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Aim. To assess the role of obstructive sleep apnea and other cardiovascular (CV) risk factors in the development of the antihypertensive therapy (AHT) efficacy escape phenomenon in patients with arterial hypertension (AH). Materials and methods. The data of 75 patients with AH stage III, grades 13 were proceeded. All patients included in the study underwent night respiratory monitoring. After AHT prescription, blood pressure (BP) was monitored by three measurement methods (office, daily monitoring and self-control of blood pressure) initially, in 1, 3 and 6 months after the inclusion in order to confirm the initial therapy efficacy and to identify or exclude the escape phenomenon. Results. In 36.0% of patients, the escape phenomenon was diagnosed in 1 or 3 months of observation. When comparing the group with the escape phenomenon, an initially higher level of systolic BP was revealed according to office measurements, 24-hour monitoring and self-control BP monitoring (134.04.7 mmHg vs 126.08.5 mmHg; 129.02.3 mmHg vs 121.07.7 mmHg; 131.08.2 mmHg vs 121.56.2 mmHg resp.; р0,05). There were no differences in sleep apnea and CV risk factors between the groups. However in patients with a minimal SpO285% during sleep, there were a higher levels of office systolic BP both before the AHT prescription, and during its use (157.610.4 mmHg vs 152.48.1 mmHg resp., р0,05; 132.06.8 vs 127.18.9 mmHg resp.; р0,05), and mean 24-hour systolic BP (125.75.9 vs 121.68.2 mmHg resp.; р0,05) compared with patients with a minimum SpO285%. Conclusion. The higher BP level in patients with lover nocturnal hypoxemia does not allow us to exclude the delayed negative impact of obstructive sleep apnea, especially severe, on the BP profile in case of initially successful AH control.

To study the effectiveness of prolonged use of PAP therapy (positive airway pressure therapy) in eliminating sleep respiratory disorders and associated cardiac conduction disturbances.We included 21 patients who were examined at the Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology, regarding cardiac rhythm and conduction disturbances, as well as obstructive sleep apnea and who have been on PAP therapy for more than 12 months. The average age was 66.5 [63.5; 73.2] years, body mass index 33.0 [30.2; 38.5] kg/m2, apnea-hypopnea index 65.0 [59.0; 86.3]/h. At the time of analysis, 15 patients continued to use PAP therapy (mean time of use: 6.0 years [4.7; 9.2]) and 6 patients refused long-term use of PAP therapy, mean time to use PAP therapy until failure amounted to 2.82.1 years.PAP therapy lead to a persistent decrease in apnea-hypopnea index of 63.6/h to 3.7/h was (p=0.0002). 86% of patients met the criteria for adherence to PAP therapy (use 4 hours/night, more than 70% of nights). Initially, before the use of PAP therapy, all cardiac conduction disorders were during sleep and exceeded 3 seconds, with fluctuations from 3.1 to 10.6 seconds. PAP therapy appeared to be effective in all patients: no asystoles, duration of more than 3 seconds, were detected.In obstructive sleep apnea patients with concomitant nighttime cardiac conduction disturbances, the long-term use of PAP therapy is effective and with good adherence.Цель.Оценить эффективность ПАП-терапии (терапия путем создания положительного давления в дыхательных путях) в устранении нарушений дыхания во время сна и ассоциированных нарушений проводимости сердца при длительном использовании. Материалы и методы.В исследование включен 21 пациент, проходивший обследование в ИКК им. А.Л. Мясникова ФГБУ НМИЦ кардиологии по поводу нарушений ритма и проводимости сердца, а также нарушений дыхания во время сна и находившийся на ПАП-терапии более 12 мес. Средний возраст составил 66,5 [63,5; 73,2] года, индекс массы тела 33,0 [30,2; 38,5] кг/м2, индекс апноэ-гипопноэ сна 65,0 [59,0; 86,3] соб/ч. На момент анализа 15 пациентов продолжали использование ПАП-терапии (среднее время использования составило 6,0 года [4,7; 9,2]), и 6 человек отказались от ее длительного применения, среднее время использования ПАП-терапии до момента отказа составило 2,82,1 года. Результаты.На фоне ПАП-терапии выявлено стойкое снижение индекса апноэ-гипопноэ сна с 63,6 до 3,7 соб/ч (р=0,0002). Критериям приверженности ПАП-терапии (использование более 4 ч за ночь, более 70% ночей) соответствовали 86% пациентов. Исходно до назначения ПАП-терапии все нарушения проводимости сердца выражались в развитии остановок сердца во время сна и превышали 3 с при колебаниях от 3,1 и до 10,6 с. На фоне ПАП-терапии асистолии длительностью свыше 3 с не зафиксировано. Заключение.При лечении пациентов с синдромом обструктивного апноэ сна в сочетании с ночными нарушениями проводимости сердца эффект ПАП-терапии сохраняется в условиях многолетнего применения и при хорошей приверженности данному виду лечения.