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Психоневрологические аспекты синдрома обструктивного апноэ сна
Лавреникова К.И., Елфимова Е.М., Михайлова О.О. и др. Психоневрологические аспекты синдрома обструктивного апноэ сна. Consilium Medicum. 2019; 21 (9): 69–73. DOI: 10.26442/20751753.2019.9.190508
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Lavrenikova K.I., Elfimova E.M., Mikhailova O.O. et al. Psyho-neurological aspects of obstructive sleep apnea syndrome. Consilium Medicum. 2019; 21 (9): 69–73. DOI: 10.26442/20751753.2019.9.190508
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Аннотация
Синдром обструктивного апноэ сна (СОАС) – одна из самых распространенных форм нарушения дыхания во сне. Для него характерно увеличение риска развития и прогрессирования большинства сердечно-сосудистых заболеваний, а в клинической картине нередко преобладают проявления со стороны нервной системы: выраженная дневная сонливость, когнитивные, тревожные и депрессивные расстройства. СОАС встречается при самых распространенных неврологических заболеваниях, и за последнее время появилось множество исследований, описывающих их взаимосвязь. С одной стороны, нарушения дыхания во сне часто являются фактором риска возникновения неврологической патологии и способны осложнять ее течение, с другой – они часто являются следствием нервных болезней. Интермиттирующая гипоксия, развивающаяся на фоне нарушений дыхания, является ключевым звеном патогенеза формирования сердечно-сосудистых и неврологических осложнений. В представленном обзоре приведены исследования, описывающие взаимосвязь СОАС с такими неврологическими заболеваниями, как церебральный инсульт, болезнь Альцгеймера, болезнь Паркинсона, эпилепсия, нейродегенеративные и нейромышечные заболеваниями. На сегодняшний день «золотым стандартом» лечения СОАС во всем мире остается СИПАП-терапия (транслитерация с англ. – CPAP: Continuous Positive Airway Pressure) – лечение путем создания постоянного положительного давления в верхних дыхательных путях. При сочетании неврологической патологии с СОАС добавление СИПАП-терапии к основному медикаментозному лечению часто оказывает статистически значимый положительный эффект на течение и прогноз неврологического заболевания.
Ключевые слова: обзор литературы, синдром обструктивного апноэ сна, патогенез синдрома обструктивного апноэ сна, нейромышечные заболевания, нейродегенеративные заболевания, болезнь Альцгеймера, болезнь Паркинсона, эпилепсия, СИПАП-терапия.
Ключевые слова: обзор литературы, синдром обструктивного апноэ сна, патогенез синдрома обструктивного апноэ сна, нейромышечные заболевания, нейродегенеративные заболевания, болезнь Альцгеймера, болезнь Паркинсона, эпилепсия, СИПАП-терапия.
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Obstructive sleep apnoea syndrome (OSAS) is one of the most frequent forms of sleep-disordered breathing. Increase of risk of development and progressing of most cardiovascular disorders is typical for this condition. In clinical presentation manifestations from nervous system such as severe daytime sleepiness, cognitive decline, anxiety and depressive disorders often predominate. OSAS occurs in most widespread neurologic disorders, at present a lot of studies emerge describing its interconnections. On the one hand, sleep-related breathing disorders are often a risk factor for neurological disorders and may complicate their flow; on the other hand, they are often the result of nerve diseases. Intermittent hypoxia that develops against the background of breathing disorders plays a key role in the pathophysiology of cardiovascular and neurological complications. Article presents existing studies that describe the relationship between obstructive sleep apnea syndrome and neurological diseases such as cerebral apoplexy, Alzheimer's disease, Parkinson's disease, epilepsy, neurodegenerative and neuromuscular diseases. At the present time, CPAP therapy remains the gold standard for the treatment of obstructive sleep apnea syndrome throughout the world. When neurological pathology is combined with the syndrome of obstructive sleep apnea, the addition of CPAP therapy to the main drug treatment often has a statistically significant positive effect on the course and prognosis of neurological diseases.
