CPAP-THERAPY IS A PROTECTIVE CARDIOVASCULAR FACTOR IN PATIENTS WITH SEVERE OBSTRUCTIVE SLEEP APNEA SYNDROME

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.

obstructive sleep apnea syndrome, sleep-disordered breathing, cardiovascular pathology, CPAP therapy

1. Lindberg E. Epidemiology of OSA European Respiratory Monograph. UK: Copyright ERS. 2010. Chapter. 4:51–68.

2. Lloberes P, Duran-Cantola J, Martinez-Garsia MA, Marin JM, Ferrer A, Corral J et al. Diagnosis and treatment of sleep apneahypopnea syndrome. Spanish Society of Pulmonology and Thoracic Surgery. Arch Bronconeumol. 2011;47(3):143–156.

3. Куликов А. Н., Кучмин А. Н., Казаченко А. А., Галактионов Д. А., Уманская Е. П. Кардиологические маски синдрома обструктивного апноэ во время сна. Артериальная гипертензия. 2015;21(3):309–318. [Kulikov AN, Kuchmin AN, Kazachenko AA, Galaktionov DA, Umanskaya EP. The cardiologic masks of obstructive sleep apnea syndrome. Arterial’naya Gipertenziya = Arterial Hypertension. 2015;21(3):309–318. In Russian].

4. Фитце И., Сукмарова З. Н. Современная клиническая практика ведения пациентов с синдромом обструктивного апноэ сна в Германии. Доктор.Ру. 2014;2(90):80–84. [Fietze I, Sukmarova ZN. Current German clinical management strategies for patients with obstructive sleep apnea. Doctor.Ru. 2014;2(90):80–84. In Russian].

5. Белкин А. А., Алексеева Е. В., Жигульская О. В., Романова Е. К. Синдром обструктивного апноэ сна как фактор аварийности у профессиональных водителей в Екатеринбурге. Исследование «Опасный сон (ОС-1)». Неврология, нейропсихиатрия, психосоматика. 2015;7(1):49–54. [Belkin AA, Alekseeva EB, Jigulskaia OV, Romanova EK. Obstructive sleep apnea syndrome as an accident risk factor in professional drivers in Yekaterinburg. Dangerous Sleep (DS-1) study. Nevrologia, Neuropsychiatria, Psychosomatica = Neurology, Neuropsychiatry, Psychosomatic medicine. 2015;7(1):49–54. In Russian].

6. Tim JA. Cognitive complaints in obstructive sleep apnea. Sleep Med Rev. 2015;19:51–58.

7. Burks SV, Anderson JE, Bombuk M, Haider R, Ganzhorn D, Jiao X et al. Nonadherence with employer-mandated sleep apnea treatment and increased risk of serious truck crashes. Sleep. 2016;39 (5):967–975.

8. Guralnick A, Bakris GL. Approaches for targeting blood pressure control in sleep disorders. Curr Opin Nephrol Hypertens. 2012;21(5):469–474.

9. Cintra FD, Leite RP, Storti LJ. Sleep apnea and nocturnal cardiac arrhythmia: a populational study. Arq Bras Cardiol. 2014;103(5):368–374.

10. Chen YL, Su MC, Liu WH, Wang CC, Lin MC, Chen MC. Influence and predicting variables of obstructive sleep apnea on cardiac function and remodeling in patients without congestive heart failure. J Clin Sleep Med. 2014;10(1):57–64.

11. Кляшев С. М., Кляшева Ю. М., Ибрагимова Е. А., Калинина В. Л., Триодина О. В. Ремоделирование левого желудочка у больных артериальной гипертонией с синдромом обструктивного апноэ сна по данным эхокардиографии. Сибирский медицинский журнал. 2011;26(2):104–108. [Klyashev SM, Klyasheva Yu M, Ibragimova EA, Kalinina VL, Triodina OV. The left ventricle remodeling in patients with arterial hypertension and the obstructive sleep apnea syndrome according to the results of echocardiography. The Siberian Medical Journal. 2011;26(2):104– 108. In Russian].

12. Ye L, Malhotra A, Kayser K, Willis DG, Horowitz JA, Aloia MS et al. Weaver Spousal involvement and CPAP adherence: a dyadic perspective. Sleep Med Rev. 2015;19:67–74.

13. Бузунов Р. В., Легеда И. В., Царева Е. В. Храп и синдром обструктивного апноэ сна у взрослых и детей. М.: ФГБУ «Клинический санаторий Барвиха», 2013. 124 с. [Buzunov RV, Legeda IV, Tsareva EV. Snoring and obstructive sleep apnea in adults and children. M.: FGBU “Klinicheskii Sanatoriy Barviha”, 2013. 124 p. In Russian].

14. Дабровски А., Дабровски Б., Пиотрович Р. Суточное мониторирование ЭКГ. М.: Медпрактика, 2000. 208 с. [Dabrowsky A, Dabrowsky B, Piotrowych P. Holter-ECG monitoring. M.: Medpractica, 2000. 208 p. In Russian].

