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Синдром обструктивного апноэ сна и дисфункция эндотелия
Синдром обструктивного апноэ сна и дисфункция эндотелия
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Аннотация
Статья посвящена вопросам взаимосвязи синдрома обструктивного апноэ сна (СОАС) и сердечно-сосудистых заболеваний. Более подробно описан вопрос взаимодействия дисфункции эндотелия (ДЭ) и СОАС. Обсуждены современные представления о механизмах развития артериальной гипертензии при СОАС. Приводятся как доказательные данные, так и мнения экспертов. Рассмотрены вопросы влияния постоянного положительного давления в дыхательных путях на ДЭ.
Ключевые слова: синдром обструктивного апноэ сна, дисфункция эндотелия, артериальная гипертензия.
Key words: obstructive sleep apnea syndrome, endothelial dysfunction, arterial hypertension.
Ключевые слова: синдром обструктивного апноэ сна, дисфункция эндотелия, артериальная гипертензия.
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Key words: obstructive sleep apnea syndrome, endothelial dysfunction, arterial hypertension.
Полный текст
Список литературы
1. Malhotra A, White DP. Obstructive sleep apnoea. Lancet 2002; 360: 237–45.
2. Bray GA. Pathophysiology of obesity. Am J Clin Nutr 1992; 55: 488–94.
3. Young T, Palta M, Dempsey J et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230–5.
4. Young T. Menopause, hormone replacement therapy, and sleepdisordered breathing: are we ready for the heat. Am J Respir Crit Care Med 2001; 163: 597–8.
5. Stradling JR, Crosby JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax 1991; 46: 85–90.
6. Wetter DW, Young TB, Bidwell TR et al. Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med 1994; 154: 2219–24.
7. American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999; 22 (5): 667–89.
8. Palmer LJ, Buxbau SG, Larkin EK et al. A Whole Genome Scan for Obstructive Sleep Apnea and Obesity in African-American Families. Am J Respir Crit Care Med 2004; 169 (12): 1314–21.
9. Вейн А.М., Елигулашвили Т.С., Полуэктов М.Г. Синдром апноэ во сне. М.: Эйдос-Медиа, 2002.
10. Hart T, Radow S, Blackard W et al. Sleep apnea in active acromegaly. Arch Int Med 1985; 145: 865–6.
11. Kapur VK, Koepsell TD, deMaine J et al. Association of Hypothyroidism and Obstructive Sleep Apnea Am J Respir Crit Care Med 1998; 158 (5): 1379–83.
12. Rosenov F, McCarthy V, Caruso C. Sleep apnea in endocrine diseases. J Sleep Res 1998; 7: 3–11
13. Lyle Olson J, Virend Somers K, Rochester MN. Modulation of Cardiovascular Risk Factors by Obstructive Sleep Apnea.
14. Meyer JS, Ishikawa Y, Hata T, Karacan I. Cerebral blood flow in normal and abnormal sleep and dreaming. Brain Cogn 1987; 6: 266–94.
15. ICSD-Internatinal Classification of Sleep Disorders: Diagnostic and Coding Manual. American Sleep Disorders Association Allen Press 1990.
16. Peppard Paul E, Young T, Palta М et al. Longitudinal study of moderate weight change and sleep disordered breathing JAMA 2000; 282: 3015–21.
17. Peppard Paul E, 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.
18. Ringler J, Basner RC, Shannon R et al. Hypoxemia alone does not explain blood pressure elevations after obstructive apneas. J Appl Physiol 1990; 69 (6): 2143–8.
19. Brooks D, Kozar L, Render-Telzelra C, Phillipson E. Obstructive sleep apnea as a cause of systemic hypertension. J Clin Invest 1997; 99 (1): 106–9.
20. Hla KM, Bidwell T, Palta M et al. Sleep apnea and hypertension: a population based study. Ann Intern Med 1994; 120: 382–8.
