arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2018-24-4-396-405arthyper-771Research ArticleСТРАНИЦА СОМНОЛОГАSOMNOLOGIST’S PAGEИспользование внутриротовых устройств при лечении обструктивного апноэ во сне и их влияние на сердечно-сосудистую системуcardiovascular effects of oral appliances in obstructive sleep apneaАгальцовМ. В.AgaltsovM. V.

кандидат медицинских наук, старший научный сотрудник отдела фундаментальных и прикладных аспектов ожирения ФГБУ «НМИЦ ПМ» Минздрава РоссииПетроверигский пер., д. 10, стр. 3, Москва, Россия, 101990

MD, PhD, Senior Researcher, Department of Fundamental and Applied Aspects of Obesity

10–3 Petroverigskiy bystreet, Moscow, 101990, Russia

agaltsov@rambler.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр профилактической медицины» Министерства здравоохранения Российской ФедерацииРоссияNational Medical Research Center for Preventive MedicineRussian Federation201826092018244396405Copyright © Агальцов М.В., 20182018Агальцов М.В.Agaltsov M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/771

Внутриротовые устройства (ВУ) являются одним из ведущих методов эффективного лечения нарушений дыхания во сне. Как известно, обструктивное апноэ во сне (ОАС) в настоящее время очень широко распространено в общей популяции и тесно ассоциировано со многими сердечно-сосудистыми заболеваниями (артериальной гипертензией, нарушениями ритма сердца, хронической сердечной недостаточностью, ишемической болезнью сердца). Своевременное выявление и лечение ОАС является важной задачей в процессе снижения числа кардиальных осложнений. Современные приборы для лечения ОАС представляют собой сделанные на заказ устройства, в которых есть возможность индивидуально изменять степень выдвижения нижней челюсти для более эффективного лечения храпа и апноэ. Изменяя степень выдвижения нижней челюсти, ВУ способствуют поддержанию просвета верхних дыхательных путей (ВДП) и косвенно стимулируют мышцы, определяющие их тонус. Эффективность устройств оценивается по полному устранению всех дыхательных событий (храп, синдром повышения резистентности ВДП, ОАС и гипопноэ), а также влиянию на структуру сна, процесс бодрствования (устранение/уменьшение выраженности избыточной дневной сонливости). Большой интерес представляет воздействие ВУ на сердечно-сосудистые заболевания (данный тип устройств показал снижение как систолического, так и диастолического артериального давления в процессе лечения, а также положительное воздействие на нарушенную эндотелиальную функцию). В ряду всех методов лечения ОАС ВУ занимают ведущие позиции, лишь немного уступая по эффективности методу неинвазивной вентиляции легких во сне — СРАР-терапии. С точки зрения долгосрочной приверженности к терапии ОАС (что особенно важно при профилактике сердечно-сосудистых осложнений), внутриротовые устройства превосходят СРАР-терапию. Таким образом, терапия ОАС при помощи ВУ является одним из ведущих лечебных направлений в современной медицине сна.

Oral  appliances  (ОА)  are  one  of  the  leading  methods  of  effective  treatment  of  sleep-related  breathing disorders. Obstructive sleep apnea (OSA) is a widespread disturbance in the general population. It is closely associated with many cardiovascular diseases (hypertension, cardiac arrhythmias, chronic heart failure, ischemic heart disease). Timely detection and treatment of OSA is an important task in the process of reducing the number of cardiac complications. Modern devices for the treatment of OSA are custom-made devices which allow to change the position of the mandible and its extension providing personalized treatment of snoring and sleep apnea. Changing the degree of the mandible extension, the ОА retains the upper respiratory tract in open position and indirectly stimulates the muscles, determining their tone. The effectiveness of the ОА is evaluated by the complete elimination of all respiratory events (snoring, upper airway resistance syndrome, OSA and hypopnea), as well as the influence on the sleep structure and the wakefulness functioning (excessive daytime sleepiness). The effects of ОА on cardiovascular diseases are of great importance, as they showed a decrease in both systolic and diastolic blood pressure, as well as a positive effect on the impaired endothelial function. Among all the treatment options, ОА take the leading positions, only slightly inferior in effectiveness to noninvasive ventilation, so called CPAP therapy. Regarding the long-term adherence to therapy (which is especially important in the cardiovascular prevention) оral appliances exceed CPAP therapy. Thus, the OA therapy is one of the leading therapeutic directions in modern sleep medicine for obstructive sleep-related breathing disorders.

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The authors declare that there are no conflicts of interest present.