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Сърдечната недостатъчност често е съпътствана от заболявания, свързани с нарушение на съня. Терапията с непрекъснато положително налягане в дихателните пътища (Continuous Positive Airway Pressure – CPAP) е утвърдена за лечение на обструктивна сънна апнея, но ползите при коморбидни пациенти и при лица със сърдечна недостатъчност още се изследват. От друга страна, централната сънна апнея също е с висока честота при тези болни, но е по-трудна за терапия. Целта на настоящата публикация е да се направи кратък обзор на острата и обострената хронична сърдечна недостатъчност при пациенти с нарушения на съня – честота, тежест и начини на повлияване. Heart failure is often accompanied by sleep disorders. Continuous Positive Airway Pressure (CPAP) therapy has proven in the treatment of obstructive sleep apnea, but the benefits associated with comorbid patients and patients with heart failure is still under research. On the other hand, central sleep apnea is also with high frequency in these patients and more difficult to treat. The aim of the current publication is to make a brief review of acute and exacerbated chronic heart failure in patients with sleep disorders – frequency, severity, and types to treat.

Obstructive sleep apnea (OSA) is a common disorder in children but can occasionally present with life-threatening hypoxemia. Obesity is a significant risk factor for poor outcomes of OSA treatment. Continuous positive airway pressure (CPAP) is indicated in children who are not candidates for or have an unsatisfactory response to adenotonsillectomy. Children acutely at risk for significant morbidity with other therapies are candidates for a tracheostomy. An eight-year-old patient with morbid obesity and severe OSA refractory to CPAP therapy was treated successfully with a novel noninvasive ventilation (NIV) mode with volume-assured pressure support (VAPS) and avoided tracheostomy.

Background. The goal of our study was to define the hemodynamic phenotypes in hypertensive patients with newly diagnosed obstructive sleep apnoea (OSA) using the individual modelling of hemodynamics derived from ambulatory blood pressure monitoring (ABPM), a method proposed by our group previously, and to assess its validity in blood pressure alterations secondary to continuous positive airway pressure (CPAP). Material and methods. Thirty-three hypertensive patients with moderate-to-severe OSA were investigated. All patients underwent ABPM on two occasions: at baseline and after one week CPAP. The sets of BP indexes at first ABPM were used for individual modelling to define the hemodynamic phenotype (class) based on regression analyses; specifically, the phenotypes were defined for daytime, nighttime and for 24 hours. The CPAP therapy efficacy was predefined as improvement in BP nighttime decrease for additional 5% as compared to baseline ABPM. With reference to this criterion, patients were further classified as responders (who achieved this target), and non-responders. Results. Only 21.2% of hypertensive patients with OSA had optimal hemodynamic phenotype (class H2), despite comprehensive antihypertensive therapy; most of the other patients were classified either as harmonic type (class H3; 39.4%), or of diastolic dysfunctional type (class D3; 15.2%). In the daytime period 18.2% of patients with OSA were classified as D1-class, which is associated with high risk of acute hypotensive episodes. Responders were more frequently characterized by phenotype H3 (daytime) vs. nonresponders: 53.3% and 5.6% respectively; P < 0.05. At nighttime non-responders were more likely to transform the different baseline classes into H3 and D2; P < 0.05 vs. responders. Conclusion. Our study suggest utility of newly developed modelling based on hemodynamic BP indexes in the prediction of BP alterations secondary to CPAP in OSA hypertensive patients.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is associated with increased cardiovascular risk. The effect of OSA treatment with continuous positive airway pressure (CPAP) on the cardiovascular response to a stressor is unknown. We sought to determine the effect of CPAP therapy on heart rate variability (HRV) and arterial stiffness, at baseline, in response to, and recovery from a physiological stressor, Angiotensin II (AngII), in humans with OSA. METHODS: Twenty-five incident healthy subjects (32% female; 49 ± 2 years) with moderate-severe OSA and nocturnal hypoxia were studied in high-salt balance, a state of maximal renin-angiotensin system (RAS) suppression, before CPAP, and after 4 weeks of effective CPAP therapy (usage > 4 h/night) in a second identical study day. HRV was calculated by spectral power and time domain analysis. Aortic augmentation index (AIx) and carotid-femoral pulse-wave velocity (PWV(cf)) were measured by applanation tonometry. HRV and arterial stiffness were measured at baseline and in response to AngII challenge (3 ng/ kg/min·30 minutes, 6 ng/kg/min·30 minutes, recovery·30 minutes). The primary outcome was the association between CPAP treatment and HRV and arterial stiffness responses to, and recovery from, AngII challenge. In an exploratory analysis subjects were stratified by sex. RESULTS: CPAP corrected OSA and nocturnal hypoxemia. CPAP treatment was associated with increased sensitivity and delayed recovery from AngII (Δln HF [high frequency; recovery: −0.09 ± 0.19 versus −0.59 ± 0.17 ms(2), P = .042; ΔrMSSD [root mean successive differences; recovery: −0.4 ± 2.0 versus −7.2 ± 1.9 ms, P = .001], ΔpNN50 [percentage of normal waves differing ≥ 50 ms compared to the preceding wave; AngII: 1.3 ± 2.3 versus −3.0 ± 2.4%, P = .043; recovery: −0.4 ± 1.4 versus −6.0 ± 1.9%, P = .001], all values pre-CPAP versus post-CPAP treatment). No differences were observed by sex. There was increased AIx sensitivity to AngII after CPAP among men (8.2 ± 1.7 versus 11.9 ± 2.2%, P = .046), but not women (11.4 ± 1.5 versus 11.6 ± 2.1%, P = .4). No change in PWV(cf) sensitivity was observed in either sex. CONCLUSIONS: CPAP therapy was associated with delayed cardiovagal reactivation after a stressor and down-regulation of the arterial RAS. These findings may have important implications in mitigating cardiovascular risk in both men and women with OSA. CITATION: Nicholl DD, Hanly PJ, Zalucky AA, Mann MC, MacRae JM, Poulin MJ, Handley GB, Sola DY, Ahmed SB. CPAP therapy delays cardiovagal reactivation and decreases arterial renin-angiotensin system activity in humans with obstructive sleep apnea. J Clin Sleep Med. 2018;14(9):1509–1520.

