Skip to main content
SpringerLink
Log in

Kreislauf und Schlaf

Circulation and sleep

  • Published:
Somnologie - Zeitschrift für Schlafforschung und Schlafmedizin Aims and scope Submit manuscript

Zusammenfassung

Der Schlaf stellt einen wichtigen Ereignisraum physiologischer wie auch pathologischer Funktionen des Kreislaufsystems dar. In den jeweiligen Schlafstadien treten charakteristische Veränderungen der Hämodynamik auf. Zahlreiche pathophysiologische Mechanismen konnten auf dem Boden des Verständnisses physiologischer Vorgänge aufgeklärt werden. So ist der Zusammenhang von arterieller Hypertonie und obstruktiver Schlafapnoe epidemiologisch und experimentell dargestellt worden. Weiterhin sind brady-wie tachykarde Herzrhythmusstörungen, zerebrale Minderperfusion sowie die Herzinsuffizienz im Schlaf von besonderer klinischer Relevanz. Daraus ergeben sich diagnostische wie auch therapeutische Konsequenzen.

Summary

Sleep includes physiological changes of cardiovascular function. Characteristic changes in hemodynamic pattern occur during the different sleep stages. From this knowldge of physiological changes in sleep many pathophysiological findings have been investigated. The linkage between arterial hypertension and obstructive sleep apnea has been investigated by many epidemiological and experimental studies. Additionally, nocturnal brady- and tachycardia, cerebral and myocardial hypoperfusion and heart failure during sleep are of clinical significance. This has to be taken into account for diagnostic and also therapeutic measures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Ali N, Davies R, Fleetham J, Stradling J: Periodic movements of legs during sleep associated with rises in systemic blood pressure. Sleep 14: 163–165, 1991.

    PubMed  CAS  Google Scholar 

  2. Argentino C, Toni D, Rasura M, Violi F, Sachetti ML, Allegretta, A, Balsano F, Fieschi C: Circadian variation in the frequency of ischemic stroke. Stroke 21: 387–389, 1990.

    PubMed  CAS  Google Scholar 

  3. Balfors EM, Franklin KA: Cerebral perfusion in OSA. Am J Resp Crit Care Med 150: 1587–91, 1994.

    PubMed  CAS  Google Scholar 

  4. Baust W, Bohnert B: The regulation of heart rate during sleep. Exp Brain Res 7: 169–180, 1969.

    Article  PubMed  CAS  Google Scholar 

  5. Becker H, Brandenburg U, Peter JH, v Wichert P: Reversal of sinus arrest and atrio ventricular conduction block of patients with sleep apnea during nasal continuous positive airway pressure. Am J Respir Crit Care Med 151: 215, 1995.

    PubMed  CAS  Google Scholar 

  6. Bolm-Audorff U, Koehler U, Becker E, Fuchs E, Meinzer K, Peter JH, v Wichert P: Nächtliche Herzrhythmusstörungen bei Schlafapnoe-Syndrom. Dtsch Med Wschr 109: 853, 1984.

    PubMed  CAS  Google Scholar 

  7. Bond WC, Bohs C, Ebey J, Wolf S: Rhythmic heart rate variability (sinus arrhythmia) related to stages of sleep. Conditional Reflex 8: 529–536, 1973.

    Google Scholar 

  8. Brandenberger G, Follenius M, Simon C, Ehrhart J, Libert JP: Nocturnal oscillations in plasma renin activity and REMNREM sleep cycles in humans: a common regulatory mechanism? Sleep 11: 242–250, 1988.

    PubMed  CAS  Google Scholar 

  9. Bradley TD: Breathing during sleep in cardiac disease. In: Saunders, NA, Sullivan CE (eds): Sleep and Breathing. Marcel Dekker, New York, Basel, Hong Kong, pp 787–821, 1994.

