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Aim. To study the effectiveness of a fixed combination of perindopril and amlodipine, with the subsequent addition of indapamide-retard in male patients with arterial hypertension (AH), obesity and severe sleep apnea (OSAS). Materials and methods. The study included 43 male patients in whom antihypertensive therapy titration was performed to achieve target blood pressure values with a fixed combination of calcium antagonist amlodipine (10 mg) and an angiotensin-converting inhibitor perindopril (5-10 mg) and indapamide-retard. At baseline and after 4-6 weeks, the effectiveness of antihypertensive therapy was monitored according to clinical measurements and ambulatory blood pressure monitoring (ABPM). An assessment of the carotid-femoral pulse wave velocity (cfPWV), aortic PWV (aoPWV), and ankle-brachial PWV (abPWV) was performed. Results and discussion. Target blood pressure values (according to clinical blood pressure, 24-hour blood pressure monitoring) during therapy with amlodipine 10 mg and perindopril 10 mg reached 65% of patients and another 30% reached target blood pressure when adding indapamide-retard 1.5 mg, that is - 95% of all patients included in the study. Upon reaching the target blood pressure values, a significant decrease in cfPWV, aoPWV and abPWV was observed. Conclusion. The fixed combination of perindopril arginine and amplodipine, with the addition of indapamide retard in male patients with hypertension 1st degree in the presence of obesity and severe OSAS allows to reach effective control of blood pressure and improve the elastic properties of large arteries, which can lead to a favorable organoprotective effect in this category of patients.

Aim. To study the relationship between the severity of erectile dysfunction and the anthropometric parameters of obesity in patients with arterial hypertension. Materials and methods. The study included 71 patients with different severity of erectile dysfunction, overweight and grade 1obesity and arterial hypertension. The anthropometric parameters were analyzed, the degree and characteristics of obesity were assessed according to data of multispiral computed tomography (MSCT), a preliminary assessment of erectile function was performed using the IIEF-5 questionnaire. Later the data of the questionnaire was compared with the in-depth urological study: the collection of anamnesis, examination and conduction of the pharmacodopplerography of the penis vessels. Results and discussion. Comparative analysis revealed statistically significant links between anthropometric data and the degree of abdominal obesity based on MSCT results (p

The aim of the study was to evaluate blood pressure (BP) level and vessel wall stiffness parameters role in antihypertensive therapy (AHT) escape phenomena development on the background of primarily effective AHT use. Materials and methods. Data from 102 patients with arterial hypertension level 1-3, stage I-II were analyzed. All patients underwent individual AHT adjustment for 2-3 weeks (adjustment period). At the end of the adjustment period the therapy effectiveness was evaluated with clinical BP measurement (target BP values less than 140/90 mm hg) and 24-hour BP monitoring (target daily BP values less than 130/80 mm hg). The study included only those patients who reached target clinical and daily BP values on the background of 2-3 antihypertensive drugs use at the end of the adjustment period. At the beginning of the observation period after effective AHT was used carotid-femoral pulse wave velocity was evaluated with applanation tonometry. For the purpose of timely escape phenomena diagnosis clinical BP measurement and 24-hour BP monitoring were performed in 1, 3, and 6 months after the trial start in all patients. Results. After 6 months of observation patients were divided in 2 groups: group 1 included 34 patients with AHT escape phenomena, group 2 - 68 patients with stable, controlled AH. In group 1 on the background of effective AHT use at the beginning of observation higher levels of following measures were observed: clinical systolic BP - SBP (125.2±11.3 mm hg vs 119.7±11.7 mm hg, p=0.021), daily SBP (128.0±3.3 mm hg vs 121.2±7.4 mm hg, p=0.000), daily average SBP (131.6±4.9 mm hg vs 125.3±8.5 mm hg, р=0.000), night average SBP (120.4±8.5 mm hg vs 111.8±8.6 mm hg, р=0.000), daily pulse BP 50.2±4.8 mm hg vs 44.2±7.6 mm hg, p=0.000), daily mean brachial artery stiffness index - ASI (161.9±28.3 mm hg vs 142.2±24.5 mm p=0.000), carotid-femoral pulse wave velocity (11.6±2.5 m/s vs 10.5±2.3 m/s, p=0.029). In single-factor logistic regression models all these measures were shown to have predictive value in AHT escape phenomena development. According to multifactor logistic regression analysis that included carotid-femoral pulse wave velocity more than 10.8 m/s, daily mean ASI>137, daily SBP>124 mm hg, and daily pulse BP>46 mm hg, the only independent predictor on the background of effective AHT at the beginning of the observation was daily SBP>124 mm hg (odds ratio 19.1, 95% confidence interval 3.6-101.8; p=0.0004). Conclusion. BP level and artery stiffness index measured on the background of effective AHT at the beginning of the observation are predictors for escape phenomena development and can be used for effectiveness and required frequency of therapy management prognosis.