21. Hall MJ, Bradley TD. Cardiovascular disease and sleep apnea. Curr Opin Pulm Med 1995; 1 (6): 512–8.
22. Naughton M. Heart failure and obstructive apnea. Sleep Med Rev 1998; 2 (2): 93–103.
23. Schafer H et al. Sleep-related myocardial ischemia and sleep structure in patients with obstructive sleep apnea and coronary heart disease Chest 1997; 111 (2): 387.
24. Coccagna G, Mantovani M, Brignani E et al. Continuous recording of the pulmonary and systemic arterial pressure during sleep in syndromes of hypersomnia with periodic breathing. Bull Eur Physiopathol Respir 1972; 8: 1159–72.
25. Carlson J, Davies R, Ehlenz K et al. Obstructive sleep apnea and blood pressure elevation. What is the relationship? Blood Press 1993; 2: 166–82.
26. Nieto FG, Young T. Association of sleep disorders breathing, sleep apnea and hypertension in a large community-based study. JAMA 2000; 283 (14): 1829–36.
27. Brooks E. A clinical study of the effects of sleep and rest on blood pressure. Arch Intern Med 1912; 97–102.
28. O`Donnell CP, Schwartz AR, Smith PI et al. Reflex modulation of renal sympathetic nerve activity in response to apnea. Am J Respir Crit Care Med 1996; 153; 4: A 406.
29. Mayer J, Becker H, Brandenburg U et al. Blood pressure and sleep apnea: results of long-term nasal continuous positive airway pressure therapy Department of Medicine Philipps-Universitat, Marburg, FRG 1999.
30. Dhillon S, Chung S, Fargher T et al. Sleep Apnea, Hypertension, and the Effects of Continuous Positive Airway Pressure. Am J Hypertens 2005; 18 (5): 594–600.
31. Narkiewicz K, Somers VK. The sympathetic nervous system and obstructive sleep apnea: implications for hypertension. J Hypertens 1997; 15 (12 Pt. 2): 1613–9.
32. Silverberg DS, Oksenberg A. Essential hypertension and abnormal upper airway resistance during sleep. Sleep 1997; 20 (9): 794–806.
33. Narkiewicz K et al. Contribution of tonic chemoreflex activation to sympathetic activation and blood pressure in patients with obstructive sleep apnea. Circulation 1998; 97: 943–5.
34. Carlson JT, Rangemark C et al. Attenuated endothelium-dependent vascular relaxation in patients with sleep apnea. J Hypertens 1996; 14 (5): 577–84.
35. Hedner J. Vascular function in OSA. Sleep 1996; 19 (Suppl. 10): 213–7.
36. Saarelainen S, Seppala E et al. Circulating endothelin-1 in obstructive sleep apnea. Endothelium 1997; 5 (2): 115–8.
37. Remsburg S, Launois SH et al. Patients with obstructive sleep apnea have an abnormal peripheral vascular response to hypoxia. J Appl Physiol 1999; 87 (3): 1148.
38. Schnall RP, Shlitner A et al. Periodic, profound peripheral vasoconstriction – a new marker of obstructive sleep apnea. Sleep1999; 22 (7): 939–46.
39. Hawrylkiewicz I, Cieslicki J et al. Pulmonary circulation at rest and during exercise in patients with obstructive sleep apnea before and after one year of treatment with CPAP]. Pneumonol Alergol Pol 1996; 64 (9–10): 638–43.
40. Schafer H, Ehlenz K et al. Atrial natriuretic peptide levels and pulmonary artery pressure awake, at exercise and asleep in obstructive sleep apnea syndrome. J Sleep Res 1999; 8 (3): 205–10.
41. Levy PA, Guilleminault C et al. Changes in left ventricular ejection fraction during REM sleep and exercise in chronic obstructive pulmonary disease and sleep apnea syndrome. Eur Respir J 1991; 4 (3): 347–52.
42. Rangemark C, Hedner J A et al. Platelet function and fibrinolytic activity in hypertensive and normotensive sleep apnea patients. Sleep 1995; 18 (3): 188–94.
43. Bittencourt LR, Moura SM et al. Assessment of ventilatory neuromuscular drive in patients with obstructive sleep apnea. Braz J Med Biol Res 1998; 31(4) : 505–13.