    Google Scholar 

  10. Brodsky M, Wu D, Denes P, Kanakis C, Rosen KM: Arrhythmias documented by 24 hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease. Am J Cardiol 39: 390, 1977.

    Article  PubMed  CAS  Google Scholar 

  11. Brooks E: A clinical study of the effects of sleep and rest on blood pressure. Arch Intern Med: 97–102, 1912.

  12. Carlson J, Hedner J, Elam M, Ejnell H, Sellgren J, Wallin G: Augmented resting sympathetic activity in awake patients with obstructive sleep apnoea. Chest 103: 1763–1768, 1993.

    PubMed  CAS  Google Scholar 

  13. Cheyne J: A case of apoplexy in which the fleshy part, of the heart was converted to fat. Dublin Hosp Rep 2: 216–223, 1818.

    Google Scholar 

  14. Cinca J, Moya A, Bardaji A: Circadian variation in the electrical properties of the human heart assessed by sequential bed-side electrophysiologic testing. Am Heart J 112: 315–321, 1986.

    Article  PubMed  CAS  Google Scholar 

  15. Coccagna G, Mantovani M, Brignani E, Manzini A, Lugaresi E: Arterial pressure changes during spontaneous sleep in man. Electroencephalogr Clin Neurophysiol 31: 277–281, 1971.

    Article  PubMed  CAS  Google Scholar 

  16. Davidson WR, Stauffer JL, Reeves Hoche MK, Zwillich CW: Cardiac sequale od sleep disordered breathing in obstructive sleep apnea: new evidence for right ventricular dysfunction. Am Rev Respir Dis 147: A1015, 1993.

    Google Scholar 

  17. Davies RJ, Belt PJ, Robert SJ, Ali NJ, Stradling JR: Arterial blood pressure responses to graded transient arousal from sleep in normal humans. J Appl Physiol 74: 1123–1130, 1993.

    PubMed  CAS  Google Scholar 

  18. Engel BT, Talan MI: Diurnal variations in central venous-pressure. Acta Physiol Scand 141 (2): 273–278, 1991.

    PubMed  CAS  Google Scholar 

  19. Ehlenz K, Schneider H, Dugi K, Peter JH, v Wichert P, Kaffarnik H: Welche Rolle spielt das Renin-Angiotensin-Aldosteron-System (RAAS) in der Pathogenese der Hypertonie beim obstruktiven Schlafapnoe-Syndrom (OSAS)? Nieren- und Hochdruckkrankheiten 10: 548–550, 1991.

    Google Scholar 

  20. Ehlenz K, Peter JH, Dugi K, Firle K, Goubeaud R, Weber K, Schneider H, Kaffarnik H, Peter JH, v Wichert P: Changes in volume- and pressure regulating hormone systems in patients with obstructive sleep apnea syndrome. In: Peter JH, Podszus T, Penzel T, v Wichert P (eds) Sleep and Health Risk. Springer, Berlin pp 518–531, 1991.

    Google Scholar 

  21. Ehlenz K: Regulation of blood volume-implications for cardiovascular pathophysiology in sleep apnoea. J Sleep Res 4 (Suppl 1): 30–33, 1995.

    PubMed  Google Scholar 

  22. Escourrou P, Tessier O, Bureau A, Nedelcoux H, Bourgin P: Non-invasive measurement of haemodynamics during sleep apnoea. J Sleep Res 4 (1): 78–82, 1995.

    PubMed  Google Scholar 

  23. Fischer AO, Chaudhary BA, Taormina MA, Akhtar MA: Intracranial haemodynamics during sleep. Chest 102: 1402–1406, 1992.

    PubMed  CAS  Google Scholar 

  24. Garpestad E, Ringler J, Parker JA, Remsburg S, Weiss JW: Sleep stage influences the hemodynamic response to obstructive apneas. Am. J. Respir Crit Care Med 152: 199–203, 1995.