15. Шомахов Р. А., Макаренко В. Н., Бокерия Л. А. Эволюция методов диагностики и прогнозирования некоронарогенных желудочковых аритмий. Креативная кардиология. 2014;2:36– 47. [Shomachov RA, Makarenko VN, Bokeria LA. Evolution of diagnostic methods and prediction of noncoronary ventricular arrhythmias. Kreativnaya Kardiologya = Creative Cardiology. 2014; 2:36–47. In Russian].

16. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1–39.

17. Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R et al. Recommendations for the management of patients with obstructive sleep apnea and hypertension. Eur Respir J. 2013;41(3):523–538.

18. McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016;375(10):919–931.

19. Sun Y, Xuang ZY, Sun QR, Qiu LP, Zhou TT, Zhou GH. CPAP therapy reduces blood pressure for patients with obstructive sleep apnoea: an update meta-analysis of randomized clinical trials. Acta Cardiol. 2016;71(3):275–280.

20. Mokhlesi B, Ayas NT. Cardio vascular events in obstructive sleep apnea — can CPAP therapy SAVE Lives? N Engl J Med. 2016;375(10):994–996.

21. Prasad B, Carley DW, Krishnan JA, Weaver TE, Weaver FM. Effects of positive airway pressure treatment on clinical measures of hypertension and type 2 diabetes. J Clin Sleep Med. 2012;8 (5):481–487.

22. Ростороцкая В. В., Эльгардт И. А., Иванов А. П., Сдобнякова Н. С. Артериальная гипертензия и синдром обструктивного апноэ сна: резистентность к лечению и роль дисфункции вегетативной нервной системы. Кардиоваскулярная терапия и профилактика. 2012;11(5):11–17. [Rostorotskaya VV, Elgardt IA, Ivanov AP, Sdobnyakova NS. Arterial hypertension and obstructive sleep apnea syndrome: treatment resistance and the role of autonomic dysfunction. Kardiovasculyarnaya Terapiya i Profilaktika = Cardiovascular Therapy and Prevention. 2012;11 (5):11–17. In Russian].

23. Filgueiras-Rama D, Arias MA, Iniesta A, Armada E, Merino GL, Peinado R et al. Atrial arrhythmias in obstructive sleep apnea: underlying mechanisms and implications in the clinical setting. Pulmon Med. 2013;2013:1–9.

24. Gami AS, Olson EJ, Shen WK, Wright RS, Balman KV, Hodge DO et al. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. J Am Coll Cardiol. 2013;62(7):610–616.

25. Simantirakis EN, Schiza SI, Marketoua ME, Chrysostomakis SI, Chlouvirakis GI, Klapsinos NC et al. Severe bradyarrhythmias in patients with sleep apnea: the effect of continuous positive airway pressure treatment. European Heart Journal. 2004;25 (12):1070–1076.

26. Roche F, Xuong AN, Court-Fortune I, Costes F, Pichot V, Duverney D et al. Relationship among the severity of sleep apnea syndrome, cardiac arrhythmias, and autonomic imbalance. Pacing Clin Electrophysiol. 2003;26(3):669–77.

27. Dediu GN, Dumitrache-Rujinski S, Lungu R, Frunza S, Diaconu C, Bartosh D et al. Positive pressure therapy in patients with cardiac arrhythmias and obstructive sleep apnea. Pneumologia. 2015;64(1):18–22.

28. Fein AS, Shvilkin A, Shah D, Haffajee CI, Das S, Kumar K et al. Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation. J Am Coll Cardiol. 2013;62(4):300–305.

29. Karamanzanis G, Panou F, Lazaros G, Oikonomou E, Nicolopoulos I, Mihaelidou M et al. Impact of continuous positive airway pressure treatment on myocardial performance in patient with obstructive sleep apnea. A conventional and tissue Doppler echocardiographic study. Sleep Breath. 2015;19(1):343–350.

30. Muller P, Grabowski C, Schiedat F, Shin DI, Dietrich JW, Mügge A et al. Reverse remodelling of obstructive sleep apnea with continuous positive airway pressure: evidence from electromechanical and endocrine markers. Heart, Lung and Circulation. 2016;25(1):53–60. doi:10.1016/j.hlc.2015.05.004

31. Egea CJ, Aizpuru F, Pinto JA, Ayuela JM, Ballester E, Zamarrón C et al. Cardiac function after CPAP therapy in patients with chronic heart failure and sleep apnea: a multicenter study. Sleep Med. 2008;9(6):660–665.

32. Escourrou P, Grote L, Penzel T, Mcnicholas WT, Verbraecken J, Tkacova R et al. The diagnostic method has a strong influence on classification of obstructive sleep apnea. J Sleep Res. 2015;24 (6):730–738. doi:10.1111/jsr.12318