44. Greenberg HE, Scharf SM. Depressed ventilatory load compensation in sleep apnea. Reversal by nasal CPAP. Am Rev Respir Dis 1993; 148 (6 Pt. 1): 1610–5.
45. Jr Shepard JW. Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea. Clin Chest Med 1992; 13 (3): 437–58.
46. Morgan BJ. Acute and chronic cardiovascular responses to sleep disordered breathing. Sleep 1996; 19 (Suppl. 10): 206–9.
47. Zwillich CW. Obstructive sleep apnea causes transient and sustained systemic hypertension. Int J Clin Pract 1999; 53 (4): 301–5.
48. Fletcher EC. Effect of episodic hypoxia on sympathetic activity and blood pressure. Respir Physiol 2000; 119 (2–3): 189–97.
49. Garcia-Rio F, Racionero MA et al. Sleep apnea and hypertension. Chest 2000; 117 (5): 1417–25.
50. Hedner J. Vascular function in OSA. Sleep 1996; 19 (Suppl. 10): 213–7.
51. Cooke JP. The endothelium: a new target for therapy. Vasc Med 2000; 5: 49–53.
52. Малая Л.Т. и др. Эндотелиальная дисфункция при патологии сердечно-сосудистой системы. Харьков: Торсинг, 2000.
53. Nieto FJ, Herrington DM, Redline S. Sleep Apnea and Markers of Vascular Endothelial Function in a Large Community Sample of Older Adults Am J Respir Crit Care Med 2004; 169: 354–60.
54. Imadojemu VA et al. Impaired Vasodilator Responses in Obstructive Sleep Apnea Are Improved with Continuous Positive Airway Pressure Therapy. Am J Respir Crit Care Med 2002; 165 (7): 950–3.
55. Daniel KNg, Kwok Ka-Li, Herrington D et al. Endothelial Dysfunction and Sleep Apnea Am J Respir Crit Care Med, Jul 15, 2004.
56. Schulz R, Schmidt D, Blum A et al. Decreased plasma levelsof nitric oxide derivatives in obstructive sleep apnoe a:response to CPAP therapy. Thorax 2000; 55: 1046–51.
57. Ip MS, Lam B, Chan LY et al. Circulating nitric oxide issup pressed in obstructive sleep apnea and is reversed bynasal continuous positive eairwaypressure. Am J Respir Crit Care Med 2000; 162: 2166–71.
58. Masahiko K, Roberts-Thomson P, Phillips BG et al. Impairment of Endothelium-Dependent Vasodilation of Resistance Vessels in Patients With Obstructive Sleep Apnea Circulation 2000; 102: 2607.
59. Phillips BG, Narkiewicz K, Pesek CA et al. Effects of obstructive sleep apnea on endothelin-1and blood pressure. J Hypertens1999; 17: 61–8.
60. Tamura DY, Moore EE, Partrick DA et al. Acute hypoxemia in humans enhances the neutrophil inflammatory response. Shock 2002; 17: 269–73.
61. Meier-Ewert HK, Ridker PM, Rifai N et al. Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol 2004; 43: 678–83.
62. Dyugovskaya L, Lavie P, Lavie L. Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am J Respir Crit Care Med 2002; 165: 934–9.
63. Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation 2003; 107: 363.
64. Wolk R, Abu S, Shamsuzzaman М, Virend Somers K. Obesity, Sleep Apnea and Hypertension Hypertension 2003; 42:1067–74.
65. Ip MS, Tse HF, Lam B et al. Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med 2004; 169 (3): 348–53.
2. Bray GA. Pathophysiology of obesity. Am J Clin Nutr 1992; 55: 488–94.
3. Young T, Palta M, Dempsey J et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230–5.
4. Young T. Menopause, hormone replacement therapy, and sleepdisordered breathing: are we ready for the heat. Am J Respir Crit Care Med 2001; 163: 597–8.
