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14.08.2020 | Adipositas | Übersichten

Adipositasassoziierte Atmungsstörungen –„State of the Art“

verfasst von: Simon Herkenrath, Winfried Randerath

Erschienen in: Somnologie | Ausgabe 3/2020

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Zusammenfassung

Die adipositasassoziierten Atmungsstörungen umfassen die obstruktive Schlafapnoe, die schlafbezogene alveoläre Hypoventilation und das Vollbild des Obesitas-Hypoventilationssyndroms. Die Pathophysiologie fußt auf adipositasbedingten Veränderungen des respiratorischen Systems mit Einengung des oberen Atemwegsdiameters, verringerter thorakaler Compliance, erhöhtem intrinsischen positiven endexspiratorischen Druck, vermehrtem Ventilations-Perfusions-Mismatch und verringerter Kohlendioxidsensitivität. Es besteht eine enge Korrelation zu metabolischen und kardiovaskulären Erkrankungen wie der Herzinsuffizienz, der koronaren Herzkrankheit und der pulmonalen Hypertonie. Je nach pathophysiologischem Schwerpunkt sind therapeutisch kontinuierliche oder Bilevel-Positivdrucktherapieverfahren etabliert.

Adams TD, Davidson LE, Litwin SE et al (2017) Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med 377:1143–1155. https://doi.org/10.1056/NEJMoa1700459CrossRefPubMedPubMedCentral

Akashiba T, Akahoshi T, Kawahara S et al (2006) Clinical characteristics of obesity-hypoventilation syndrome in Japan: a multi-center study. Intern Med 45:1121–1125. https://doi.org/10.2169/internalmedicine.45.1747CrossRefPubMed

American Academy of Sleep Medicine (2014) Diagnostic and coding manual, international classification of sleep disorders, 3. Aufl. American Academy of Sleep Medicine, Westchester

Ashrafian H, Toma T, Rowland SP et al (2015) Bariatric surgery or non-surgical weight loss for obstructive sleep apnoea? A systematic review and comparison of meta-analyses. Obes Surg 25:1239–1250. https://doi.org/10.1007/s11695-014-1533-2CrossRefPubMed

Ayappa I, Berger KI, Norman RG et al (2002) Hypercapnia and ventilatory periodicity in obstructive sleep apnea syndrome. Am J Respir Crit Care Med 166:1112–1115. https://doi.org/10.1164/rccm.200203-212OCCrossRefPubMed

BaHammam AS (2015) Prevalence, clinical characteristics, and predictors of obesity hypoventilation syndrome in a large sample of Saudi patients with obstructive sleep apnea. Saudi Med J 36:181–189. https://doi.org/10.15537/smj.2015.2.9991CrossRefPubMedPubMedCentral

Balachandran JS, Masa JF, Mokhlesi B (2014) Obesity hypoventilation syndrome epidemiology and diagnosis. Sleep Med Clin 9:341–347. https://doi.org/10.1016/j.jsmc.2014.05.007CrossRefPubMedPubMedCentral

Basoglu OK, Tasbakan MS (2014) Comparison of clinical characteristics in patients with obesity hypoventilation syndrome and obese obstructive sleep apnea syndrome: a case-control study. Clin Respir J 8:167–174. https://doi.org/10.1111/crj.12054CrossRefPubMed

Berg G, Delaive K, Manfreda J et al (2001) The use of health-care resources in obesity-hypoventilation syndrome. Chest 120:377–383CrossRefPubMed

10.

Berger KI, Ayappa I, Chatr-Amontri B et al (2001) Obesity hypoventilation syndrome as a spectrum of respiratory disturbances during sleep. Chest 120:1231–1238. https://doi.org/10.1378/chest.120.4.1231CrossRefPubMed

11.

Berger KI, Ayappa I, Sorkin IB et al (2002) Postevent ventilation as a function of CO₂ load during respiratory events in obstructive sleep apnea. J Appl Physiol 93:917–924. https://doi.org/10.1152/japplphysiol.01082.2001CrossRefPubMed

12.