    PubMed  CAS  Google Scholar 

  25. Grimm W, Hoffmann J, Koehler U, Peter JH, v Wichert P, Maisch B: Invasive electrophysiologic evaluation of patients with sleep apnea associated ventricular asystole—methods and preliminary results. J Sleep Res 4 (1): 160–165, 1995.

    PubMed  Google Scholar 

  26. Grote L, Radeck A, Krzyzanek E, Ploch T, Brandenburg U, Peter JH: Nächtliche Hypertonie bei Schlafapnoe im NREM-und REM-Schlaf im Vergleich zu körperlicher Belastung am Tage. Nieren und Hochdruckkrankheiten 24: 104–106, 1995.

    Google Scholar 

  27. Grote L: Schlaf-Atmung-Hämodynamik. Internist 37: 470–482, 1996.

    PubMed  CAS  Google Scholar 

  28. Grote L, Heitmann J, Köhler U, Penzel T, Peter JH, v Wichert P: Assessment of the nocturnal blood pressure relative to sleep stages in patients with obstructive sleep apnea. Z Kardiologie 85: 112–114, 1996.

    Google Scholar 

  29. Guilleminault C, Connolly SJ, Winkle RA: Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol 52: 490, 1983.

    Article  PubMed  CAS  Google Scholar 

  30. Guyton AC, Lindsey AW, Abernathy B, Richardson T: Venous return at various right atrial pressures, and the normal venous return curve. Am J Physiol 189: 609–615, 1957.

    PubMed  CAS  Google Scholar 

  31. Hajak G, Klingelhöfer J, Schulz-Varszegi M, Sander D, Staedt J, Conrad B, Rüther E: Cerebral perfusion during sleep disordered breathing. J Sleep Res 4 (1): 135–144, 1995.

    PubMed  Google Scholar 

  32. Hanly PJ, Millar TW, Steljes DG, Baert R, Frais MA, Kryger MH: Respiration and abnormal sleep in patients with congestive heart failure. Chest 96: 480–488, 1989.

    PubMed  CAS  Google Scholar 

  33. He JH, Kryger MH, Zorick FJ, Conway W, Roth T: Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest 94: 9–14, 1988.

    PubMed  CAS  Google Scholar 

  34. Hedner J, Ejnell H et al.: Is high and fluctuating muscle sympathetic nerve activity in the sleep apnea syndrome of patho-genetic importance for the development of hypertension? J Hypertension 6 (S4): 529–31, 1988.

    Google Scholar 

  35. Hedner J, Ejnell H, Caidahl K: Left ventricular hypertrophy independent of hypertension in patients with obstructive sleep apnea. J Hypertension 8: 941–946, 1990.

    Article  CAS  Google Scholar 

  36. Hedner J: Daytime waking autonomic function and vascular control in OSA. J Sleep Res 4 (1): 171–175, 1995.

    PubMed  Google Scholar 

  37. Hla KM, Young TB, Bidwell T, Palta M, Skatrud JBB, Dempsey J: Sleep Apnea and Hypertension. Ann Intern Med 120: 382–388, 1994.

    PubMed  CAS  Google Scholar 

  38. Hoffstein V, Mateika S: Cardiac arrhythmia, snoring, and sleep apnea. Chest 106: 466, 1993.

    Google Scholar 

  39. Kirby DA, Verrier RL: Differential effects of sleep stage on coronary hemodynamic function. Am J Physiol H1378–H1383, 1989.

  40. Köhler U, Dübler H, Glaremin T, Peter JH, v Wichert P: Nocturnal myocardial ischemia and cardiac arrhythmia in patients with sleep apnea with and without coronary heart disease. Klin Wschr 69: 474–482, 1991.

    Article  Google Scholar 

  41. Köhler U, Fett I, Hay J, Lübbeke A, Ploch T, Wolff H, Zindler G: Bradycarde Herzrhythmusstörungen im Schlaf—Das Morbiditätsspektrum bei Patienten mit Schlafapnoe und nächtlichen bradycarden Herzrhythmusstörungen. In: Peter JH, Cassel W, Penzel T, v Wichert P (eds): Schlaf-Atmung-Kreislauf. Springer, Berlin Heidelberg New York, 374–383, 1993.