Key words: overview, obstructive sleep apnea syndrome, pathogenesis of obstructive sleep apnea, neuromuscular diseases, neurodegenerative diseases, Alzheimer's disease, Parkinson's disease, epilepsy, CPAP-therapy.
Полный текст
Список литературы
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3. Bixler EO, Vgontzas AN, Lin HM et al. Association of hypertension and sleep-disordered breathing. Arch Intern Med 2000; 160: 2289–95.
4. Sert Kuniyoshi FH, Pusalavidyasagar S, Singh P, Somers VK. Cardiovascular consequences of obstructive sleep apnoea. Indian J Med Res 2010; 131: 196–205.
5. Meslier N, Gagnadoux F, Giraud P et al. Impaired glucose-insulin metabolism in males with obstructive sleep apnea syndrome. Eur Respir J 2003; 22 (1): 156–60.
6. Jean-Louis G, Brown CD, Zizi F et al. Cardiovascular disease risk reduction with sleep apnea treatment. Expert Rev Cardiovasc Ther 2014; PMCID: PMC4234108.
7. Horner RL et al. Evidence for reflex upper airway dilator muscle activation by sudden negative airway pressure in man. J Physiol 1991; 436: 15–29.
8. Kimoff RJ et al. Upper airway sensation in snoring and obstructive sleep apnea. Am J Respir Crit Care Med 2001; 164: 250–5.
9. Broderick M, Guilleminault C. Neurological Aspects of Obstructive Sleep Apnea. Stanford University Sleep Medicine Program. Ann NY Acad Sci 2008; 1142: 44–57. DOI: 10.1196/annals.1444.003
10. Fogel RB et al. The effect of sleep onset on upper airway muscle activity in patients with sleep apnoea versus controls. J Physiol 2005; 564 (Part. 2): 549–62.
11. Svanborg E. Impact of obstructive apnea syndrome on upper airway respiratory muscles. Respir Physiol Neurobiol 2005; 147: 263–72.
12. Fogel RB et al. Genioglossal activation in patients with obstructive sleep apnea versus con- trol subjects. Mechanisms of muscle control. Am J Respir Crit Care Med 2001; 164: 2025–30.
13. Mezzanotte WS, Tangel DJ, White DP. Influence of sleep onset on upper-airway muscle activity in apnea patients versus normal controls. Am J Respir Crit Care Med 1996; 153 (6 Part. 1): 1880–7.
14. Berry RB et al. Sleep apnea impairs the arousal response to airway occlusion. Chest 1996; 109: 1490–6.
15. Webster KE, Colrain IM. Multichannel EEG analysis of respiratory evoked-potential components during wakefulness and NREM sleep. J Appl Physiol 1998; 85: 1727–35.
16. Afifi L, Guilleminault C, Colrain IM. Sleep and respiratory stimulus specific dampening of cortical responsiveness in OSAS. Respir Physiol Neurobiol 2003; 136: 221–34.
17. Deacon NL, Catcheside PG. The role of high loop gain induced by intermittent hypoxia in the pathophysiology of obstructive sleep apnoea. Sleep Med Rev 2015; 22: 3–14.
18. Yaggi HK et al. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005; 353: 2034–41.
19. Taheri S, Lin L, Austin D et al. Short Sleep Duration Is Associated with Reduced Leptin, Elevated Ghrelin, and Increased Body Mass Index. PLoS Med 2004; 1 (3): e62.
20. Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet 1999; 354: 1435–9.
21. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000; 342: 1378–84.
22. Drager LF et al. Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 2007; 176: 706–12.
23. Johnson KG, Johnson DC. Frequency of Sleep Apnea in Stroke and TIA Patients: A Meta-analysis. J Clin Sleep Med 2010; 6 (2): 131–7.
24. Полуэктов М.Г., Бахревский И.Е., Кошелев И.Ю. и др. Расстройства дыхания во сне при мозговом инсульте. Инсульт. 2002; 5: 22–6.
[Poluektov M.G., Bakhrevskii I.E., Koshelev I.Iu. et al. Rasstroistva dykhaniia vo sne pri mozgovom insul'te. Insult. 2002; 5: 22–6 (in Russian).]