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. To evaluate the influence of cardiovascular risk factors on antihypertensive therapy (AHT) efficiency escape (EE). Subjects and methods. Data on 59 patients with grades 1—3 hypertension (Stages I—II) were analyzed. During chosen AHT, 24-hour blood pressure monitoring was done at baseline, 1 and 3 months after beginning the observation to identify/rule out the AHT EE phenomenon. Results. The AHT EE group (Group 1) as compared with the group that needed no therapy correction within 3 months (Group 2) was observed to have the following: elevated fasting blood glucose levels (FBGL) (5.8±0.8 vs 5.3±0.7 mmol/l; p=0.008) and higher impaired glucose tolerance (IGT) rates (8 (27.6%) vs 4 (13.3%) cases (p=0.03)); a more number of smoking patients (8 (27.6%) vs 3 (10%) cases; p=0.02); a larger number of patients with a compromised family history of cardiovascular diseases (17 (58.6%) vs 11 (36%); p=0.02). Furthermore, in Group 1 baseline average systolic blood pressure during 24 hours (SBP-24) proved to be higher than that in Group 2 (127.4±4.2 vs 122.4±6.8 mm Hg; p=0.002). Odds ratio (OR) for developing the EE phenomenon increased by 60% with a rise of 0.5 mmol in FBGL (OR, 1.60; 95% confidence interval (CI), 1.06 to 2.4; p=0.02) and by 18% with an increase of 1 mm Hg in baseline SBP-24 (OR, 1.18; 95% CI, 1.05 to 1.33; p=0.004). Multivariate analysis indicated that the independent predictors of AHT EE were a compromised family history (OR, 3.7; 95% CI, 1.1 to 12.1; p=0.03) and IGT (OR, 4.1; 95% CI, 1.02 to 16.4; p=0.04). Conclusion. AHT EE was influenced by FBGL, IGT, smoking, a compromised family history, and baseline SBP-24 level.