    Google Scholar 

  42. Köhler U, Dübler H, Glaremin T, Junkermann H, Lübbers C, Ploch T, Peter JH, Pomykaj T, Peter JH, v Wichert P: Nocturnal myocardial ischemia and cardiac arrhythmia in patients with sleep apnea with and without coronary heart disease. Klin Wschr 69: 474, 1991.

    Article  Google Scholar 

  43. Köhler U, Glaremin T, Cassel W, Feuring M, Pomykaj T, Schäfer H, Stellwaag M: Nächtliche ventrikuläre Arrhythmien bei Patienten mit Schlafapnoe und Verdacht auf koronare Herzerkrankung. Med Klinik 88: 684, 1993.

    Google Scholar 

  44. Koepchen HP: Neurophysiologische Grundlagen der nervösen Steuerung der Herzfrequenz, insbesondere ihrer atemrhythmischen Schwankungen. Med Sport 17 (5): 136–141, 1977.

    Google Scholar 

  45. Krieger J, Sforza E, Apprill M, Lampert E, Weitzenblum E, Ratomaharo J: Pulmonary hypertension, hypoxemia and hypercapnia in obstructive sleep apnea patients. Chest 96: 729–37, 1989.

    PubMed  CAS  Google Scholar 

  46. Kryger MH, Roth T, Carskadon M: Circadian rhythms in humans: an overview. In: Kryger M, Roth T, Dement WC (eds): Principles and practice of sleep medicine, Saunders, Philadelphia, pp 301–308, 1994.

    Google Scholar 

  47. Laks L: Pumonary artery pressure in sleep apnoea and snoring. J Sleep Res 4 (1): 182–184, 1995.

    PubMed  Google Scholar 

  48. Levy P, Guilleminault C, Fagret D: Changes in left ventricular ejection fraction during REM-sleep and exercise in chronic obstructive pulmonary disease and sleep apnea syndrome. Eur Respir J 4: 347–352, 1991.

    PubMed  CAS  Google Scholar 

  49. Lugaresi E, Coccagna G, Mantovani M, Lebrun R: Some periodic phenomena arising during drowsiness and sleep in man. Electroencephalogr Clin Neurophysiol 39: 59–64, 1972.

    Google Scholar 

  50. Meyer JS, Ishikawa Y, Hata T, Karacan I: Cerebral blood flow in normal and abnormal sleep and dreaming. Brain Cogn 6: 266–294, 1987.

    Article  PubMed  CAS  Google Scholar 

  51. Middeke M, Schrader J: Nocturnal blood pressure in normotensive subjects and those with white coat, primary, and secondary hypertension. Br Med J 308: 630–632, 1994.

    CAS  Google Scholar 

  52. Millar-Craig MW, Bishop CN, Raftery EB: Circadian variation of blood pressure. Lancet 795–797, 1978.

  53. Mills JN, Stanbury SW: Persistent 24 hour renal excretory rhythm on a 12 hour cycle of activity. J Physiol 117: 22–37, 1952.

    PubMed  CAS  Google Scholar 

  54. Müller J: Vom Schlaf. In: Handbuch der Physiologie des Menschen für Vorlesungen, Band 6. J. Hölscher, Coblenz, pp 579–588, 1840.

    Google Scholar 

  55. O'Brien E, Sheridan J, O'Malley K: Dippers and non-dippers. Lancet II: 397, 1988.

    Article  Google Scholar 

  56. O'Brien E, Staessen E: Normotension and hypertension as defined by 24-hour. Ambulatory Blood Pressure Monitoring. Blood Pressure 4: 266–82, 1995.