Berger S, Pho H, Fleury-Curado T et al (2019) Intranasal Leptin relieves sleep-disordered breathing in mice with diet-induced obesity. Am J Respir Crit Care Med 199:773–783. https://doi.org/10.1164/rccm.201805-0879OCCrossRefPubMedPubMedCentral

13.

Berry RB, Brooks R, Gamaldo CE (2020) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, version 2.6. American Academy of Sleep Medicine, Darien

14.

Berry RB, Chediak A, Brown LK et al (2010) Best clinical practices for the sleep center adjustment of noninvasive positive pressure ventilation (NPPV) in stable chronic alveolar hypoventilation syndromes. J Clin Sleep Med 6:491–509CrossRefPubMed

15.

Budweiser S, Riedl SG, Jörres RA et al (2007) Mortality and prognostic factors in patients with obesity-hypoventilation syndrome undergoing noninvasive ventilation. J Intern Med 261:375–383. https://doi.org/10.1111/j.1365-2796.2007.01765.xCrossRefPubMed

16.

Carrillo A, Ferrer M, Gonzalez-Diaz G et al (2012) Noninvasive ventilation in acute hypercapnic respiratory failure caused by obesity hypoventilation syndrome and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 186:1279–1285. https://doi.org/10.1164/rccm.201206-1101OCCrossRefPubMed

17.

Castro-Añón O, Golpe R, Pérez-de-Llano LA et al (2012) Haemodynamic effects of non-invasive ventilation in patients with obesity-hypoventilation syndrome. Respirology 17:1269–1274. https://doi.org/10.1111/j.1440-1843.2012.02252.xCrossRefPubMed

18.

Considine RV, Sinha MK, Heiman ML et al (1996) Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med 334:292–295. https://doi.org/10.1056/NEJM199602013340503CrossRefPubMed

19.

Corral J, Mogollon MV, Sánchez-Quiroga M‑Á et al (2018) Echocardiographic changes with non-invasive ventilation and CPAP in obesity hypoventilation syndrome. Thorax 73:361–368. https://doi.org/10.1136/thoraxjnl-2017-210642CrossRefPubMed

20.

Davidson AC, Banham S, Elliott M et al (2016) BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax 71(Suppl 2):ii1–ii35. https://doi.org/10.1136/thoraxjnl-2015-208209CrossRefPubMed

21.

Deutsche Gesellschaft für Schlafforschung, und Schlafmedizin (DGSM) (2016) S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen – Kapitel „Schlafbezogene Atmungsstörungen“

22.

Drager LF, Brunoni AR, Jenner R et al (2015) Effects of CPAP on body weight in patients with obstructive sleep apnoea: a meta-analysis of randomised trials. Thorax 70:258–264. https://doi.org/10.1136/thoraxjnl-2014-205361CrossRefPubMed

23.

Eckert DJ, Jordan AS, Merchia P, Malhotra A (2007) Central sleep apnea: pathophysiology and treatment. Chest 131:595–607. https://doi.org/10.1378/chest.06.2287CrossRefPubMed

24.

Harada Y, Chihara Y, Azuma M et al (2014) Obesity hypoventilation syndrome in Japan and independent determinants of arterial carbon dioxide levels. Respirology 19:1233–1240. https://doi.org/10.1111/resp.12367CrossRefPubMed

25.

Heinemann F, Budweiser S, Dobroschke J, Pfeifer M (2007) Non-invasive positive pressure ventilation improves lung volumes in the obesity hypoventilation syndrome. Respir Med 101:1229–1235. https://doi.org/10.1016/j.rmed.2006.10.027CrossRefPubMed

26.

Herkenrath S, Randerath WJ (2016) Adipositas assoziierte Hypoventilation und Obstruktive Schlafapnoe. Klinikarzt 45:546–551. https://doi.org/10.1055/s-0042-120115CrossRef

27.