25. Pepperell JC, Davies RJ, Stradling JR. Systemic hypertension and obstructive sleep apnoea. Sleep Med Rev 2002; 6: 157–73.
26. Sandberg O et al. Nasal continuous positive airway pressure in stroke patients with sleep apnoea: a randomized treatment study. Eur Respir J 2001; 18: 630–4.
27. Valham F, Mooe T, Rabben et al. Increased Risk of Stroke in Patients With Coronary Artery Disease and Sleep Apnea. Circulation 2008; 118: 955–60.
28. Manni R, Terzaghi M, Arbasino C et al. Obstructive sleep apnea in a clinical series of adult epilepsy patients: Frequency and features of the comorbidity. Epilepsia 2003; 44: 836e40.
29. Malow BA, Levy K, Maturen K, Bowes R. Obstructive sleep apnea is common in medically refractory epilepsy patients. Neurology 2000; 55: 1002–7.
30. Malow BA, Fromes GA, Aldrich MS. Usefulness of polysomnography in epilepsy patients. Neurology 1997; 48: 1389–94.
31. Vendrame M, Auerbach S, Loddenkemper T et al. Effect of continuous positive airway pressure treatment on seizure control in patients with obstructive sleep apnea and epilepsy. Epilepsia 2011; 52 (11): e168–e171.
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33. Lugaresi E et al. Staging of heavy snorers’ disease. Aproposal Bull Eur Physiopathol Respir 1983; 19: 590–4.
34. Kanemura H, Sano F, Maeda Y et al. Valproate sodium enhances body weight gain in patients with childhood epilepsy: A pathogenic mechanisms and open-label clinical trial of behavior therapy. Seizure 2012; 21 (7): 496–500.
35. Pagel JF, Parnes BL. Medications for the Treatment of Sleep Disorders: An Overview. Prim Care Companion J Clin Psychiatry 2001; 3 (3): 118–25.
36. Culebras A. Sleep and neuromuscular disorders. Neurol Clin 2005; 23: 1209–23.
37. Krahn LE. Psychiatric disorders associated with disturbed sleep. Semin Neurol 2005; 25: 90–6.
38. Su VYi-F, Chen Y-T, Lin W-Ch et al. Sleep Apnea and Risk of Panic Disorder. Ann Fam Med 2015; 13 (4): 325–30.
39. Reynolds CF, Kupfer DJ, Mceachran AB et al. Depressive psychopathology in male sleep apneics. J Clin Psychiatry 1984; 45: 287–90.
40. Kalucy MJ, Grunstein R, Lambert T, Glozier N. Obstructive sleep apnoea and schizophrenia – a research agenda. Sleep Med Rev 2013; 17: 357–65.
41. Winkelman JW. Schizophrenia, obesity, and obstructive sleep apnea. J Clin Psychiatry 2001; 62: 8–11.
42. Boufidis S, Kosmidis MH, Bozikas VP et al. Treatment outcome of obstructive sleep apnea syndrome in a patient with schizophrenia: case report. Int J Psychiatry Med 2003; 33: 305–10.
43. Spira AP et al. Sleep-disordered breathing and cognition in older women. J Am Geriatr Soc 2008; 56: 45–50.
44. Gehrman PR et al. Sleep-disordered breathing and agitation in institutionalized adults with Alzheimer disease. Am J Geriatr Psychiatry 2003; 11: 426–33.
45. Liu Q, Li J, Jubair Sh et al. Sparstolonin B Attenuates Hypoxia-Induced Apoptosis, Necrosis and Inflammation in Cultured Rat Left Ventricular Tissue Slices. Cardiovasc Drugs Ther 2014; 28 (5): 433–9.
46. Fung SJ, Xi MC, Zhang JH et al. Apnea promotes glutamate-induced excitotoxicityin hippocampal neurons. Brain Res 2007; 1179: 42–50.
47. Gottlieb DJ, De Stefano AL, Foley MS et al. APOE e4 is associated with obstructive sleep apnea/hypopnea. The Sleep Heart Health Study. Neurology 2004; 63 (4): 664–8.
