Srdeční arytmie při obstruktivní spánkové apnoe

English version Czech version

: P. Schweitzer
: Division of Cardiology, Department of Medicine, Beth Israel Medical Center, New York N. Y. USA
: Vnitř Lék 2008; 54(10): 1006-1009
: Reviews

Předneseno na vědecké pracovní schůzi Spolku lekárov v Košicích dne 21. dubna 2008 na XV. memoriálu profesora F. Póra.

Syndrom obstruktivní spánkové apnoe (OSA) je spojen s různými typy srdečních arytmií. Původní studie se většinou zaměřovaly na noční bradyarytmii a tachyarytmii. Novější studie dokumentují vysokou prevalenci atriální fibrilace (AF) a její souvislost s obezitou a dalšími rizikovými faktory AF. Kontinuální pozitivní přetlak v dýchacích cestách (CPAP) navíc zabraňuje recidivě AF po kardioverzi. Nejvyšší míra rizika náhlého úmrtí při OSA je v noci, na rozdíl od obecné populace, u které většina náhlých úmrtí nastává mezi šestou hodinou a polednem. Z tohoto zjištění lze usuzovat, že hypoxie a další noční abnormality mohou vyprovokovat náhlé úmrtí. Důležitým zjištěním z poslední doby je příznivý účinek, který má na náhlé úmrtí CPAP. Názory na roli kardiostimulace při OSA se nadále různí. Obecně vzato není kardiostimulace indikována u pacientů s noční bradyarytmií. Někteří autoři však doporučují kardiostimulaci u těch pacientů, kteří trpí závažnou noční bradyarytmií a netolerují nebo nereagují na CPAP. Podle studie z nedávné doby je u 59 % pacientů s permanentním kardiostimulátorem přítomna OSA.

Klíčová slova:
syndrom obstruktivní spánkové apnoe – srdeční arytmie – atriální fibrilace – obezita – kontinuální pozitivní přetlak v dýchacích cestách – noční bradyarytmie

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Article was published in

Internal Medicine

2008 Issue 10