Herkenrath SD, Randerath WJ (2019) Neues zur Pathophysiologie schlafbezogener Atmungsstörungen. Somnologie 23:164–171. https://doi.org/10.1007/s11818-019-00220-0CrossRef

28.

Hodgson LE, Murphy PB, Hart N (2015) Respiratory management of the obese patient undergoing surgery. J Thorac Dis 7:943–952. https://doi.org/10.3978/j.issn.2072-1439.2015.03.08CrossRefPubMedPubMedCentral

29.

Hollier CA, Harmer AR, Maxwell LJ et al (2014) Moderate concentrations of supplemental oxygen worsen hypercapnia in obesity hypoventilation syndrome: a randomised crossover study. Thorax 69:346–353. https://doi.org/10.1136/thoraxjnl-2013-204389CrossRefPubMed

30.

Howard ME, Piper AJ, Stevens B et al (2017) A randomised controlled trial of CPAP versus non-invasive ventilation for initial treatment of obesity hypoventilation syndrome. Thorax 72:437–444. https://doi.org/10.1136/thoraxjnl-2016-208559CrossRefPubMed

31.

Janssens J‑P, Derivaz S, Breitenstein E et al (2003) Changing patterns in long-term noninvasive ventilation: a 7-year prospective study in the Geneva Lake area. Chest 123:67–79. https://doi.org/10.1378/chest.123.1.67CrossRefPubMed

32.

Javaheri S, Simbartl LA (2014) Respiratory determinants of diurnal hypercapnia in obesity hypoventilation syndrome. What does weight have to do with it? Ann Am Thorac Soc 11:945–950. https://doi.org/10.1513/AnnalsATS.201403-099OCCrossRefPubMed

33.

Jennum P, Ibsen R, Kjellberg J (2013) Morbidity prior to a diagnosis of sleep-disordered breathing: a controlled national study. J Clin Sleep Med 9:103–108. https://doi.org/10.5664/jcsm.2398CrossRefPubMedPubMedCentral

34.

Jennum P, Kjellberg J (2011) Health, social and economical consequences of sleep-disordered breathing: a controlled national study. Thorax 66:560–566. https://doi.org/10.1136/thx.2010.143958CrossRefPubMed

35.

Kaw R, Hernandez AV, Walker E et al (2009) Determinants of hypercapnia in obese patients with obstructive sleep apnea: a systematic review and metaanalysis of cohort studies. Chest 136:787–796. https://doi.org/10.1378/chest.09-0615CrossRefPubMed

36.

Kawata N, Tatsumi K, Terada J et al (2007) Daytime hypercapnia in obstructive sleep apnea syndrome. Chest 132:1832–1838. https://doi.org/10.1378/chest.07-0673CrossRefPubMed

37.

Kikuchi R, Tsuji T, Watanabe O et al (2017) Hypercapnia accelerates adipogenesis: a novel role of high CO₂ in exacerbating obesity. Am J Respir Cell Mol Biol 57(5):570–580. https://doi.org/10.1165/rcmb.2016-0278OCCrossRefPubMed

38.

Lemyze M, Taufour P, Duhamel A et al (2014) Determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure. PLoS One 9:e97563. https://doi.org/10.1371/journal.pone.0097563CrossRefPubMedPubMedCentral

39.

Lévy P, Kohler M, McNicholas WT et al (2015) Obstructive sleep apnoea syndrome. Nat Rev Dis Primers 1:15015. https://doi.org/10.1038/nrdp.2015.15CrossRefPubMed

40.

Macavei VM, Spurling KJ, Loft J, Makker HK (2013) Diagnostic predictors of obesity-hypoventilation syndrome in patients suspected of having sleep disordered breathing. J Clin Sleep Med 9:879–884. https://doi.org/10.5664/jcsm.2986CrossRefPubMedPubMedCentral

41.