48. Liu Ch-Ch, Kanekiyo T, Xu H et al. Apolipoprotein E and Alzheimer disease: risk, mechanisms, and therapy. Nat Rev Neurol 2013; 9 (2): 106–18.
49. Nikodemova M, Finn L, Mignot E et al. Association of sleep disordered breathing and cognitive deficit in APOE ε4 carriers. Sleep 2013; 36 (6): 873–80.
50. Daulazati MA. Death by a Thousand Cuts in Alzheimer’s Disease: Hypoxia – The Prodrome. Neurotox Res 2013; 24: 216–43.
51. Zhang X, Weidong L. Pathological role of hypoxia in Alzheimer’r disease. Exp Neurol 2010; 223: 299–303.
52. Ferini-Strambi L, Marelli S. Sleep dysfunction in multiple system atrophy. Curr Treat Options Neurol 2012; 14 (5): 464–73.
53. Shimohata T, Shinoda H, Nakayama H et al. Daytime hypoxemia, sleep-disorder breathing, and laryngopharyngeal findings in multiple system atrophy. Arch Neurol 2007; 64: 856–61.
54. Diederich NJ, Vaillant M, Leischen M et al. Sleep apnea syndrome in Parkinson's disease. A case-control study in 49 patients. Mov Disord 2005; 20: 1413–8.
55. Нодель М.Р. Нарушения сна при болезни Паркинсона: расширение возможностей терапии. Consilium Medicum. Неврология и ревматология. (Прил.) 2013; 1: 33–8.
[Nodel M.R. Narusheniia sna pri bolezni Parkinsona: rasshirenie vozmozhnostei terapii.Consilium Medicum. Neurology and Rheumatology (Suppl.) 2013; 1: 33–8 (in Russian).]
56. Zeng J, Wei M, Li T et al. Risk of Obstructive Sleep Apnea in Parkinson’s Disease: A Meta-Analysis. PLoS One 2013; 8 (12): e82091.
57. Young T, Peppard PE, Taheri S. Excess weight and sleep- disordered breathing. J Appl Physiol 2005; 99: 1592–9. DOI: 10.1152/japplphysiol.00587.2005
58. Yong MH, Fook-Chong S, Pavanni R et al. Case Control polysomnographic studies of sleep disorders in Parkinson’s diesease. PloS One 2011; 6: 22511.
59. Vincken WG, Darauay CM, Cosio MG. Reversibility of upper airway obstruction after levodopa therapy in Parkinson's disease. Chest 1989; 96: 210–2.
60. Вейн А.М., Елигулашвили Т.С., Полуэктов М.Г. Синдром апноэ во сне и другие расстройства дыхания, связанные со сном: клиника, диагностика, лечение. М.: Эйдос Медиа, 2002.
[Vein A.M., Eligulashvili T.S., Poluektov M.G. The syndrome of sleep apnea and other breathing disorders associated with sleep: clinic, diagnostics, treatment. Moscow: Eidos Media, 2002 (in Russian).]
61. Schwartz A, Gold A, Schubert N et al. Effect of weight loss on upper airway collapsibility in obstructive sleep apnea. Am Rev Respir Dis 1991; 144: 494–8.
62. Strobel RJ, Rosen RC. Obesity and weight loss in obstructive sleep apnea: a critical revew. Sleep 1996; 19 (2):104–15.
63. Parra O, Arboix A, Bechich S et al. Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack. Am J Crit Care Med 2000; 161: 375–80.
64. Engleman HM et al. Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome. Lancet 1994; 343: 572–5.
65. Siccoli MM, Pepperell JC, Kohler M et al. Effects of Continuous Positive Airway Pressure on Quality of Life in Patients With Moderate to Severe Obstructive Sleep Apnea: Data From a Randomized Controlled Trial. Sleep 2008; 31 (11): 1551–8.
66. Bedard MA et al. Persistent neuropsychological deficits and vigilance impairment in sleep apnea syndrome after treatment with continuous positive airways pressure (CPAP). J Clin Exp Neuropsychol 1993; 15: 330–41.