Objective. To evaluate the effect of antihypertensive therapy (AHT) and CPAP therapy on inflammatory and endothelial dysfunction markers levels in patients with severe obstructive sleep apnea (OSA) syndrome in association with arterial hypertension (AH). Materials and methods. The study included 43 male patients with severe OSA syndrome (Apnea-Hypopnea Index 52.4 [46.1; 58.6]) and AH (systolic blood pressure 144.0 [142.0; 156.0] mm Hg, diastolic blood pressure 90.9 [88.3; 93.5] mm Hg). Treatment with angiotensin-converting enzyme inhibitors, calcium antagonists, and thiazide-like diuretics was performed till target BP level measured with Korotkoff method was achieved. The patients who had reached target BP level (BP≤140/90 mm Hg) were randomized into two groups: group 1 included 23 patients who continued taking the AHT, group 2 included 22 patients who continued taking the AHT to which CPAP therapy was added. Peripheral blood lymphocyte immunophenotyping, cytokine panel test (IL-1β, IL-6, tumor necrosis factor a, IL-2Ra, sCD40L), adhesion molecule analysis (ICAM-1, VCAM-1), thromboxane B2, 6-keto-prostaglandin F1 alpha (6-keto-PGF1a), and endothelin-1 levels in blood serum were evaluated at admission, after target BP level achievement (2nd visit) and after 3 months of AHT or AHT+CPAP therapy (3rd visit). Flow-mediated dilation of brachial artery was assessed using reactive hyperemia test by D.Celermajer. Results. Against the background of combined AHT the target BP level was achieved by 95% of patients. After target BP level achievement a significant decrease of IL-1β -0.16 [-0.5; 0], p=0.000 level and number of CD50+ cells (lymphocytes with inter-cellular adhesion molecule ICAM-3) from 2158.5 [1884.7; 2432.3] to 1949.6 [1740.9; 2158.3], p=0.050 were observed in patients with severe OSA associated with AH. There were no significant changes in vascular endothelial function observed in patients taking only AHT. Significant decrease of fibrinogen (-0.3 [-0.4; -0.1], p=0.002) and homocystein (-2.03 [-3.8; -0.2], p=0.03) levels was observed in patients taking both AHT and CPAP therapy. Conclusion. The combination of AHT and CPAP therapy in patients with severe OSA and AH not only allows reaching the target BP level but also leads to inflammatory and endothelial dysfunction markers levels decrease.

Goal: to study the effectiveness of combination antihypertensive therapy (AHT) and its influence on the indices characterizing the arterial stiffness of various types in patients with arterial hypertension (AH) in combination with obesity and severe obstructive sleep apnea (OSA). Material and methods. The study included 27 male patients with hypertension [143.0 (142.0; 150.0)/91.0 (85.3; 94.8) mm Hg. century], obesity [body mass index of 33.8 (32.0; 37.2) kg/m2] and OSA was severe [the index of apnea/hypopnea - AHI - 46.8 (33.3; 63.4) events per hour] who underwent AHT titration to achieve target values of blood pressure (BP), a fixed combination of the calcium antagonist amlodipine (10 mg) and the angiotensin-converting enzyme inhibitor perindopril (5-10 mg). At baseline and after 4-6 weeks when reaching target blood pressure was assessed pulse wave velocity (PWV) using different instrumental techniques. Carotid-femoral PWV (CFSP) was determined by applanation tonometry (SphygmoСor AtCor, Australia), aortic PWV - ultrasonic technique in the descending aorta (thoracic spine), the ankle-brachial PWV - using volumetric sphygmography (VaseraVS-1000 Fukuda Dens, Japan). Results. The target pressure (according to clinical blood pressure, daily monitoring blood pressure) on the background of amlodipine 10 mg and perindopril 5 mg was 58% patients and 42% of patients reached the target level of blood pressure against the background amlodipine 10 mg and perindopril 10 mg. On a background of 4-6 weeks of admission AHT 33.8% increase in the number of patients with a normal circadian profile of blood pressure - «dipper». Upon reaching the target blood pressure revealed a significant decrease CFSP, ankle-brachial PWV and aortic PWV 11.4, 11.0 and 15.4%, respectively. Conclusion. A fixed combination of perindopril arginine and amlodipine in patients with arterial hypertension of the 1st degree in the presence of obesity and OSA allows achieving a good level of BP control, to improve the performance of the daily profile and to improve the elastic properties of large arteries, which has a beneficial protective effect in these patients.

The aim of our study is to determine association between obstructive sleep apnea (OSA) syndrome and levels of blood coagulation markers and evaluate possible effects of continuous positive airway pressure (CPAP) therapy. Materials and methods. We included 74 middle-aged (mean age 48 [40; 55] years) male patients with arterial hypertension (AH) of average duration 8 [5; 10] years without antiplatelet, anticoagulant therapy and diabetes mellitus. All patients underwent sleep breathing study. According to the severity of OSA, patients were divided into 2 groups: 40 patients with severe OSA - apnea/hypopnea index - AHI 50.2 (37.8; 75.2) and control group with 34 patients with mild or no OSA - AHI 4.8 (2.6; 7.8). In all patients were analyzed markers of hemostasis system and parameters of whole blood viscosity; 34 patients with severe OSA underwent 3-4 nights of effective CPAP therapy (with achievement AHI

