Stellbrink Christoph, Hansky Bert, Baumann Philipp, Lawin Dennis
Klinik für Kardiologie und Internistische Intensivmedizin, Städtische Kliniken Bielefeld, Lehrkrankenhaus der Westfälischen Wilhelms-Universität Münster, Teutoburger Straße 50, 33604, Bielefeld, Deutschland.
Herzschrittmacherther Elektrophysiol. 2018 Dec;29(4):377-382. doi: 10.1007/s00399-018-0591-x. Epub 2018 Oct 10.
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.
睡眠相关呼吸障碍可分为阻塞性（阻塞性睡眠呼吸暂停，OSA）或中枢性睡眠呼吸暂停（CSA）。虽然关于OSA的病理生理学已有大量知识，且对其诊断和治疗也有合理建议，但CSA的起源仍未完全明了，患者识别困难，且特定治疗的必要性仍存在争议。CSA常伴随心力衰竭，并与不良预后相关。优化的心力衰竭治疗可减少CSA，因此是CSA治疗的基石。与OSA不同，无创通气并不能改善CSA的预后，而适应性伺服通气（ASV）甚至可能导致死亡率增加。经静脉膈神经刺激目前正在临床研究中作为CSA的一种新治疗方式。早期结果显示对睡眠参数和生活质量有积极影响，且没有任何证据表明对死亡率有负面影响。然而，在这种新方法可被提倡用于常规临床使用之前，这些结果有待更大规模研究的证实。