67. Naegele B et al. Cognitive executive dysfunction in patients with obstructive sleep apnea syndrome (OSAS) after CPAP treatment. Sleep 1998; 21: 392–7.
68. Lim W et al. Neuropsychological effects of 2 week continuous positive airway pressure treatment and supplemental oxygen in patients with obstructive sleep apnea: a randomized placebo-controlled study. J Clin Sleep Med 2007; 3: 380–6.
69. Iftikhar IH, Khan MF, Magalang UJ et al. Meta-analysis: Continuous Positive Airway Pressure Improves Insulin Resistance in Patients with Sleep Apnea without Diabetes. Ann Am Thorac Soc 2013; 10 (2): 115–20.
70. Бабак С.Л., Белов А.М., Бузунов Р.В. и др. Лечение синдрома апноэ во сне постоянным положительным давлением в воздухоностных путях. Пульмонология. 1997; 2: 86–92.
[Babak S.L., Belov A.M., Buzunov R.V. et al. Lechenie sindroma apnoe vo sne postoiannym polozhitel'nym davleniem v vozdukhonostnykh putiakh. Pul'monologiia. 1997; 2: 86–92 (in Russian).]
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62. Strobel RJ, Rosen RC. Obesity and weight loss in obstructive sleep apnea: a critical revew. Sleep 1996; 19 (2):104–15.
63. Parra O, Arboix A, Bechich S et al. Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack. Am J Crit Care Med 2000; 161: 375–80.
64. Engleman HM et al. Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome. Lancet 1994; 343: 572–5.
65. Siccoli MM, Pepperell JC, Kohler M et al. Effects of Continuous Positive Airway Pressure on Quality of Life in Patients With Moderate to Severe Obstructive Sleep Apnea: Data From a Randomized Controlled Trial. Sleep 2008; 31 (11): 1551–8.
66. Bedard MA et al. Persistent neuropsychological deficits and vigilance impairment in sleep apnea syndrome after treatment with continuous positive airways pressure (CPAP). J Clin Exp Neuropsychol 1993; 15: 330–41.
67. Naegele B et al. Cognitive executive dysfunction in patients with obstructive sleep apnea syndrome (OSAS) after CPAP treatment. Sleep 1998; 21: 392–7.
68. Lim W et al. Neuropsychological effects of 2 week continuous positive airway pressure treatment and supplemental oxygen in patients with obstructive sleep apnea: a randomized placebo-controlled study. J Clin Sleep Med 2007; 3: 380–6.
69. Iftikhar IH, Khan MF, Magalang UJ et al. Meta-analysis: Continuous Positive Airway Pressure Improves Insulin Resistance in Patients with Sleep Apnea without Diabetes. Ann Am Thorac Soc 2013; 10 (2): 115–20.
70. Babak S.L., Belov A.M., Buzunov R.V. et al. Lechenie sindroma apnoe vo sne postoiannym polozhitel'nym davleniem v vozdukhonostnykh putiakh. Pul'monologiia. 1997; 2: 86–92 (in Russian).
Авторы
К.И. Лавреникова*1, Е.М. Елфимова2, О.О. Михайлова2, Н.Т. Хачатрян2, В.И. Федорова2, А.Ю. Литвин2,3, И.Е. Чазова2
1 ГБУЗ КО «Городская клиническая больница №2 “Cосновая роща”», Калуга, Россия;
2 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
3 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*karina1606@rambler.ru
1 ГБУЗ КО «Городская клиническая больница №2 “Cосновая роща”», Калуга, Россия;
2 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
3 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*karina1606@rambler.ru
________________________________________________
Karina I. Lavrenikova*1, Evgeniia M. Elfimova2, Oksana O. Mikhailova2, Narine T. Khachatryan2, Vera I. Fedorova2, Aleksandr Yu. Litvin2,3, Irina E. Chazova2
1 City Clinical Hospital №2 “Sosnovaia roshcha”, Kaluga, Russia;
2 National Medical Research Center for Cardiology, Moscow, Russia;
3 Pirogov Russian National Research Medical University, Moscow, Russia
*karina1606@rambler.ru
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