The case history of a 46-year-old patient with obstructive sleep apnea syndrome was analyzed. The examination revealed fourth-degree obesity, prior myocardial infarction, persistent atrial fibrillation with nocturnal asystoles lasting as long as 14.3 sec. During selected drug therapy and regular application of secondary ventilation (continuous positive airway pressure (CPAP) therapy) used to correct breathing problems, there was a reduction in the signs of circulatory deficiency, cessation of cardiac pauses, and recovery of sinus rhythm. The therapeutic effect persisted during a 24-month follow-up.

The paper describes a clinical case of a female patient with severe obstructive sleep apnea syndrome in the presence of congenital hemangioma of the face, soft palate, and tongue concurrent with paroxysmal atrial fibrillation and atrial flutter, paroxysmal supraventricular tachycardia, and sinoatrial block (maximally up to 3.9 sec). Continuous positive airway pressure therapy could reduce the number of paroxysms of atrial fibrillation and atrial flutter, supraventricular tachycardia and eliminate sinoatrial block.

Currently, adequate reduction of blood pressure (BP) during the night in patients with arterial hypertension remains important problem. To study chronotherapy’s opportunities to achieve better BP control by a single dose of antihypertensive drugs while maintaining high compliance. Aim. To evaluate the efficacy, tolerability, safety of various prescription regimes of fixed combination: perindopril 10 mg and indapamide 2.5 mg in patients with insufficient degree of BP reduction at night. Design and methods. The study included 30 patients (20 men and 10 women, 56±9.3 years, body mass index 30.5±5.3 kg/m2, the duration of arterial hypertension - 7.1±5.8 years), on ineffective dual antihypertensive therapy (BP>140/90 mm Hg). Initially, ambulatory BP monitoring (ABPM) and blood tests were performed. Then, previous therapy was terminated and fixed combination of perindopril 10 mg/indapamide 2.5 mg (Noliprel A Bi-forte) was administered. Patients were randomized into two groups: morning and evening regimens of therapy. After 8 weeks of treatment ABPM and blood tests were repeated. Statistical analysis was done after further separation of patients into groups with sufficient (dippers) and insufficient (non-dippers) degree of BP reduction at night. Results. In the group of "non-dippers" average ambulatory systolic BP (SBP) during wakefulness declined from 149.4±11.7 mm Hg to 129.8±10.6 mmHg (p

Как показывают фармакоэпидемиологические исследования, роль комбинированной терапии в лечении АГ становится все более важной и все больше врачей отдают предпочтение фиксированным комбинациям АГП для лечения АГ. Это связано с тем, что фиксированные комбинации не только позволяют повысить эффективность антигипертензивной терапии, но и улучшают приверженность.Учитывая, что проблема контроля АД у пациентов с АГ по-прежнему остается актуальной, новые фиксированные комбинации АГП могут представлять интерес для врачей.

Objective: The most common strategy to improve blood pressure (BP) control is improving compliance with once daily administration of antihypertensive therapy. Aim: To assess the efficacy, tolerability, safety of different regimes of prescription of combination of perindopril 10 mg and indapamide 2.5 mg.Design and methods. We included 31 patients (56±9.3 years, BMI 30.5±5.3 kg/m2, duration of arterial hypertension - 7.1±5.8 years), on two-component therapy (except combination of perindopril and indapamide) with BP>140/90 mmHg. At baseline ambulatory blood pressure monitoring (ABPM), blood tests were performed in 20 men and 10 women, then, patients were randomized into two groups: morning and evening regimes. Previous therapy was canceled and prescribed a combination of perindopril 10 mg and indapamide 2.5 mg. After 8 weeks of treatment, ABPM and blood tests were re-conducted. Results. Baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the whole group - 148.4±10.0/95.6±10.7 mm Hg. After 1 and 2 months of treatment Noliprel-A bi-forte SBP/DBP decreased to 131.4±8.4/86.6±5.7 mm Hg and to 133.4±11.2/84.5±8.8 mm Hg respectively. ( p