5. Stradling JR, Crosby JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax 1991; 46: 85–90.
6. Wetter DW, Young TB, Bidwell TR et al. Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med 1994; 154: 2219–24.
7. American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999; 22 (5): 667–89.
8. Palmer LJ, Buxbau SG, Larkin EK et al. A Whole Genome Scan for Obstructive Sleep Apnea and Obesity in African-American Families. Am J Respir Crit Care Med 2004; 169 (12): 1314–21.
9. Вейн А.М., Елигулашвили Т.С., Полуэктов М.Г. Синдром апноэ во сне. М.: Эйдос-Медиа, 2002.
10. Hart T, Radow S, Blackard W et al. Sleep apnea in active acromegaly. Arch Int Med 1985; 145: 865–6.
11. Kapur VK, Koepsell TD, deMaine J et al. Association of Hypothyroidism and Obstructive Sleep Apnea Am J Respir Crit Care Med 1998; 158 (5): 1379–83.
12. Rosenov F, McCarthy V, Caruso C. Sleep apnea in endocrine diseases. J Sleep Res 1998; 7: 3–11
13. Lyle Olson J, Virend Somers K, Rochester MN. Modulation of Cardiovascular Risk Factors by Obstructive Sleep Apnea.
14. Meyer JS, Ishikawa Y, Hata T, Karacan I. Cerebral blood flow in normal and abnormal sleep and dreaming. Brain Cogn 1987; 6: 266–94.
15. ICSD-Internatinal Classification of Sleep Disorders: Diagnostic and Coding Manual. American Sleep Disorders Association Allen Press 1990.
16. Peppard Paul E, Young T, Palta М et al. Longitudinal study of moderate weight change and sleep disordered breathing JAMA 2000; 282: 3015–21.
17. Peppard Paul E, 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.
18. Ringler J, Basner RC, Shannon R et al. Hypoxemia alone does not explain blood pressure elevations after obstructive apneas. J Appl Physiol 1990; 69 (6): 2143–8.
19. Brooks D, Kozar L, Render-Telzelra C, Phillipson E. Obstructive sleep apnea as a cause of systemic hypertension. J Clin Invest 1997; 99 (1): 106–9.
20. Hla KM, Bidwell T, Palta M et al. Sleep apnea and hypertension: a population based study. Ann Intern Med 1994; 120: 382–8.
21. Hall MJ, Bradley TD. Cardiovascular disease and sleep apnea. Curr Opin Pulm Med 1995; 1 (6): 512–8.
22. Naughton M. Heart failure and obstructive apnea. Sleep Med Rev 1998; 2 (2): 93–103.
23. Schafer H et al. Sleep-related myocardial ischemia and sleep structure in patients with obstructive sleep apnea and coronary heart disease Chest 1997; 111 (2): 387.
24. Coccagna G, Mantovani M, Brignani E et al. Continuous recording of the pulmonary and systemic arterial pressure during sleep in syndromes of hypersomnia with periodic breathing. Bull Eur Physiopathol Respir 1972; 8: 1159–72.
25. Carlson J, Davies R, Ehlenz K et al. Obstructive sleep apnea and blood pressure elevation. What is the relationship? Blood Press 1993; 2: 166–82.
26. Nieto FG, Young T. Association of sleep disorders breathing, sleep apnea and hypertension in a large community-based study. JAMA 2000; 283 (14): 1829–36.
27. Brooks E. A clinical study of the effects of sleep and rest on blood pressure. Arch Intern Med 1912; 97–102.
28. O`Donnell CP, Schwartz AR, Smith PI et al. Reflex modulation of renal sympathetic nerve activity in response to apnea. Am J Respir Crit Care Med 1996; 153; 4: A 406.
29. Mayer J, Becker H, Brandenburg U et al. Blood pressure and sleep apnea: results of long-term nasal continuous positive airway pressure therapy Department of Medicine Philipps-Universitat, Marburg, FRG 1999.
30. Dhillon S, Chung S, Fargher T et al. Sleep Apnea, Hypertension, and the Effects of Continuous Positive Airway Pressure. Am J Hypertens 2005; 18 (5): 594–600.
31. Narkiewicz K, Somers VK. The sympathetic nervous system and obstructive sleep apnea: implications for hypertension. J Hypertens 1997; 15 (12 Pt. 2): 1613–9.
