[Long-term theophylline therapy in sleep apnea--follow-up over a period of 12 months]. / Theophyllinlangzeittherapie bei Schlafapnoe--Verlaufsbeobachtung über einen Zeitraum von 12 Monaten.

Among all the sleep-related respiratory disorders, sleep apnoea is clinically the most important one because of its high incidence and potential cardiovascular sequelae. Treatment depends upon the risk profile of the individual patient; in severe cases or in risk patients nasal continuous superpressure ventilation is employed, whereas in milder cases theophylline has been successfully used alongside general measures. 103 patients were followed up during treatment on an outpatient basis for 2 to maximum 12 months. Initially a significant reduction of the apnoea index by a 50% average was achieved. This therapeutical effect remained largely constant with a slight average deterioration at the end of the observation period, whereas the subjective feeling tone also improved in most patients. The treatment course was prematurely discontinued in 34 patients. Good to very good success was achieved in a total of 43 patients, whereas 26 patients were non-responders either initially or as the treatment proceeded. Even though theophylline treatment is now well-tried in mild forms of sleep apnoea, predictors for its use in certain groups of patients must be determined before treatment is initiated.

[Therapy control of theophylline evening dosage in patients with sleep-related respiratory disorders--follow-up study]. / Therapiekontrolle unter Theophyllin in abendlicher Dosierung bei Patienten mit schlafbezogenen Atmungsstörungen (SBAS)--Verlaufsbeobachtung.

We conducted a prospective study to perform classification according to responder types and follow-up during theophyllin treatment (500 mg/d) in a group of (up to now) 65 patients suffering from sleep apnoea. Changes in the apnoea index (AI) and clinical symptoms were taken as response criteria. A significant AI reduction was seen during a follow-up period of 3 months. At the last control measurement after 6 months no significant change has been detected so far. 10 patients were classified as Type I responders (improvement in initial AI 60%, over the total period at least 25%). No patient had a responder type II profile. 13 patients were nonresponders (improvement in initial AI and over the whole period not more than 25%, no improvement in the pattern of clinical symptoms). 13 patients dropped out of the trial due to non-compliance. Side effects typical of theophyllin leading to discontinuation of the treatment course occurred in 5 patients. 22 patients have not yet completed the course at the time of writing. Standardised questioning of patients showed a definite improvement in feeling tone, especially with regard to the tendency to fall asleep during the day and refreshed feeling in the morning. Nocturnal complaints occurred in only a few isolated cases. Hence, administration of theophyllin retard preparations in evening doses of 500 mg/d remains a meaningful therapeutic approach to sleep apnoea.

[Sleep-related respiratory disorders and coronary heart disease]. / Schlafbezogene Atmungsstörungen (SBAS) und koronare Herzerkrankung (KHK).

A review of the literature shows that more than 50% of examined patients suffering from coronary heart disease were also suffering from sleep-related apnea. We were able to diagnose a pathological sleep apnea in 9 out of 25 patients (36%) suffering from an angiographically confirmed coronary 2-vessel and 3-vessel disorder. Patients with this combination--this is the hypothesis derived from our study--are at risk due to nocturnal apnea-induced myocardial ischaemia and rhythmic disorders. In 15 patients with sleep apnea and coronary heart disease or small vessel disease, nocturnal polysomnography was conducted, in parallel a 6-channel ECG was recorded. The apnea index (second night) was on the average 33 phases/h, the maximal duration of an apnea phases being 120 seconds. The minimal blood gas saturation recorded during sleep was between 46 and 89% (median 76.0%). In 4 of the 15 patients it was possible to confirm myocardial ischaemia (correlated via REM and also via NREM) with a maximum duration of 60 seconds, mainly during the phases of maximal apnea activity and blood gas desaturation. On comparing the ventricular arrhythmias waking/sleep, the Lown class did not change in 12 patients; there was deterioration in 2 patients and in one patient a qualitative improvement during the sleep phase. Patients suffering from sleep-related respiratory disorders and coronary heart disease are at cardiac risk, the more so since long-lasting apneas can lead to conditions of hypoxia at the heart in pre-existing changes in the coronary arteries, restricted coronary reserves and reduced tolerance to hypoxia. Such hypoxia can in turn induce enhanced electrical instability and a disturbance of the contractile function.