BACKGROUND AND OBJECTIVE A major challenge with the treatment of obstructive sleep apnoea (OSA) is adherence to continuous positive airway pressure (CPAP) therapy. Mask tolerability is an important determinant of adherence, however evidence to guide selection of mask interfaces is lacking. METHODS We conducted a randomized crossover trial of mask interfaces in CPAP therapy for moderate-to-severe OSA to assess adherence and efficacy of CPAP therapy with nasal mask, nasal pillow and oronasal masks. Demographic data, Nasal Obstruction Symptom Evaluation (NOSE) scores and craniofacial measurements were also analysed for associations with adherence with oronasal masks. RESULTS Eighty-five patients were included in the study (mean ± SD age: 46 ± 12 years; body mass index: 29.9 ± 5.6 kg/m2 ; apnoea-hypopnoea index (AHI): 53.6 ± 24.0 events/h). Patients had better adherence with nasal masks (average night use: 3.96 ± 2.26 h/night) compared to oronasal masks (3.26 ± 2.18 h/night, P

Представлено клиническое наблюдение пациентки с артериальной гипертензией и синдромом обструктивного апноэ сна, получающей лечение в амбулаторно-поликлинических условиях.

Introduction The diurnal hypersomnia associated with obstructive sleep apnea (OSA) affects soldier employment and deployability. In this study, we examined the impact of OSA on the employment of soldiers on continuous positive airways pressure (CPAP) therapy by measuring several items: work absenteeism using the Work Productivity and Activity Impairment (WPAI) questionnaire, diurnal hypersomnia, and career advancement. Methods A questionnaire was sent by regular mail to 940 soldiers with OSA on CPAP therapy who are insured by the French Military Healthcare Fund (Caisse Nationale Militaire de Securite Sociale). Results Questionnaires were returned by 439 soldiers: mean age 47 years; mean body mass index 29.8 kg/m2. Absenteeism reached 0.45%, and work productivity impairment 8.7%. Hypersomnia was reported by 15.4% and was severe for 9.7%. The average daily working time was 6.5 hours. Quality of life was improved for 91.1%. The military practitioner had diagnosed OSA in 19.6% of these soldiers and had prescribed treatment in 14.9%. Discussion Residual OSA in these soldiers on CPAP therapy had little impact on work productivity impairment that was less than observed in populations with chronic diseases. In our study population, hypersomnia was less common than observed in the general population. An impact on career advancement could not be clearly demonstrated. Close medical follow-up is warranted in certain populations due to the persistence of severe somnolence in a significant number of patients.

