Arousals: Aktueller Stand, Klinische Bedeutung und offene Fragen.

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 continously 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 hypersonmias the effects of arousals are discussed. Additionally to arousals further... [ABSTRACT FROM AUTHOR]