Kardiale Arrhythmien bei obstruktiver Schlafapnoe : Eine Übersicht (Übersichten)

Cyclic variations of the heart rate as a pathognomonic finding is observed in 80-100% of patients with obstructive sleep apnea (OSA). It is caused by an interaction of parasympathetic and sympathetic activity. Bradycardiac rhythm disorders are predominantly found in obese patients with a frequency of roughly 10%. The most important pathogenetic mechanism is a vagal cardioinhibitory reflex. Apnea-associated variations of the heart rate ongoing with bradycardiac arrhythmias disappear under effective nasal noninvasive ventilatory therapy. In patients with bradyarrhythmias refractory to therapy, pacemaker implantation should be considered. Regarding tachycardiac arrhythmias, both cardiovasculatory morbidity and the extent of apnea-associated hypoxemic events and sympathetic response are relevant for its pathogenesis. Obstructive sleep apnea can lead to an imbalance of the autonomous nervous system by different pathways, implying the risk for (lethal) cardiac arrhythmias. Patients with unclear arrhythmias and hypertension refractory to therapy should be screened for the presence of OSA.