Patients suffering from obstructive sleep apnea are mainly treated with continuous positive airway pressure (CPAP). Good compliance with this therapy is broadly accepted as more than 4h of CPAP average use nightly. Although it is a highly effective treatment, compliance with this therapy is problematic to achieve with serious consequences for the patients' health. Previous works already reported factors significantly related to compliance with the therapy. However, further research is still required to support clinicians to early anticipate patients' therapy compliance. This work intends to take a further step in this direction by building compliance classifiers with CPAP therapy at three different moments of the patient follow-up (i.e. before the therapy starts and at months 1 and 3 after the baseline). Results of the clinical trial confirmed that month 3 was the time-point with the most accurate classifier reaching an f1-score of 87% and 84% in cross-validation and test. At month 1, performances were almost as high as in month 3 with 82% and 84% of f1-score. At baseline, where no information about patients' CPAP use was given yet, the best classifier achieved 73% and 76% of f1-score in cross-validation and test set respectively. Subsequent analyses carried out with the best classifiers of each time point revealed that certain baseline factors (i.e. headaches, psychological symptoms, arterial hypertension and EuroQol visual analogue scale) were closely related to the prediction of compliance independently of the time-point. In addition, among the variables taken only during the follow-up of the patients, Epworth and the average nighttime hours were the most important to predict compliance with CPAP., 22 pages, 11 figures

Study objectives We prospectively investigated the effects of continuous positive airway pressure (CPAP) on long-term cognitive and psychomotor performances, and excessive daytime sleepiness in severe obstructive sleep apnea (OSA) patients. Methods A total of 40 patients were recruited and 23 patients with severe OSA fully completed the study protocol to investigate the effects of CPAP therapy on psychomotor performance at 1, 3, and 6 months and 1 year following initiation of the therapy. Psychomotor CRD-series tests measuring reaction times of light stimulus perception, solving simple arithmetic operations, and complex psychomotor limb coordination, were used in this study. The data collected following CPAP therapy were compared to baseline values prior to the CPAP treatment for each patient. Results All of the measured variables improved following CPAP treatment. However, the most pronounced effect was observed in improvement of reaction times to complex psychomotor limb coordination test (p < 0.05). Self-reported evaluation of excessive daytime sleepiness measured by Epworth Sleepiness Scale (ESS) showed significant decrease from 10.0 ± 1.1 before to 3.5 ± 0.5 (p < 0.001), after 1 year on CPAP therapy. Conclusions The CPAP therapy improved cognitive and psychomotor performance on CRD-series tests with the most significant improvement observed in complex psychomotor limb coordination of severe OSA patients.

Backgrounds Mask-related side effects can negatively influence adherence to continuous positive airway pressure (CPAP). Nasal pillows (P) can be an alternative to the standard nasal masks (N), although there are no data about their long-term efficacy. This study aimed to assess long-term effectiveness and adherence to CPAP therapy delivered with nasal pillows in obstructive sleep apnea syndrome (OSAS) patients. Methods A retrospective observational design involving a series of consecutive CPAP-naive patients affected by OSAS. After an initial mask fitting session all patients were allowed to choose the type of nasal interface (N or P) they preferred. Outcomes were assessed 5 days after CPAP titration, and after 2 and 12 months. Patients were offered the option of switching to an alternative mask if needed. Results Data from 144 patients were analyzed. Subjects were predominantly male (76%), middle aged (58.14 ± 12.86), moderately obese (body mass index: 33.89 ± 7.56), and affected by severe OSAS (apnea-hypopnea index: 47.60 ± 21.31). A total of 102 patients (70.8%) chose P, and 42 (29.2%) chose N. Clinical and polygraphic features, and CPAP pressure levels were similar in P and N groups, both at baseline and at 12 months. A good adherence to treatment was observed in both groups (P, 5.5 ± 1.8 h; N, 5.3 ± 1.5 h). Seventy-six patients (53%) reported at least one side effect during the whole study period, without statistically significant between-group differences. Nostril pain was the most frequent side effect in P. Conclusions Nasal pillows showed equal long-term effectiveness and objective adherence as standard nasal masks.

