und Therapie der nächtlichen Atmungsstörungen.

Abstract

Sleep is characterized by a profound change of load and capacity of the respiratory system. Load increases due to a rise in upper and lower airway resistance. Capacity decreases due to reduced chemosensitivity, a decrease in muscle activity and minute ventilation. Whereas these changes do not lead to relevant blood gas changes and do not disturb sleep in healthy subjects, patients with respiratory diseases frequently show the first symptoms of their disease during sleep. Pulmonary diseases in which sleep plays an important role are asthma, COPD, hypercapnic respiratory failure, sleep disordered breathing, the overlap-syndrome and cystic fibrosis.

Medical history should include sleep and complaints during the night. In asthmatics peak-flow measurements during the night may provide valuable information. In all other disorders mentioned, nocturnal ambulatory recording of respiration and arterial oxygen saturation often allow the detection of relevant disorders of breathing during sleep. If ambulatory monitoring reveals relevant pathology, then further evaluation and treatment in the sleep laboratory are warranted.

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  1. Schwerpunkt Pneumologie, Klinik für Innere Medizin, Philipps-Universität Marburg

    H. F. Becker

  2. Schwerpunkt Pneumologie, Klinik für Innere Medizin, Philipps-Universität, Baldingerstraße, 35033, Marburg

    H. F. Becker

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Becker, H.F. Bedeutung des Schlafs bei Patienten mit Lungenerkrankungen. Internist 45, 1026–1034 (2004). https://doi.org/10.1007/s00108-004-1260-1

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