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Arousals: Aktueller Stand, Klinische Bedeutung und offene Fragen

Arousals: Actual situation, clinical importance and open questions

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Zusammenfassung

Aufgrund der erheblichen Bedeutung von Arousals für die Interpretation von Schlaf-Wachstörungen werden in einem umfassenden Überblick die Genese und Bedeutung, methodische Aspekte und ihre klinische Relevanz dargestellt. Es existiert eine Vielzahl von extero- und enteroceptiven Arousal-Stimuli, wobei die Reizantwort als EEG-Arousal, vegetatives Arousal oder Verhaltensänderung mit Bewegungen registriet werden kann. Auch in der pädiatrischen Schlafmedizin gewinnt die Analyse von Arousals zunehmend an Bedeutung, da Arousal-Störungen als Erklärung für lebensbedrohliche Ereignisse, aber auch für gestörte Tagesbefindlichkeit herangezogen werden können. Trotz klarer Diagnosekriterien von Arousals (ASDA) besteht eine gewisse Interrater-Variabilität, die zu einer unterschiedlichen Beurteilung von Schlaffragmentation führt. Eine automatische Computeranalyse bietet keine Alternative. Sie dient lediglich zur Vorauswertung und sollte immer durch geschulte Experten kontrolliert und eventuell korrigiert werden. Die Detektion respiratorischer Ereignisse mit konsekutivem EEG-Arousal wurde in den letzten Jahren durch nicht-invasive Verfahren, wie Standruck, Impedanz-Messung, Effort-/Phasenwinkel-Analyse verbessert. Die Registrierung der puls-transit-time (PTT) und des kontinuierlich erfassten Blutdruckes ist geeignet, vegetative Arousals zu quantifizieren, wobei Aussagen über Sensitivität und Spezifität noch nicht möglich sind. Am Beispiel verschiedener Krankheitsbilder, wie obstruktives Schlafapnoesyndrom, zentrales Schlafapnoesyndrom, chronisch-obstruktive Ventilationsstörung, periodische Beinbewegungen im Schlaf, psychophysiologische Insomnie, Epilepsie, Parasomnien und Hypersomnien werden die Effekte von Arousals erörtert. In Zukunft ist zusätzlich zur Erfassung von Arousals die Suche nach weiteren Messgrößen/Methoden erforderlich, um die Leistungseinschränkungen durch Schlafstörungen noch besser objektivieren zu können.

Summary

Due to the importance of arousals for the interpretation of sleep wake disturbances, origin and meaning, methodological aspects and clinical relevance are discussed. There exist multiple entero- and exteroceptive arousal stimuli followed by EEG, autonomic and behavioral arousals. Also in pediatric sleep medicine the analysis of arousals is of great importance, because disturbances of the arousal mechanism can play a causal role for life threatening events or daytime somnolence. Despite clear criteria for the diagnosis of arousals (ASDA) there exists a certain interrater variability leading to different evaluation of sleep fragmentation. Automatic computer analysis offers no alternative: the results should always be controlled and eventually corrected by trained experts. In the last years the detection rate of respiratory events with consecutive EEG arousals was improved by non invasive methods as measurement of pressure with nasal prongs, impedance or effort/phase angle. The registration of pulse-transit-time and continuously measured blood pressure allows to quantify autonomic arousals. By examples of different diseases as obstructive sleep apnea, central sleep apnea, chronic obstructive lung disease, periodic movement during sleep, psychophysiological insomnias, epilepsy, parasomnias and hypersomnias the effects of arousals are discussed. Additionally to arousals further research for other measurements/methods is needed to improve the evaluation of daytime consequences by sleep disturbances.

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  1. Klinik für Pneumologie, Klinik Ambrock, Universität Witten-Herdecke, 58091, Hagen

    Karl-Heinz Rühle (Prof.), Friedhart Raschke, Holger Hein, Joachim H. Ficker, Ingo Fietze, Gabor Janos Juhasz, Sylvia Kotterba, Geert Mayer, Thomas Penzel, Kurt Rasche, Hans-Werner Duchna, Bernd Sanner, Winfried J. Randerath, Günther-H. Wiest, Thorsten Schäfer, Sabine Scholle & Thomas Sobanski

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Rühle, KH., Raschke, F., Hein, H. et al. Arousals: Aktueller Stand, Klinische Bedeutung und offene Fragen. Somnologie 5, 24–45 (2001). https://doi.org/10.1046/j.1439-054x.2001.01150.x

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