Continuous positive airway pressure (CPAP) remains the gold standard treatment for obstructive sleep apnoea hypopnoea syndrome (OSAHS). However, the high efficacy of CPAP is offset by intolerance and poor compliance, which can undermine effectiveness. This means that alternatives to CPAP are also necessary. In recent years, oral appliances have emerged as the leading alternative to CPAP. There is now a strong body of evidence supporting their use in OSAHS and clinical guidelines now recommend their use in mild OSAHS and in more severe cases when CPAP fails. These devices are by no means a homogenous group as they differ greatly in both design and action. The most commonly used appliances are mandibular advancement devices (MAD) that increase airway diameter with soft tissue displacement achieved by mandibular protrusion. Despite the growing evidence, there are still barriers to MAD provision. Their effectiveness can be difficult to predict and there is debate about the required level of design sophistication. These uncertainties prevent more widespread inclusion of MAD within clinical sleep services. This review will focus on the efficacy, effectiveness, design features, side-effects of and patient selection for MAD therapy. Comparison will also be made between MAD and CPAP therapy.

Obstructive sleep apnea can have consequences such as cardiovascular disease and motor vehicle accidents. Continuous positive airway pressure (CPAP) is the gold standard treatment, but nonadherence limits efficacy. This project used a telemedicine strategy that included remote adherence monitoring and telephone communication from a nurse practitioner in the first week of CPAP therapy to promote adherence. Of patients who received the telemedicine, 71% were adherent at follow-up. Incorporating telemedicine into clinical practice may promote adherence to CPAP therapy.

The objective: to analyze the features of diagnosis and treatment of respiratory disturbances during sleep in patients with acute stroke (AS) with concomitant diabetes mellitus (DM). Materials and methods. The study involved 300 patients (180 men and 120 women) aged 46 to 82 years who were diagnosed with acute ischemic stroke with comorbid diabetes on admission. Results. When comparing the results of the use of various tracheotomy techniques in the Intensive Care Unit of the Kyiv Regional Clinical Hospital, it was established that percutaneous puncture-dilatational tracheotomy has several advantages over traditional tracheotomy. In particular, the peculiarities of the technique of performing the dilatational tracheotomy allow it to be performed in much shorter periods than the traditional one. Thus, the time for performing the manipulation in the main group of patients was 10.8 ± 3.6 min, whereas in the control group 1 49.7 ± 12.3 min (p 15, atechnique of early non-invasive ventilation correction using constant positive airway pressure (CPAP) should be used.

В результате проведенного исследования установлено, что вероятность возникновения синдрома обструктивного апноэ сна (СОАС) у больных острым инсультом (ОИ) является высокой (63,3%). Факторами риска являются мужской пол, сахарный диабет (СД), ожирение, высокий балл по NIHSS (Г15). С целью диагностики СОАС и определения дальнейшей тактики респираторной поддержки у этих больных при поступлении нужно проводить скрининг-диагностику. Особенностями развития СОАС у пациентов с ОИ и сопутствующим СД является быстрое улучшение показателей в 1-3 дни лечения и потребность в длительной терапии на последующих этапах. Тактика респираторной поддержки у этих больных должна быть следующей. При выявлении больных с «мягким» СОАС (ИАГ 5 -15) проводится «позиционная» терапия с целью максимального уменьшения времени пребывания больного в положении на спине. У больных с ИАГГ15 следует применять методику ранней неинвазивной вентиляционной коррекции с использованием постоянного положительного давления в дыхательных путях (СРАР). В случае выявления у больного СОАС тяжелой степени (ИАГ> 20) и отсутствии эффекта от СРАР-терапии в течение 2-3 суток, больным показан перевод на ИВЛ с ранней трахеостомией (метод выбора – чрескожная дилятационная трахеостомия).