The study had two phases: the first phase of exploring the possibility of a computer pulse oximetry as a screening method for the diagnosis of respiratory disorders during sleep in patients with cardiac profile in steady-state conditions, the second - a screening study of prevalence of obstructive sleep apnea in the same category of patients. In a comparative study of two methods: cardiorespiratory monitoring (4 channels, held monitoring device «Kardiotekhnika-07», «Incart», Russian, and computer pulse oximetry device PulseOx 7500, SPO medical, Israel) included 70 patients (70% men and 30% of women), mean age 55,5±11,2 years. The sensitivity of the computed pulse oximetry in detecting disorders of breathing during sleep (number of episodes of more than 5 per hour, reducing the saturation of more than 3%) was 94,4%; specificity - 79,2%; positive predictive value - 91,1%; negative - 86,4%; accuracy - 87,7%. In a screening study included every fifth patient entering the Russian Cardiology Research and Production Complex MH of the Russian Federation. Patients of the departments of cardiovascular surgery, emergency cardiology department of chronic heart failure, patients with respiratory diseases COPD, asthma were excluded. Statistical analysis included 206 patients. Median age was 68,4±13,7 years, BMI - 32,9±5,5 kg/m2, 43,6% of men and 56,3% of women. From 5 to 15 events per hour was observed in 31,1% of patients, from 15 to 30 events/h - 31,1% and more than 30 events per hour - 23,9%. Thus, respiratory disorders of varying severity were in 77,4% randomly sampled in the study patients.

The combination of the obstructive sleep apnea (OSA) syndrome and arterial hypertension (AH) is a common problem affecting both the medical and social aspects of a patient's life. CPAP-therapy is the main treatment of sleep-discorded breathing. This paper focuses on up-to-date data on the relationship between OSA and AH and reviews studies evaluating the effect of CPAP-therapy on blood pressure, the risk of cardiovascular complications and the quality of life of patients.

The aim of this guideline is to assist physicians in the management of patients with cardiovascular pathology and obstructive sleep-disordered breathing. The article consists data on diagnostic tactics for patients with possible sleep-breathing disorders, describes the basic principles of obstructive sleep apnea treatment, and substantiates the clinical significance of obstructive sleep apnea therapy initiating in the management of patients with cardiovascular diseases.

Aim. To assess efficacy of two- and three-component antihypertensive treatment (AHT) in patients with severe sleep apnea and arterial hypertension (AH) of the second and third degree in combination with CPAP therapy (continuous positive air pressure) and without it. Material and methods. A total of 58 patients aged 55.5±9.6 years participated in the study. Clinical blood pressure (BP) before treatment was 172.0 (170.7-175.9)/100.0 (98.5-104.2) mm Hg, apnea/ hypopnea index was 26.3 episodes an hour. The patients received amlodipin in combination with walsartan in a dose 5-10/160 mg with addition of 25 mg hydrochlorothiaside if target BP was not achieved. This treatment was followed for 3 weeks by CPAP-therapy. Monitoring was made of clinical BP, central BP, target mean 24-h pressure. Results. Despite a significant reduction of systolic arterial pressure/diastolic arterial pressure (by 30/ 14 mm Hg) as a result of antihypertensive treatment, this reduction was lower than in such patients without obstructive sleep apnea (by data from other investigators). CPAP-therapy reduced the number of resistant patients from 58 to 31%, patients with masked AH - from 19 to 11%, cases of arrhythmia - from 69 to 47%. Conclusion. Multicomponent pathophysiologically sound AHT in hypertensive patients with severe obstructive sleep apnea was effective in less than 42% cases. The maximal effect was achieved in combined treatment with CPAP-therapy.

