Diagnostik und Therapie der residualen Tagesschläfrigkeit bei Patienten mit therapierter obstruktiver Schlafapnoe
Open accessAbstract
Zusammenfassung Die residuale Tagesschläfrigkeit tritt bei 12–65 % der Schlafapnoe-Patienten unter eingeleiteter Positivdrucktherapie („positive airway pressure“) auf. Eine häufige Ursache ist die geringe PAP-Nutzungszeit. Mögliche weitere Gründe sind ein hoher Rest-Apnoe-Hypopnoe-Index und eine vorhandene Komorbidität. Prädiktoren sind ein initial hoher Epworth-Schläfrigkeitsscore, jüngeres Alter und die erst kurze PAP-Nutzung. Gesichert wird die Restschläfrigkeit mittels objektiver Testverfahren (z. B. multipler Wachbleibetest oder Oxford Sleep Resistance Test [Osler-Test]). Eine der wesentlichen Ursachen für die residuale Schläfrigkeit nach Ausschluss konkurrierender Auslöser ist die stattgehabte intermittierende nächtliche Hypoxämie, die zu nervalen Zellschädigungen, zu hormonellen und genetischen Veränderungen und zu Änderungen des Mikrobioms führen kann. Die klinischen Beschwerden werden bestimmt durch eine ausgeprägte Tagesschläfrigkeit, depressive Verstimmung und eine Minderung der Lebensqualität. Nach Ausschluss möglicher therapiebedingter Ursachen kann die residuale Tagesschläfrigkeit medikamentös mit u. a. Modafinil, Armodafinil, Pitolisant oder Solriamfetol behandelt werden. Die genannten Arzneimittel haben unterschiedliche Wirkmechanismen. Die Studien und die Effekte der Substanzen auf die Tagesschläfrigkeit, die Lebensqualität und die Leistungsfähigkeit der Betroffenen werden vorgestellt. Das Nebenwirkungsprofil der Wirkstoffe ist ähnlich. Für die Indikation residuale Schläfrigkeit einer therapierten obstruktiven Schlafapnoe ist in Europa derzeit nur Solriamfetol zugelassen. Ein vom Autorenteam entworfener Behandlungspfad für Patienten mit therapierter obstruktiver Schlafapnoe mit residualer Tagesschläfrigkeit, von der Erstvorstellung nach Therapiebeginn über die Therapieoptimierung bis hin zu einer medikamentösen Behandlung, wird vorgestellt.
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Despite positive airway pressure therapy, at least 10% of patients still suffer from residual excessive daytime sleepiness.
“Despite PAP therapy, at least 10% of patients still suffer from residual EDS (rEDS) (Fietze et al., 2021;Gasa et al., 2013;Javaheri & Javaheri, 2020;Launois et al., 2013;Pépin et al., 2009).”
From Effects of mindfulness meditation and Acceptance and commitment therapy in patients with obstructive sleep apnea with residual excessive sleepiness: A randomized controlled pilot study (2023) · cites this paper as Fietze et al., 2021
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Roncero, A., Mediano, O., Pumarega, I. C., Barbé, F., Lopez-Picado, A., & Torre, M. S. D. L. (2026) · Sleep Medicine · doi:10.1016/j.sleep.2026.109115
- Authors
- Fietze, I., Blum, H.-C., Grüger, H., Käßner, F., Maurer, J. T., Nilius, G., Penzel, T., Triché, D., & Arzt, M.
- Affiliations
- Charité – Universitätsmedizin Berlin (DE)
- Medizinische Universität Lausitz - Carl Thiem (DE)
- University Medical Centre Mannheim (DE)
- Kliniken Essen-Mitte (DE)
- Nuremberg Hospital (DE)
- University Hospital Regensburg (DE)
- Corresponding author
- Fietze, Ingo
- Venue
- Somnologie
- Published
- 2021-04-20
- Volume
- 25
- Issue
- 2
- Pages
- 99-109
- ISSN
- 1432-9123 (ISSN-L)
- 1439-054X
- OpenAlex
- W3153657724
- Cited by
- 7
- References
- 42
- Citations by year
- 2026: 1 · 2023: 2 · 2022: 4
- FWCI
- 0.94
- Type
- journal article
- Language
- de
- Open access
- hybrid
- doi.org
- Locations
- Somnologie - Schlafforschung und Schlafmedizin (publishedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- residual daytime sleepiness, obstructive sleep apnea, positive airway pressure, PAP adherence, residual apnea-hypopnea index, Epworth Sleepiness Scale, multiple sleep latency test, modafinil, armodafinil, pitolisant, solriamfetol, treatment pathways, quality of life
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