Introduction A previous high-density EEG investigation in OSA showed regional sleep EEG deficits particularly slow wave activity (SWA) in the parietal region. It is unclear whether CPAP treatment can reverse local sleep EEG abnormalities, and whether any recovery is related to improved cognitive function. Methods Fifteen males with moderate-severe OSA (age 50.4±6.5yrs, AHI 51.7±23.5/h) underwent polysomnography with 256-channel high-density EEG at baseline and following 3 months of CPAP. Tasks assessing cognitive performance and sleep-dependent memory were administered. Topographical spectral power maps were calculated for standard frequency ranges for sleep stages. Differences in normalized power between baseline and treatment were determined by statistical nonparametric mapping. Results In 11 CPAP compliant patients (data loss: intolerant of CPAP[n=3]/high-density EEG [n=1]), total sleep time did not change after CPAP but N1 (baseline vs. treatment: 66.9 vs. 39.5 mins, p=0.008) and N2 (195.0 vs. 150.6 mins, p=0.002) sleep was lower and N3 (89.8 vs. 128.7 mins, p=0.003) was higher. Topographic high-density EEG analysis revealed a regional increase in SWA (1–4.5Hz) during N3 sleep in a cluster of 22 electrodes overlying the parietal cortex (paired t-test, t(10)=-3.9, p=0.0029). The change in N3 SWA in the parietal cluster after CPAP was correlated with improved overnight procedural memory on the motor sequence task (rho=0.79, p=0.03) and better executive functioning (Stroop accuracy, rho=0.73, p=0.01). Conclusion CPAP treatment reduces localised deficits in sleep EEG, and specific regional recovery relates to short-term improvements in memory and executive function. These data also highlight the potential for long-term therapeutic effects on cognitive outcomes.

To study the frequency and possible causes of severe corneal opacities in premature infants undergoing retinopathy of prematurity (ROP) screening in the neonatal intensive care unit (NICU) at a single institution.The medical records of all infants screened for ROP in the NICU between January 2015 and March 2019 were reviewed retrospectively. Criteria for screening were gestational age (GA) of32 weeks or birth weight (BW)1501 g. Characteristics of premature infants with severe corneal opacities were extracted from the record.A total of 445 premature infants were screened during the 51-month period. The prevalence of severe corneal opacities was 1.4% (6 infants). The median GA of the affected infants was 24.5 weeks (range, 23-32), and the mean BW was 624 g (range, 500-860 g). Two infants had lagophthalmos; their corneal opacity was unilateral. All the infants were under continuous positive airway pressure (CPAP) for a prolonged period. All 4 infants with bilateral corneal opacities required treatment for severe ROP-laser (n =1), bevacizumab injection (n = 1), or both (n = 2).Severe corneal opacities in premature infants are rare but potentially sight threatening, because they can hinder the retinal examination. Lagophthalmos-related exposure keratopathy is an obvious risk factor. CPAP therapy may be another risk factor leading to the development of severe corneal opacities. Identification of infants at risk and prompt commencement of lubricants is necessary to avoid long-term corneal opacities.

Objective. To determine the dynamics of the clinical and psychological characteristics on the background of 1 month of CPAP therapy in patients with obstructive sleep apnea syndrome (OSA) and arterial hypertension (AH), both adherent and non-adherent to the treatment. Methods. The study included 180 patients with OSA and AH. Upon enrollment, anthropometric data, the results of polysomnography and cardiorespiratory studies, Beck depression scale, Spielberger personal and situational anxiety scale, Epworth daytime sleepiness scale, Pittsburgh sleep quality questionnaire and Quality of Life (WHO QOL-100) questionnaire were analysed. Out of 40 patients undergoing CPAP therapy, 30 patients were adherent to the treatment within a month. The adherence criterion was considered to be the usage of the CPAP device more than 4 hours per night, more than 5 days a week. In this article, the dynamics of the questionnaire scales is given only for those who were adherent to CPAP therapy. Results. Patients with OSA and AH adherent to CPAP therapy showed a statistically significant reduction in daytime sleepiness and depression, as well as improved quality of sleep and quality of life in the physical domain within 1 month of using CPAP therapy. Conclusion. Even short-term use of CPAP therapy in patients with OSA and AH leads to a reduction in daytime sleepiness and depression, improved quality of sleep and quality of life in the physical domain.