    Google Scholar 

  57. O'Donnell C, King ED, Schwartz AR, Robotham JL, Smith PL: The relationship between blood pressure and airway obstruction during sleep in the dog. J Appl Physiol 77: 1819–1828, 1994.

    PubMed  Google Scholar 

  58. Pankow W, Nabe B, Lies A, Kohl FV, Lohmann W: Influence of obstructive sleep apnea on circadian blood pressure profile. J Sleep Res 4 (1): 102–106, 1995.

    PubMed  Google Scholar 

  59. Palomäki H: Snoring and the risk of ischemic brain infarction. Stroke 22: 1021–1025, 1991.

    PubMed  Google Scholar 

  60. Partinen M, Palomäki H: Snoring and cerebral infarction. Lancet II: 1325–1326, 1985.

    Article  Google Scholar 

  61. Penzel T: Manifestationen von Schlaffragmentation. In: Pathophysiologie schlafbezogener Atmungsstörungen. Biological Rhythms. Roderer Verlag, Regensburg, pp 90–103, 1995.

    Google Scholar 

  62. Peter JH, Bolm-Audorff U, Becker E, Eble R, Fuchs E, Meinzer K, Penzel T, v Wichert P: Schlafapnoe und essentielle Hypertonie. Verh Dtsch Ges Inn Med 89: 1132–1135, 1983.

    Google Scholar 

  63. Peter JH, Siegrist J, Podszus T, Mayer J, Selzer K, v Wichert P: Prevalence of sleep apnea in healthy industrial workers. Klin Wschr 63 (17): 807–811, 1985.

    Article  PubMed  CAS  Google Scholar 

  64. Peter JH, Grote L, Fus E, Ploch T, Stammnitz A: REM-sleep hypertension in obstructive sleep apnea. Eur J Med Res 1: 132–136, 1995.

    PubMed  CAS  Google Scholar 

  65. Podszus T, Mayer J, Penzel T, Peter JH, v Wichert P: Nocturnal hemodynamics in patients with obstrucitve sleep apnea. Eur J Resp Dis 69: 435–442, 1986.

    Google Scholar 

  66. Podszus T, Greenberg H, Scharf SM: Influence of sleep state and sleep disordered breathing on cardiovascular function. In: Saunders NA, Sullivan CE (eds): Sleep and Breathing. Marcel Dekker, New York, Basel, Hong Kong, pp 257–310, 1994.

    Google Scholar 

  67. Raschke F, Klöppel HB, Breithaupt H, Hildebrandt G: The phase coupling between heart beat and onset of respiration during night sleep. In: Popoviciu L, Asgian B, Badiu G (eds): Sleep 78. Karger, Basel, München, Paris, pp 391–395, 1980.

    Google Scholar 

  68. Scharf S, Brown R, Tow DE, Paris AF: Cardiac effects of increased lung volume and decreased pleural pressure in men. J Appl Physiol 47: 257–62, 1979.

    PubMed  CAS  Google Scholar 

  69. Schroeder JS, Motta J, Guilleminault C: Hemodynamic studies in sleep apnea. In: Guilleminault C, Dement WC (eds): Liss, New York, pp 177–196, 1978.

    Google Scholar 

  70. Shepard JW: Gas exchange and hemodynamics during sleep. Med Clinics North Am 69: 1243–1264, 1985.

    Google Scholar 

  71. Shiomi T, Guilleminault C, Stoohs R, Schnittger I: Leftward shift of the interventricular septum and pulsus paradoxus in obstructive sleep apnea syndrome. Chest 100: 894–902, 1991.

    PubMed  CAS  Google Scholar 

  72. Skatrud JB, Morgan B: Hypertension and sleep apnoea. J Sleep Res 4 (1): 34–36, 1995.

    PubMed  Google Scholar 

  73. Snyder F, Hobson JA, Morrison FM, Goldfrank F: Changes in respiration, heart rate and systolic blood pressure in human sleep. J Appl Physiol 19: 417–422, 1964.

