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Обструктивное апноэ сна и артериальная гипертония: состояние проблемы глазами сомнолога
Пальман А.Д., Шишкин Р.К. Обструктивное апноэ сна и артериальная гипертония: состояние проблемы глазами сомнолога. Consilium Medicum. 2025;27(1):12–17. DOI: 10.26442/20751753.2025.1.203051
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
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Palman AD, Shishkin RK. Obstructive sleep apnea and hypertension: The state of the problem from the eyes of a somnologist. Case report. Consilium Medicum. 2025;27(1):12–17. DOI: 10.26442/20751753.2025.1.203051
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Аннотация
Обструктивное апноэ сна (ОАС) является одним из наиболее распространенных патологических состояний, непосредственно связанных со сном, и сопровождается большим числом сердечно-сосудистых осложнений. Частота артериальной гипертонии (АГ) среди пациентов с ОАС значительно превышает распространенность этого заболевания в популяции в целом. При этом ОАС может как приводить к возникновению АГ, так и обусловливать ее отягощенное течение и резистентность к медикаментозной терапии. Кроме того, ОАС часто ведет к изменению суточного профиля артериального давления (АД) с отсутствием его физиологического снижения или повышением во время сна. Настороженность врача в первую очередь должны вызывать пациенты с сочетанием храпа и дневной сонливости, особенно если это мужчины среднего возраста с избыточной массой тела. Наличие патологического суточного профиля АД и/или АГ, резистентной к многокомпонентной гипотензивной терапии, также является достаточным основанием, чтобы подозревать у таких пациентов ОАС. При этом диагноз ОАС всегда должен подтверждаться с помощью специальных инструментальных методов исследования. Наиболее эффективным и безопасным методом лечения клинически значимого ОАС является неинвазивная вентиляция постоянным положительным давлением в дыхательных путях (СИПАП-терапия). Адекватное лечение ОАС часто приводит к нормализации суточного профиля АД, его снижению как во время сна, так и в бодрствовании, восстановлению чувствительности к медикаментозной гипотензивной терапии.
Ключевые слова: артериальная гипертония, обструктивное апноэ сна, СИПАП-терапия
Ключевые слова: артериальная гипертония, обструктивное апноэ сна, СИПАП-терапия
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Obstructive sleep apnea (OSA) is one of the most common conditions directly related to sleep and is associated with many cardiovascular complications. The prevalence of hypertension among patients with OSA significantly exceeds that in the general population. OSA can both lead to the occurrence of hypertension, complicate its course, and cause resistance to drug therapy. Also, OSA often leads to a change in the daily blood pressure (BP) profile with no physiological decrease or increase during sleep. Physicians should be alert to patients who are snoring and experiencing daytime sleepiness, especially if they are middle-aged, overweight men. An abnormal diurnal profile of BP and/or hypertension resistant to multicomponent antihypertensive therapy also indicates probable OSA in such patients. The diagnosis of OSA should always be confirmed using special instrumental examination methods. The most effective and safe treatment method for clinically significant OSA is non-invasive ventilation with constant positive airway pressure (CPAP therapy). Proper treatment of OSA often leads to normalizing the diurnal blood pressure profile, decreasing BP both during sleep and wakefulness, and restoring sensitivity to antihypertensive drug therapy.
Keywords: hypertension, obstructive sleep apnea, CPAP therapy
Полный текст
Список литературы
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2. Fernandez-Mendoza J, Vgontzas AN, Liao D, et al. Insomnia with objective short sleep duration and incident hypertension: the Penn State Cohort. Hypertension. 2012;60(4):929-35. DOI:10.1161/HYPERTENSIONAHA.112.193268
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5. Dolan E, Stanton A, Thijs L, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension. 2005;46(1):156-61. DOI:10.1161/01.HYP.0000170138.56903.7a
6. Бузунов Р.В., Пальман А.Д., Мельников А.Ю., и др. Диагностика и лечение синдрома обструктивного апноэ сна у взрослых. Рекомендации Российского общества сомнологов. Эффективная фармакотерапия. 2018;35:34-45 [Buzunov RV, Palman AD, Melnikov AYu, et al. Diagnostics and Treatment of Obstructive Sleep Apnea Syndrome in Adults. Recommendations of the Russian Society of Sleep Medicine. Effektivnaia Farmakoterapiia. 2018;35:34-45 (in Russian)].
7. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-14. DOI:10.1093/aje/kws342
8. Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071-8.