Aim. Evaluation of CPAP treatment (continuous positive upper airway pressure) in obstructive sleep apnea patients (OSA) and atrial fibrillation (AF) in comparison with antiarrhythmic medication therapy. Material and methods. Totally, 36 patients included (58% males, mean age 61±11 y.) with AF and definite OSA by the data from cardiorespiratory monitoring. In 6 (17%) patients there was moderate level of respiratory disorders and in 30 (83%) — severe. Twenty four (67%) patients had paroxysmal and 12 (33%) — persistent AF. All patients, to retain sinus rhythm and prevent AF relapses, were taking antiarrhythmic medications (AAM). Therapy by CPAP was recommended to all patients, but after familiarization nights (1-3), 18 agreed to continue this type of treatment at home (group 1), other 18 (group 2) were unable to apply CPAP due to low tolerance. During 12 month follow-up, comparative analysis was done, of AAM efficacy in both groups of patients. Groups did not differ significantly by the medications being taken. Results. With CPAP therapy, in group 1 most patients (12, 67%) during 12 months did not develop AF relapses, and in the group 2 — only 6 (33%) did not have AF. It is worthy to mention than group 1 patients had potentially less chance for antiarrhythmic therapy success, if to consider traditional risk factors of AF, as they had higher body mass (body mass index 39,5 kg/m2 versus 34, p=0,07), more severe sleep respiration disorders (apnea-hypopnea index 50,8 events per hour versus 37,4, p=0,09) and larger left atrium (82 mL versus 60,5, p=0,02) comparing to group 2 patients. During 3-month CPAP treatment, in group 1 patients a significant decrease of P-wave dispersion was noted, by 30,8% (р=0,05). Conclusion . Therapy with CPAP in moderate and severe OSA makes it to more than two times (from 33% to 67%) increase efficacy of antiarrhythmic drug treatment for AF. One of the mechanisms of antiarrhythmic action of CPAP againts AF might be a decrease of atrial conduction time dispersion.

Prospective studies show an association between obstructive sleep apnea and cardiovascular disease. Continuous positive airway pressure (CPAP) is the treatment of choice and effectively reduces subjective sleepiness and apneic and hypopneic events. However, randomized trials have not shown a reduction in cardiovascular outcomes with CPAP therapy. We review the past 10 years of randomized trial evidence regarding the therapeutic efficacy of CPAP on cardiovascular outcomes and mortality in adults with obstructive sleep apnea. The majority of studies found no significant improvement in cardiovascular outcomes with CPAP, although many noted nonsignificant benefits. Adjusted analysis in several trials showed significant cardiovascular benefit in those patients with higher CPAP compliance. Existing trials may lack sufficient follow-up and CPAP compliance, among other limitations.

Among the Type 2 Diabetes Mellitus (Type 2 DB) patients obstructive sleep apnoea (OSA) syndrome, which adversely affects the state of carbohydrate exchange and the quality of sleep, is widespread. The standard for the treatment of OSA is CPAP therapy. In this retrospective cohort study, the influence of CPAP-therapy on the level of glycosylated haemoglobin (HbA1c) was assessed in the 34 second-type SR patients receiving sugar-reducing therapy. As a result of 3 months of treatment, there has been a decrease of HbA1c by 0.7%, the disappearance of day sleepiness, and the overwhelming majority of normalization of the quality of sleep. Thus, with the combination of the Type 2 DM and the OSA of medium or heavy degree, CPAP therapy has an independent beneficial effect on the state of carbohydrate exchange.

Purpose of Review This paper aims to critically evaluate recent literature on the epidemiology, pathophysiology, and management of overlap syndrome (OS).

To determine the proportion and physiological characteristics of nonobese patients with obstructive sleep apnea (OSA) and their response to prescribed therapy.Data from 163 consecutive in-laboratory diagnostic sleep studies for participants referred to an academic teaching-hospital sleep clinic for suspected OSA were assessed. Sleep and anthropometric parameters at baseline and follow-up (up to 22 mo) were examined and compared between obese and nonobese patients with a diagnosis of OSA (apnea-hypopnea index5 events/h sleep). A key nonanatomical contributor to OSA pathogenesis, the respiratory arousal threshold, was compared between groups.Twenty-five percent of the participants with a diagnosis of OSA had a body mass index (BMI) within the normal range (BMI25 kg/mA substantial proportion of patients with OSA are not obese. These patients are challenging to treat with existing therapies as they are less adherent and compliant with CPAP therapy. Nonanatomical contributors to OSA, such a low threshold for arousal, are likely to be particularly important in OSA pathogenesis in nonobese patients with OSA. These findings have important implications for the pathogenesis of OSA in nonobese patients and potential therapeutic targets for this group of patients.

