Ночное апноэ у пациентов с артериальной гипертензией и метаболическим синдромом. Влияние сипап-терапии

In recent years in cardiology actively studied the problem of breathing during sleep in connection with the fact that accumulate more and more data on the value of breathing during sleep in the development of cardiovascular disease, including fatal complications. In particular, great attention is paid to obstructive sleep apnea (OSA), as the condition is most clearly associated with cardiovascular disease. The prevalence of OSAS varies greatly in different study populations, and epidemiological data for Russia are practically absent. As the mechanism responsible for the increase in blood pressure in patients with OSA is usually considered activation of the sympathetic nervous system due to episodes of sleep apnoea. This pathophysiological process is also an important factor in the development of arterial hypertension in obesity. The results of researches, studying the mechanisms of interaction between obesity and OSA, very mosaic. Since OSA sleep much upset and is accompanied by episodes of hypoxia, there is nothing surprising that the secretion of hormones, usually having a circadian daily fluctuations, is also changed. These problems and devoted presented in this article the literature review.

1. Бузунов Р.В., Ерошина В.А. Зависимость тяжести синдрома обструктивного апноэ во время сна от увеличения массы тела после возникновения у пациентов симптома храпа // Терапевтический архив. 2004. № 3. С. 59–62.

2. Вейн А.М., Елигулашвили Е.С., Полуэктов М.Г. Синдром апноэ во сне и другие расстройства дыхания, связанные со сном: клиника, диагностика, лечение. М.: Эйдос Медиа, 2002. С. 310.

3. Ерошина В.А., Бузунов Р.В. Дифференциальная диагностика обструктивного и центрального апноэ сна при полисомнографическом исследовании // Терапевтический архив. 1999. № 4. С. 18–21.

4. Курлыкина Н.В., Певзнер А.В., Литвин А.Ю., Галицин П.В., Чазова И.Е., Соколов С.Ф., Голицын С.П. Возможности лечения больных с длительными ночными асистолиями и синдром обструктивного апноэ сна созданием постоянного положительного давления воздуха в верхних дыхательных путях // Кардиология. 2009. № 6. Т. 49. С. 36–42.

5. Лышова О.В., Иванникова С.В., Смольянинов С.В. Скрининговые методы в диагностике синдрома апноэ во сне // ВГМА им. Н.Н. Бурденко. Воронеж. 2009 с.

6. Чазова И.Е. Синдром обструктивного апноэ во время сна и связанные с ним сердечно-сосудистые осложнения // Российский кардиологический журнал. 2006. № 1. С. 75–86.

7. Andreas S., Hajak G., v. Breska B. et al. Changes in heart rate during obstructive sleep apnoea // Eur. Respir. J. 1992. Vol. 5. P. 853–857.

8. Becker H., Brandenburg U., Peter J.H., von Wichert P. Reversal of sinus arrest and atrioventricular conduction block in patients with sleep apnea during nasal continuous positive airway pressure // Am. J. Respir. Crit. Care Med. 1995. Vol. 151. P. 215–218.

9. Chen H.S. Obstructive sleep apnea presenting with nocturnal angina, heart failure and near-miss sudden death // Chest. 1991. Vol. 99. P. 1023–1025.

10. Davies R.J.O., Crosby J., Prothero A., Stradling J.R. Ambulatory blood pressure and left ventricular hypertrophy in untreated obstructive sleep apnoea and snoring, compared to matched controls, and their response to treatment // Clin. Sci. 1994. Vol. 86. P. 417–424.

11. Davies R.J.O., Crosby J., Vardi-Visy K. et al. Non-invasive beat to beat arterial blood pressure during non-REM sleep in obstructive sleep apnoea and snoring // Thorax. 1994. Vol. 49. P. 335–339.

12. Dursunoglu D. Cardiovascular diseases in obstructive sleep apnea // Tuberkuloz ve Toraks Dergisi. 2006. Vol. 54, № 4. P. 382–296.

13. Ehlenz K., Herzog P., von Wichwrt P. et al. Renal excretion of endotelin in obstructive sleep apnea syndrome. In: Sleep and cardiorespiratory control / Eds. C. Gautier, P. Escourou, P. Curzi-Dascalova. Montrouge: John Libby Eurotext, 1991. 217: 403.

14. Flemons W.W., Remmers J.E., Gillis A.M. Sleep apnea and cardiac arrhythmias: is there a relationship? // Am. Rev. Respir. Dis. 1993. Vol. 148. P. 618–621.

15. Grunstein R.R., Yang T.S., Wilcox I. Sleep apnea and pattern of obesity // Am. Rev. Respir. Dis. 1991. Vol. 143. A380.

16. Guilleminault C., Shiomi T., Stoohs R., Schnittger I. Echocardiographic studies in adults and children presenting with obstructive sleep apnea or heavy snoring. In: Sleep and cardiorespiratory control / Eds. C. Gaultier, P. Escourrou, L. Curzi-Dascalova. Montrouge: John Libbey Eurotext, 1991. P. 95–103.

17. He J., Kryger M.H., Zorick F.J. et al. Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients // Chest. 1988. Vol. 94. P. 9–14.