    PubMed  CAS  Google Scholar 

  74. Sobotka PA, Mayer JH, Bauernfeind RA, Kanakis C, Rosen KM: Arrhythmias documented by 24 hour continuous ambulatory electrocardiographic monitoring in young women without apparent heart disease. Am Heart J 101: 753, 1981.

    Article  PubMed  CAS  Google Scholar 

  75. Stoohs R, Guilleminault C: Cardiovascular changes associated with obstructive sleep apnea syndrome. J Appl Physiol 19: 417–422, 1992.

    Google Scholar 

  76. Talan MI, Engel BT, Kawate R: Overnight increases in haematocrit: additional evidence for a nocturnal fall in plasma volume. Acta Physiol Scand 144 (4): 473–476, 1992.

    PubMed  CAS  Google Scholar 

  77. Tafil-Klawe M, Klawe J, Moog R, Schneider H, Grote L, Janicki J, Raschke F, Penzel T, Peter JH, Hildebrandt G: Arterielle Baro- und Chemorezeptorenreflexe bei Schlafapnoepatienten. In: Peter JH, Penzel T, Cassel W, v Wichert P: Schlaf—Atmung —Kreislauf. Springer-Verlag, Berlin, Heidelberg, New York, pp 142–163, 1993.

    Google Scholar 

  78. Tilkian AG, Guilleminault C, Schroeder JS, Lehrman KL, Simmons FB, Dement WC: Sleep-induced apnea syndrome. Prevalence of cardiac arrhythmias and their reversal after tracheostomy. Am J Med 63: 348, 1977.

    Article  PubMed  CAS  Google Scholar 

  79. Tobin MJ, Snyder JV: Cheyne-Stokes respiration revisited: Controversies and implications. Crit Care Med 12: 882–887, 1984.

    PubMed  CAS  Google Scholar 

  80. Tolle FA, Judy WV, Yu P: Reduced stroke volume related to pleural pressure in obstructive sleep apnea. J Appl Physiol 55: 1718–1724, 1983.

    PubMed  CAS  Google Scholar 

  81. Townsend RE, Prinz PN, Obrist WD: Human cerebral blood flow during sleep and waking. J Appl Physiol 35: 620–625, 1973.

    PubMed  CAS  Google Scholar 

  82. Weitzenblum E, Krieger J, Apprill M, Vallée E, Ehrhart M, Ratomaharo J, Oswald M, Kurtz D: Daytime pulmonary hypertension in patients with obstructive sleep apnea syndrome. am Rev Respir Dis 138: 345–349, 1988.

    PubMed  CAS  Google Scholar 

  83. Working Group on OSAS and Hypertension: Carlson J, Davies R, Ehlenz K, Grunstein R, Hedner J, Podszus T, Sinaway L, Stradling J, Telakivi T, Zwillich C: Obstructive sleep apnea and blood pressure elevation. What is the relationship? Blood Pressure 2: 166–182, 1993.

    Google Scholar 

  84. Younes M: The physiologic basis of central apnea and periodic breathing. Curr Pulmonol 10: 265–325, 1989.

    Google Scholar 

  85. Zwillich C, Devlin T, White D, Douglas N, Weil J, Martin R: Bradycardia during sleep apnea. Characteristics and mechanism. J Clin Invest 68: 1286, 1982.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Schafmedizinisches Labor, Medizinische Poliklinik, Philipps-Universität Marburg, Baldingerstraße 1, D-35033, Marburg

    L. Grote, H. Schneider & T. Podszus

Authors
  1. L. Grote
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Podszus
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grote, L., Schneider, H. & Podszus, T. Kreislauf und Schlaf. Somnologie 1, 27–36 (1997). https://doi.org/10.1007/s11818-997-0007-03

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11818-997-0007-03

Schlüsselwörter

Key words

Search

Navigation