Mandal S, Suh E‑S, Harding R et al (2018) Nutrition and exercise rehabilitation in obesity hypoventilation syndrome (NERO): a pilot randomised controlled trial. Thorax 73:62–69. https://doi.org/10.1136/thoraxjnl-2016-209826CrossRefPubMed

42.

Marik PE, Desai H (2013) Characteristics of patients with the “malignant obesity hypoventilation syndrome” admitted to an ICU. J Intensive Care Med 28:124–130. https://doi.org/10.1177/0885066612444261CrossRefPubMed

43.

Masa JF, Corral J, Alonso ML et al (2015) Efficacy of different treatment alternatives for obesity hypoventilation syndrome. Pickwick study. Am J Respir Crit Care Med 192:86–95. https://doi.org/10.1164/rccm.201410-1900OCCrossRefPubMed

44.

Masa JF, Corral J, Romero A et al (2016) Protective cardiovascular effect of sleep apnea severity in obesity hypoventilation syndrome. Chest 150:68–79. https://doi.org/10.1016/j.chest.2016.02.647CrossRefPubMed

45.

Masa JF, Mokhlesi B, Benítez I et al (2019) Long-term clinical effectiveness of continuous positive airway pressure therapy versus non-invasive ventilation therapy in patients with obesity hypoventilation syndrome: a multicentre, open-label, randomised controlled trial. Lancet 393:1721–1732. https://doi.org/10.1016/S0140-6736(18)32978-7CrossRefPubMed

46.

Mokhlesi B, Kryger MH, Grunstein RR (2008) Assessment and management of patients with obesity hypoventilation syndrome. Proc Am Thorac Soc 5:218–225. https://doi.org/10.1513/pats.200708-122MGCrossRefPubMedPubMedCentral

47.

Mokhlesi B, Tulaimat A, Evans AT et al (2006) Impact of adherence with positive airway pressure therapy on hypercapnia in obstructive sleep apnea. J Clin Sleep Med 2:57–62CrossRefPubMed

48.

Mokhlesi B, Tulaimat A, Faibussowitsch I et al (2007) Obesity hypoventilation syndrome: prevalence and predictors in patients with obstructive sleep apnea. Sleep Breath 11:117–124. https://doi.org/10.1007/s11325-006-0092-8CrossRefPubMed

49.

Murphy PB, Davidson C, Hind MD et al (2012) Volume targeted versus pressure support non-invasive ventilation in patients with super obesity and chronic respiratory failure: a randomised controlled trial. Thorax 67:727–734. https://doi.org/10.1136/thoraxjnl-2011-201081CrossRefPubMed

50.

Nowbar S, Burkart KM, Gonzales R et al (2004) Obesity-associated hypoventilation in hospitalized patients: prevalence, effects, and outcome. Am J Med 116:1–7CrossRefPubMed

51.

Ojeda Castillejo E, de Lucas Ramos P, López Martin S et al (2015) Noninvasive mechanical ventilation in patients with obesity hypoventilation syndrome. Long-term outcome and prognostic factors. Arch Bronconeumol 51:61–68. https://doi.org/10.1016/j.arbres.2014.02.015CrossRefPubMed

52.

Pérez de Llano LA, Golpe R, Ortiz Piquer M et al (2005) Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Chest 128:587–594. https://doi.org/10.1378/chest.128.2.587CrossRefPubMed

53.

Picot J, Jones J, Colquitt JL et al (2009) The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. https://doi.org/10.3310/hta13410CrossRefPubMed

54.

Piper AJ, Wang D, Yee BJ et al (2008) Randomised trial of CPAP vs bilevel support in the treatment of obesity hypoventilation syndrome without severe nocturnal desaturation. Thorax 63:395–401. https://doi.org/10.1136/thx.2007.081315CrossRefPubMed

55.