18. Hedner J., Ejnell H., Wallin G. et al. Consequences of increased sympathetic activity in sleep apnea. A pathogenetic mechanism for cardiovascular complications? In: Sleep ‘90 / Ed. J. Horne, Bochum: Pontenagel Press, 1995. P. 435–439.

19. Hoffstein V., Mateika J. Evening to morning blood pressure variations in snoring patients with and without obstructive sleep apnea // Chest. 1992. Vol. 101. P. 379–384.

20. Hung J., Whitford E.G., Parsons R.W., Hillman D.R. Association of sleep apnea and myocardial infarction in men // Lancet. 1990. Vol. 336. P. 261–264.

21. Jennum P., Wildschiotz G., Christensen N.J., Schwartz T. Blood pressure, cathecholamines and pancreatic polypeptide in obstructive sleep apnea with and without nasal continuous positive airway pressure (nCPAP) treatment // Am. J. Hypertens. 1992. Vol. 2. P. 847–852.

22. Keenan S.P., Burt H., Ryan C.F., Fleetham J.A. Chronic nasal CPAP therapy reduces systemic hypertension in patients with obstructive sleep apnea // Am. Rev. Respir. Dis. 1991. Vol. 143. A608.

23. Klingelhofer J., Hajak G., Sander D. et al. Assessment of intracranial hemodynamics in obstructive sleep apnea syndrome // Stroke. 1992. Vol. 23. P. 1427–1433.

24. Koehler U., Fett I., Hay J. et al. Bradicarde Herzrhythmusstorungen im Schlaf-Morbiditatsspektrum bei Patienten mit Schlaf-Apnoe und nachtlichen bradicarden Herzrhythmusstorungen. In: Schlaf-Atmung-Kreislauf / Eds. J.H. Pener, W. Cassel, T. Penzel. Berlin: Springer 1993. P. 374–383.

25. Krieger J., Benzoni D., Sforza E., Sassard J. Urinary excretion of prostanoids during sleep in obstructive sleep apnea patients // Clin. Exp. Pharmacol. Physiol. 1991. Vol. 18. P. 511–515.

26. Kurtz D., Krieger J., Kowalski J. et al. Nycterohemoral variations in plasma groth hormone (GH) levels and sleep apnea syndromes: their relationship with obesity // Rev. EEG Neurophysiol. 2007. Vol. 10. P. 366–375.

27. Laks L., Krieger J., Podszus T. Pulmonary hypertension in obstructive sleep apnea — retrospective multicenter study // Am. Rev. Respir. Dis. 1992. Vol. 145. A865.

28. Langanke P., Podszus T., Penzel T. et al. Venous return during upper airway obstruction in obstructive sleep apnea // Sleep Res. 1991. Vol. 20. P. 275.

29. Lavie P., Berger I., Yoffe N. et al. Long-term morbidity and mortality of SAS patients // J. Sleep Res. 1992. Vol. 1 (Suppl. 1). P. 131.

30. Mayer J., Brandenburg U., Ploth T. et al. Blood pressure and sleep apnea. Results after long-term therapy with nCPAP. European Sleep Research Society (Strassburg). 1991. P. 410.

31. McNamara S.G., Grunstein R.R., Sullivan C.E. Obstructive sleep apnea // Thorax. 1993. Vol. 48. P. 754–764.

32. Naughton M., Pierce R. Effects of nasal continuous positive airway pressure on blood pressure and body mass index in obstructive sleep apnoea // Aust. NZ J. Med. 1991. Vol. 21. P. 917–919.

33. Palomaki H., Partinen M., Erkinjuntti T., Kaste M. Snoring, sleep apnea syndrome, and stroke // Neurology. 1992. Vol. 42 (Suppl. 6). P. 75–81.

34. Pekmezovic Z., Konjevic M. Holter monitoring in sleep apnea // Вестник аритммологии. 2009. Приложение А. С. 129.

35. Punjabi N.M. The epidemiology of adult obstructive sleep apnea // Proc. Am. Thoracic Society. 2008. Vol. 5, № 2. P. 136–143.

36. Rudenstein D.O., D’Odemont J.P., Pieters T., Aubert-Tulkens G. Diurnal and nocturnal diuresis and natriuresis in obstructive sleep apnea // Am. Rev. Respir. Dis. 1992. Vol. 145. P. 1367–1371.

37. Sajkov D., Cowie R.J., Thornton A.T. et al. Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome // Am. J. Respir. Crit. Care Med. 1994. Vol. 149. P. 416–422.

38. Warley A.R.H., Morice A., Stradling J.R. Plasma levels of atrial natriuretic peptide (ANP) in obstructive sleep apnoea (OSA) // Thorax. 1997. Vol. 18. P. 195.

39. Wilcox I., Grunstein R.R., Hedner J.A. et al. Effect of continuous positive airway pressure during sleep on 24 hours blood pressure in obstructive sleep apnea syndrome // Sleep. 1993. Vol. 16. P. 539–544.

40. Young T., Zaccaro D., Leder R. et al. Prevalence and correlates of sleep disordered breathing in the Wisconsin sleep cohort study // Am. Rev. Respir. Dis. 1991. Vol. 143. A380.