В последние годы исследователи уделяют все большее внимание синдрому обструктивного апноэ во время сна (СОАС), в частности его взаимосвязи с сердечно-сосудистыми заболеваниями, особенно с артериальной гипертензией (АГ) различного генеза. Стало очевидным, что СОАС является распространенной формой патологии и с ним связаны актуальные медицинские и социальные проблемы Взаимосвязь нарушений дыхания во время сна и заболеваний сердечно-сосудистой системы достаточно сложна, но углубление ее понимания имеет неоценимое значение для лечения огромного числа больных, у которых сочетаются эти патологические состояния. Хотя исследования последних лет значительно расширили наши познания в этой области, многие аспекты проблемы требуют дальнейшего изучения.

Сочетание таких патологических состояний, как ХОБЛ и АГ, требует более дифференцированного подхода в выборе антигипертензивной терапии. Такая терапия не должна приводить к усилению бронхообструкции и влиять на эффективность лекарственных препаратов, применяющихся для лечения ХОБЛ.К настоящему времени имеется достаточно большой опыт использования высокоселективных b-адреноблокаторов при заболеваниях легких у больных АГ и ИБС, который свидетельствует об их безопасности в плане влияния на дыхательную функцию у данной категории пациентов. Одним из наиболее часто используемых селективных b-адреноблокаторов является метопролол. Несомненно, наиболее интересная и перспективная его форма – метопролола сукцинат в форме медленного высвобождения (Беталок ЗОК).Очевидно, лучшая переносимость Беталока ЗОК, отсутствие резких колебаний его концентрации в крови и вследствие этого поддержание постоянного уровня селективной b1-блокады позволяет считать его одним из b1-блокаторов, которые возможно использовать у больных ХОБЛ.Учитывая опыт предыдущих исследований и незначительное количество работ, посвященных применению b-адреноблокаторов у больных АГ и ХОБЛ в нашей стране, мы провели исследование и проанализировали эффективность и переносимость Беталока ЗОК и комбинированного препарата “Логимакс” у данной категории больных.

Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guide-lines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Russian Society of Cardiology, National Society of Preventive Cardiology

Aim. To evaluate the prevalence of possible obstructive respiratory disorder during sleep in outpatients by the data from computed monitoring pulse oxymetry (CPO) and questionnaires.Material and methods. To the open one stage non-randomized comparative study, 175 patients included: 37,1% males, 62,9% females, age 55,1±11,1 y.o., visiting a clinician office at outpatient facility. Sleep disordered breathing of obstructive origin was diagnosed with a survey, modified Stradling questionnaire and CPO; and excessive daytime sleepiness — with Epworth score. For confirmation of obstructive sleep apnea (OSA), a bifunctional monitoring was performed (BM) with further comparison of the data with CPO results.Results. Chronic hypoxemia at night by CPO was found in 71,4% patients, and probability of OSA moderate and severe — in 42,8% patients. By the modified Stradling, OSA was predicted in 57,7%, by Epworth, the daytime sleepiness was found in 11,4%. Mild OSA in BM was found in 8,9%, moderate — 14,7%, severe — 20,6%. The data from CPO matched with BM in 80% patients. Sensitivity of CPO for nocturnal hypoxemia of various severity was 92,4%, specificity — 76,4%; sensitivity of the Stradling questionnaire — 88,9%, specificity — 88,2%. Sensitivity of Epworth score — 27,8%, specificity — 82,4%.Conclusion. Chronic nocturnal hypoxemia was found in 71,4%, and probability of moderate and severe OSA — in 42,8% in outpatients with internal diseases profile. CPO and Stradling questionnaire can be applied as diagnostic instruments for OSA at outpatient stage.

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.