Asthma and obstructive sleep apnea syndrome (OSAS) are one of the most common chronic respiratory diseases. These have common risk factors that include obesity, gastroesophageal reflux disease (GERD) and impaired nasal breathing (allergic rhinitis, sinusitis). At the same time, experimental evidence demonstrates common pathophysiological mechanisms of these diseases, such as involvement in the process of the respiratory tract, a systemic inflammatory response, and implementation of neuromechanical reflexes. Thus, there is an obvious synergism between these conditions, which affects symptoms, response to therapy, and prognosis. The available data allow discussion on whether there is a need to identify and treat OSAS in asthmatic patients. By keeping in mind the high incidence of OSAS in patients with severe asthma, it may be suggested that treatment for OSAS can reduce the number of exacerbations, improve the quality of life, and decline the number of obstinate asthma cases. It is very important for general practitioners to assess risk factors, such as body weight, nasal stuffiness, and GERD, and to utilize screening tools for more efficient use of healthcare resources. Considering the known positive effects of CPAP therapy in short-term studies, future investigations should focus on the impact of CPAP therapy on asthma symptoms in the long-term, as well as on the effects of asthma drugs on the course of OSAS.Бронхиальная астма (БА) и синдром обструктивного апноэ во сне (СОАС) - одни из самых распространенных хронических заболеваний дыхательной системы. Они имеют общие факторы риска, к которым относятся ожирение, гастроэзофагеальная рефлюксная болезнь (ГЭРБ) и нарушение носового дыхания (аллергические риниты, синуситы). При этом экспериментальные данные показывают общие патофизиологические звенья этих заболеваний: вовлечение в процесс дыхательных путей, системный воспалительный ответ, а также реализация нейромеханических рефлексов. Таким образом, очевиден синергизм этих заболеваний, который влияет на симптомы у пациентов, ответ на терапию и прогноз. Имеющиеся данные позволяют обсуждать необходимость выявления и лечения СОАС у пациентов с БА. Учитывая высокую распространенность СОАС у пациентов с тяжелой БА, можно предположить, что лечение СОАС может снизить количество обострений, улучшить качество жизни и уменьшить число случаев трудно контролируемой БА. Для врачей практического здравоохранения очень важно оценивать факторы риска, такие как масса тела, заложенность носа, наличие ГЭРБ, а также применять инструменты скрининга для более эффективного использования ресурсов здравоохранения. Учитывая известные положительные эффекты от CPAP-терапии в непродолжительных исследованиях, будущие работы должны быть направлены на изучение воздействия CPAP-терапии на симптомы БА в долгосрочной перспективе, а также активнее исследовать влияние препаратов для лечения БА на течение СОАС.

Objective. To analyze the state of the cardiovascular system in middle-aged patients with severe obstructive sleep apnea syndrome (OSAS), before and 6 months after the use of CPAP therapy. design and methods. The study involved 35 hypertensive patients with verified severe OSAS. All patients underwent comprehensive cardiovascular assessment (blood pressure (BP) and electrocardiogram monitoring, echocardiography), CPAP therapy has been recommended as the primary treatment of obstructive sleep-disordered breathing. After 6 months, all patients underwent a complete re-examination. Patients were divided into 2 groups: the experimental group consisted of 17 people (16 men and 1 woman, mean age 49,6 ± 10,1 years) treated with CPAP therapy throughout the study period, the control group included 18 patients, who refused CPAP-therapy. Results. After 6 months of CPAP therapy, patients with severe OSAS demonstrated favourable changes in the cardiovascular system: reduction of office and average daily BP, reduced BP variability, normalization of BP circadian profile and velocity of morning BP rise. BP reduction in CPAP-users was associated with the decrease of myocardial afterload. As a result, we have witnessed a reverse myocardial remodeling, manifested by a decrease in size of both left and right heart, which also contributed to the increase in exercise tolerance and improvement of quality of life. In CPAP use was associated with the tendency to the decrease in cardiac arrhythmias. conclusions. Six-month CPAP therapy in highly compliant patients leads to the BP reduction and normalization of BP daily profile, reduction in the number of antihypertensive drugs, as well as — to a reverse myocardial remodeling.