Priou P, Hamel J‑F, Person C et al (2010) Long-term outcome of noninvasive positive pressure ventilation for obesity hypoventilation syndrome. Chest 138:84–90. https://doi.org/10.1378/chest.09-2472CrossRefPubMed

56.

Ramirez J‑M, Garcia AJ, Anderson TM et al (2013) Central and peripheral factors contributing to obstructive sleep apneas. Respir Physiol Neurobiol 189:344–353. https://doi.org/10.1016/j.resp.2013.06.004CrossRefPubMedPubMedCentral

57.

Randerath W, Verbraecken J, Andreas S et al (2017) Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J 49:1600959. https://doi.org/10.1183/13993003.00959-2016CrossRefPubMed

58.

Randerath WJ, Stieglitz S, Galetke W et al (2010) Evaluation of a system for transcutaneous long-term capnometry. Respiration 80:139–145. https://doi.org/10.1159/000295904CrossRefPubMed

59.

Salord N, Mayos M, Miralda RM et al (2013) Continuous positive airway pressure in clinically stable patients with mild-to-moderate obesity hypoventilation syndrome and obstructive sleep apnoea. Respirology 18:1135–1142. https://doi.org/10.1111/resp.12131CrossRefPubMed

60.

Shimura R, Tatsumi K, Nakamura A et al (2005) Fat accumulation, leptin, and hypercapnia in obstructive sleep apnea-hypopnea syndrome. Chest 127:543–549. https://doi.org/10.1378/chest.127.2.543CrossRefPubMed

61.

Simonds AK (2013) Chronic hypoventilation and its management. Eur Respir Rev 22:325–332. https://doi.org/10.1183/09059180.00003113CrossRefPubMed

62.

Sugerman HJ, Fairman RP, Lindeman AK et al (1981) Gastroplasty for respiratory insufficiency of obesity. Ann Surg 193:677–685. https://doi.org/10.1097/00000658-198106000-00002CrossRefPubMedPubMedCentral

63.

Trakada GP, Steiropoulos P, Nena E et al (2010) Prevalence and clinical characteristics of obesity hypoventilation syndrome among individuals reporting sleep-related breathing symptoms in northern Greece. Sleep Breath 14:381–386. https://doi.org/10.1007/s11325-010-0360-5CrossRefPubMed

64.

Vivodtzev I, Tamisier R, Croteau M et al (2018) Ventilatory support or respiratory muscle training as adjuncts to exercise in obese CPAP-treated patients with obstructive sleep apnoea: a randomised controlled trial. Thorax. https://doi.org/10.1136/thoraxjnl-2017-211152CrossRefPubMed

65.

White LH, Bradley TD (2013) Role of nocturnal rostral fluid shift in the pathogenesis of obstructive and central sleep apnoea. J Physiol 591:1179–1193. https://doi.org/10.1113/jphysiol.2012.245159CrossRefPubMed

66.

Windisch W, Dreher M, Geiseler J et al (2017) Guidelines for non-invasive and invasive home mechanical ventilation for treatment of chronic respiratory failure—Update 2017. Pneumologie 71:722–795. https://doi.org/10.1055/s-0043-118040CrossRefPubMed

67.

Zavorsky GS, Hoffman SL (2008) Pulmonary gas exchange in the morbidly obese. Obes Rev 9:326–339. https://doi.org/10.1111/j.1467-789X.2008.00471.xCrossRefPubMed

Titel: Adipositasassoziierte Atmungsstörungen –„State of the Art“
verfasst von: Simon Herkenrath
Winfried Randerath
Publikationsdatum: 14.08.2020
Verlag: Springer Medizin
Schlagwörter: Adipositas
Adipositas
Schlafapnoe
Erschienen in: Somnologie / Ausgabe 3/2020
Print ISSN: 1432-9123
Elektronische ISSN: 1439-054X
DOI: https://doi.org/10.1007/s11818-020-00258-5

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Zusammenfassung

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