9. Tietjens JR, Claman D, Kezirian EJ, et al. Obstructive Sleep Apnea in Cardiovascular Disease: A Review of the Literature and Proposed Multidisciplinary Clinical Management Strategy. J Am Heart Assoc. 2019;8(1):e010440. DOI:10.1161/JAHA.118.010440
10. Logan AG, Perlikowski SM, Mente A, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens. 2001;19(12):2271-7. DOI:10.1097/00004872-200112000-00022
11. Oscullo G, Torres G, Campos-Rodriguez F, et al. Resistant/Refractory Hypertension and Sleep Apnoea: Current Knowledge and Future Challenges. J Clin Med. 2019;8(11):1872. DOI:10.3390/jcm8111872
12. Kwon Y, Tzeng WS, Seo J, et al. Obstructive sleep apnea and hypertension; critical overview. Clin Hypertens. 2024;30(1):19. DOI:10.1186/s40885-024-00276-7
13. Seif F, Patel SR, Walia HK, et al. Obstructive sleep apnea and diurnal nondipping hemodynamic indices in patients at increased cardiovascular risk. J Hypertens. 2014;32(2):267-75. DOI:10.1097/HJH.0000000000000011
14. Akashiba T, Minemura H, Yamamoto H, et al. Nasal continuous positive airway pressure changes blood pressure "non-dippers" to "dippers" in patients with obstructive sleep apnea. Sleep. 1999;22(7):849-53. DOI:10.1093/sleep/22.7.849
15. Pio-Abreu A, Moreno H Jr, Drager LF. Obstructive sleep apnea and ambulatory blood pressure monitoring: current evidence and research gaps. J Hum Hypertens. 2021;35(4):315-24. DOI:10.1038/s41371-020-00470-8
16. Crinion SJ, Ryan S, Kleinerova J, et al. Nondipping Nocturnal Blood Pressure Predicts Sleep Apnea in Patients With Hypertension. J Clin Sleep Med. 2019;15(7):957-63. DOI:10.5664/jcsm.7870
17. Genta-Pereira DC, Furlan SF, Omote DQ, et al. Nondipping Blood Pressure Patterns Predict Obstructive Sleep Apnea in Patients Undergoing Ambulatory Blood Pressure Monitoring. Hypertension. 2018;72(4):979-85. DOI:10.1161/HYPERTENSIONAHA.118.11525
18. 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(19):1378-84. DOI:10.1056/NEJM200005113421901
19. Marin JM, Agusti A, Villar I, et al. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA. 2012;307(20):2169-76. DOI:10.1001/jama.2012.3418
20. O'Connor GT, Caffo B, Newman AB, et al. Prospective study of sleep-disordered breathing and hypertension: the Sleep Heart Health Study. Am J Respir Crit Care Med. 2009;179(12):1159-64. DOI:10.1164/rccm.200712-1809OC
21. Haas DC, Foster GL, Nieto FJ, et al. Age-dependent associations between sleep-disordered breathing and hypertension: importance of discriminating between systolic/diastolic hypertension and isolated systolic hypertension in the Sleep Heart Health Study. Circulation. 2005;111(5):614-21. DOI:10.1161/01.CIR.0000154540.62381.CF
22. Bliwise DL. Normal aging. In: Principles and Practice of Sleep Medicine. 3ed ed. Philadelphia: W.B. Saunders Company, 2000; p. 26-41.
23. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365(9464):1046-53. DOI:10.1016/S0140-6736(05)71141-7
24. Uataya M, Banhiran W, Chotinaiwattarakul W, et al. Association between hypoxic burden and common cardiometabolic diseases in patients with severe obstructive sleep apnea. Sleep Breath. 2023;27(6):2423-8. DOI:10.1007/s11325-023-02860-x
25. Feng J, He QY, Zhang XL, Chen BY; Sleep Breath Disorder Group, Society of Respiratory Medicine. Epworth Sleepiness Scale may be an indicator for blood pressure profile and prevalence of coronary artery disease and cerebrovascular disease in patients with obstructive sleep apnea. Sleep Breath. 2012;16(1):31-40. DOI:10.1007/s11325-011-0481-5
26. Jones DW, Hall JE. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and evidence from new hypertension trials. Hypertension. 2004;43(1):1-3. DOI:10.1161/01.HYP.0000110061.06674.ca
27. Sarber KM, Dhanda Patil R. Comorbid Insomnia and Sleep Apnea: Challenges and Treatments. Otolaryngol Clin North Am. 2024;57(3):385-93. DOI:10.1016/j.otc.2023.11.001
28. Liu J, Zang C, Yi M, Zhang Y. Clinical Characteristics and Treatment Efficacy for Co-Morbid Insomnia and Sleep Apnea (COMISA): Evidence from Qualitative and Quantitative Analysis. Behav Sleep Med. 2024;22(5):611-35. DOI:10.1080/15402002.2024.2324361
29. Pejovic S, Vgontzas AN, Fernandez-Mendoza J, et al. Obstructive sleep apnea comorbid with insomnia symptoms and objective short sleep duration is associated with clinical and preclinical cardiometabolic risk factors: Clinical implications. Sleep Med. 2024;124:115-9. DOI:10.1016/j.sleep.2024.09.013
30. Draelants L, Point C, Wacquier B, et al. 10-Year Risk for Cardiovascular Disease Associated with COMISA (Co-Morbid Insomnia and Sleep Apnea) in Hypertensive Subjects. Life (Basel). 2023;13(6):1379. DOI:10.3390/life13061379
31. Patil SP, Ayappa IA, Caples SM, et al. Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2019;15(2):335-43. DOI:10.5664/jcsm.7640
32. Аксенова А.В., Сивакова О.А., Блинова Н.В., и др. Консенсус экспертов Российского медицинского общества по артериальной гипертонии по диагностике и лечению резистентной артериальной гипертонии. Терапевтический архив. 2021;93(9):1018-29 [Aksenova AV, Sivakova OA, Blinova NV, et al. Russian Medical Society for Arterial Hypertension expert consensus. Resistant hypertension: detection and management. Terapevticheskii Arkhiv (Ter. Arkh). 2021;93(9):1018-29 (in Russian)]. DOI:10.26442/00403660.2021.09.201007
33. Liu L, Cao Q, Guo Z, Dai Q. Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea and Resistant Hypertension: A Meta-Analysis of Randomized Controlled Trials. J Clin Hypertens (Greenwich). 2016;18(2):153-8. DOI:10.1111/jch.12639
34. Iftikhar IH, Valentine CW, Bittencourt LR, et al. Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis. J Hypertens. 2014;32(12):2341-50; discussion 2350. DOI:10.1097/HJH.0000000000000372
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34. Iftikhar IH, Valentine CW, Bittencourt LR, et al. Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis. J Hypertens. 2014;32(12):2341-50; discussion 2350. DOI:10.1097/HJH.0000000000000372
35. Sumarokov AV, Pal'man AD, Daniliak IG. Arterial'noe davlenie u bol'nykh s sindromom apnoe vo sne i ego dinamika v protsesse lecheniia. Rossiiskie Meditsinskie Vesti. 1998;2:61-4 (in Russian).
36. Pengo MF, Soranna D, Giontella A, et al. Obstructive sleep apnoea treatment and blood pressure: which phenotypes predict a response? A systematic review and meta-analysis. Eur Respir J. 2020;55(5):1901945. DOI:10.1183/13993003.01945-2019
37. Javaheri S, Javaheri S, Gozal D, et al. Treatment of OSA and its Impact on Cardiovascular Disease, Part 2: JACC State-of-the-Art Review. J Am Coll Cardiol. 2024;84(13):1224-40. DOI:10.1016/j.jacc.2024.07.024
38. Montesi SB, Edwards BA, Malhotra A, Bakker JP. The effect of continuous positive airway pressure treatment on blood pressure: a systematic review and meta-analysis of randomized controlled trials. J Clin Sleep Med. 2012;8(5):587-96. DOI:10.5664/jcsm.2170
39. Litvin AYu, Chazova IE, Elfimova EM, et al. Eurasian Association of Cardiology (EAC) / Russian society of somnologists (RSS) guidelines for the diagnosis and treatment of obstructive sleep apnea in patients with cardiovascular diseases (2024). Eurasian Heart Journal. 2024;(3):6-27 (in Russian). DOI:10.38109/2225-1685-2024-3-6-27
40. Pal'man AD. Obstruktivnoe apnoe sna. Assotsiirovannye sindromy i klinicheskie sostoianiia: prakticheskoe posobie dlia vrachei. Moscow: GEOTAR-Media, 2020 (in Russian).
Авторы
А.Д. Пальман*, Р.К. Шишкин
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*doctorpalman@mail.ru
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*doctorpalman@mail.ru
________________________________________________
Alexander D. Palman*, Roman K. Shishkin
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*doctorpalman@mail.ru
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