Objective: to evaluate the upper airway (UA) soft tissue structures in patients with obesity, comparable body mass index (BMI), and obstructive sleep apnea syndrome (OSAS) varying in severity, by using magnetic resonance imaging (MRI).Material and methods. The results of UA soft tissue MRI were analyzed in 20 patients without obesity and OSAS (a control group), in 42 patients with obesity and severe OSAS (a study group), and in 32 patients with obesity and mild OSAS (a comparison group). MRI scans were used to calculate the volumes of the soft palate (SPV), tongue (TV), lateral pharyngeal walls (LPWV) at the level of the retropharyngeal and retroglossal regions (RPR and RGR), soft tissue amounts (STA) at the level of the RPO and RGR, lingual fat inclusions, as well as lingual fat concentrations, and the area of maximum upper airway stenosis (MUAS) at the level of the RPR and RGR.Results. It was found that in the patients with OSAS, obesity, and comparable BMI, SPV and LPWV at the level of the RPR and RGR, STA at the level of RPR and RGR, and lingual fat inclusions and concentrations were higher in the severe OSAS group than those in the mild OSAS group (p < 0.001). The area of MUAS at the level of RPR and RGR was smaller than that in the mild OSAS group (p < 0.001).Conclusion. In patients with obesity and OSAS, BMI is not always a clear predictor of the degree of severity due to the uneven accumulation of adipose tissue in the soft tissues surrounding the the upper airway.

Russian Experts’ Consensus on Metabolic Syndrome Problem in the Russian Federation: Defenition, Diagnosis Criteria, Primary Prevention and Treatment.

Aim. To study the specifics of soft tissues surrounding upper airways (STSUA) structure using magnetic resonance tomography (MRI) in patients with obesity and obstructive sleep apnea syndrome (OSAS). Material and methods. Totally 40 men studied with the mean age 44,7±9,6 y. Of those 20 had obesity of I-II grade — with body mass index (BMI) 35,1±3,4 кг/м2 and severe OSAS (apnea-hypopnea index — AHI — was 53,4±15,7). Controls consisted of 20 persons without obesity — BMI 23,8±1,3 kg/m2 . Assessment of upper airways was performed on Philips Achieva 3.0T tomograph. We measured the volumes of soft palate (VSP), tongue (VT), lateral pharyngeal walls (VLPW) and the squares of maximum upper airways narrowing (SMUAN) at retropharyngeal (RP) and retroglossal (RG) levels. Results. In obese patients with OSAS we found higher values of TV — 70,5±12,4 vs 45,0±5,7 cm3 , VSP — 7,5±1,7 vs 3,5±0,7 cm3 , VLPW at the level of RP — 11,7±4,1 vs 3,2±0,8 cm3 , VLPW at the level of RG — 10,4±2,8vs 3,1±8,4 cm3 and lower values of SMUAN at the level of RP — 6,3±3,5 vs 14,0±3,8 cm2 , as RG — 19,3±7,5 vs 27,0±5,0 mm2 . All differences were statistically significant (p

A substantial body of evidence has been obtained on an independent association between sleep obstructive apnoea syndrome (SOAS) and cardiovascular disease (CVD). It is particularly relevant for arterial hypertension (AH), coronary heart disease (CHD), stroke (S), heart failure, atrial fibrillation, and sudden cardiac death. Therefore, the present review focuses on an important issue of interrelations between SOAS and CVD, including AH, CHD, S, diabetes mellitus and mortality.

Aim. To examine continuous positive airway pressure (CPAP) therapy effects on carbohydrate and lipid metabolism in patients with metabolic syndrome (MS) and obstructive sleep apnea syndrome (OSAS). Material and methods. The study involved 62 MS patients: 20 females and 42 males, aged 39-66 years (mean age 52.4±7.6 years). Control group included 15 patients without OSAS, another 47 had OSAS of varying severity (main group). CPAP therapy was administered to 11 OSAS patients for 12 weeks. At baseline and 12 weeks later, height, body weight (BW), waist and hips circumference (WC, HC) were measured, with body mass index calculation (BMI); levels of total cholesterol (TCH), high-density lipoprotein (HDL) CH, triglycerides (TG), glucose, leptin, resistin, adiponectin were assessed; glucose tolerance test and 24-hour blood pressure (BP) monitoring were performed. Results. BW, BMI, WC, WC/HC, TCH decrease wasn’t statistically significant. HDL CH level increased from 0.99±0.2 to 1.12±0.1 mmol/l (р