Zusammenfassung
Es ist von grundlegender Bedeutung, zu unterscheiden, ob eine chronische Hypoxie intermittierend oder persistierend auftritt. Während eine chronisch-intermittierende Hypoxie (CIH) typischerweise bei Patienten mit obstruktiver Schlafapnoe (OSA) zu finden ist, wird eine chronisch-persistierende Hypoxie (CPH) typischerweise bei Patienten mit chronischen Lungenerkrankungen diagnostiziert. Das kardiovaskuläre Risiko ist bei Patienten mit CIH deutlich erhöht im Vergleich zur Patienten mit CPH. Der häufige Wechsel von Sauerstoffdesaturation und Reoxygenierung bei Patienten mit CIH ist assoziiert mit vermehrtem hypoxischen Stress, gesteigerter systemischer Inflammation und gesteigerter adrenerger Aktivierung, gefolgt von endothelialer Dysfunktion und vermehrter Arteriosklerose. Die pathophysiologischen Konsequenzen der CPH sind weniger gut verstanden. Gesichert ist der Zusammenhang zwischen CPH und der Entstehung einer pulmonalarteriellen Hypertonie, eines Cor pulmonale sowie einer Polyglobulie.
Abstract
It is of fundamental importance to differentiate whether chronic hypoxia occurs intermittently or persistently. While chronic intermittent hypoxia (CIH) is found typically in patients with obstructive sleep apnea (OAS), chronic persistent hypoxia (CPH) is typically diagnosed in patients with chronic lung disease. Cardiovascular risk is markedly increased in patients with CIH compared to patients with CPH. The frequent change between oxygen desaturation and reoxygenation in patients with CIH is associated with increased hypoxic stress, increased systemic inflammation, and enhanced adrenergic activation followed by endothelial dysfunction and increased arteriosclerosis. The pathophysiologic consequences of CPH are less well understood. The relationship between CPH and the development of pulmonary hypertension, pulmonary heart disease as well as polycythemia has been established.
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U. Koehler, O. Hildebrandt, J. Krönig, W. Grimm, J. Otto, W. Hildebrandt und R. Kinscherf geben an, dass kein Interessenkonflikt besteht.
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Koehler, U., Hildebrandt, O., Krönig, J. et al. Chronische Hypoxie und kardiovaskuläres Risiko. Herz 43, 291–297 (2018). https://doi.org/10.1007/s00059-017-4570-5
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DOI: https://doi.org/10.1007/s00059-017-4570-5
Schlüsselwörter
- Chronisch-persistierende Hypoxie
- Chronisch-intermittierende Hypoxie
- Oxidativer Stress
- Systemische Inflammation
- Endotheliale Dysfunktion