32. Silverberg DS, Oksenberg A. Essential hypertension and abnormal upper airway resistance during sleep. Sleep 1997; 20 (9): 794–806.
33. Narkiewicz K et al. Contribution of tonic chemoreflex activation to sympathetic activation and blood pressure in patients with obstructive sleep apnea. Circulation 1998; 97: 943–5.
34. Carlson JT, Rangemark C et al. Attenuated endothelium-dependent vascular relaxation in patients with sleep apnea. J Hypertens 1996; 14 (5): 577–84.
35. Hedner J. Vascular function in OSA. Sleep 1996; 19 (Suppl. 10): 213–7.
36. Saarelainen S, Seppala E et al. Circulating endothelin-1 in obstructive sleep apnea. Endothelium 1997; 5 (2): 115–8.
37. Remsburg S, Launois SH et al. Patients with obstructive sleep apnea have an abnormal peripheral vascular response to hypoxia. J Appl Physiol 1999; 87 (3): 1148.
38. Schnall RP, Shlitner A et al. Periodic, profound peripheral vasoconstriction – a new marker of obstructive sleep apnea. Sleep1999; 22 (7): 939–46.
39. Hawrylkiewicz I, Cieslicki J et al. Pulmonary circulation at rest and during exercise in patients with obstructive sleep apnea before and after one year of treatment with CPAP]. Pneumonol Alergol Pol 1996; 64 (9–10): 638–43.
40. Schafer H, Ehlenz K et al. Atrial natriuretic peptide levels and pulmonary artery pressure awake, at exercise and asleep in obstructive sleep apnea syndrome. J Sleep Res 1999; 8 (3): 205–10.
41. Levy PA, Guilleminault C et al. Changes in left ventricular ejection fraction during REM sleep and exercise in chronic obstructive pulmonary disease and sleep apnea syndrome. Eur Respir J 1991; 4 (3): 347–52.
42. Rangemark C, Hedner J A et al. Platelet function and fibrinolytic activity in hypertensive and normotensive sleep apnea patients. Sleep 1995; 18 (3): 188–94.
43. Bittencourt LR, Moura SM et al. Assessment of ventilatory neuromuscular drive in patients with obstructive sleep apnea. Braz J Med Biol Res 1998; 31(4) : 505–13.
44. Greenberg HE, Scharf SM. Depressed ventilatory load compensation in sleep apnea. Reversal by nasal CPAP. Am Rev Respir Dis 1993; 148 (6 Pt. 1): 1610–5.
45. Jr Shepard JW. Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea. Clin Chest Med 1992; 13 (3): 437–58.
46. Morgan BJ. Acute and chronic cardiovascular responses to sleep disordered breathing. Sleep 1996; 19 (Suppl. 10): 206–9.
47. Zwillich CW. Obstructive sleep apnea causes transient and sustained systemic hypertension. Int J Clin Pract 1999; 53 (4): 301–5.
48. Fletcher EC. Effect of episodic hypoxia on sympathetic activity and blood pressure. Respir Physiol 2000; 119 (2–3): 189–97.
49. Garcia-Rio F, Racionero MA et al. Sleep apnea and hypertension. Chest 2000; 117 (5): 1417–25.
50. Hedner J. Vascular function in OSA. Sleep 1996; 19 (Suppl. 10): 213–7.
51. Cooke JP. The endothelium: a new target for therapy. Vasc Med 2000; 5: 49–53.
52. Малая Л.Т. и др. Эндотелиальная дисфункция при патологии сердечно-сосудистой системы. Харьков: Торсинг, 2000.
53. Nieto FJ, Herrington DM, Redline S. Sleep Apnea and Markers of Vascular Endothelial Function in a Large Community Sample of Older Adults Am J Respir Crit Care Med 2004; 169: 354–60.
54. Imadojemu VA et al. Impaired Vasodilator Responses in Obstructive Sleep Apnea Are Improved with Continuous Positive Airway Pressure Therapy. Am J Respir Crit Care Med 2002; 165 (7): 950–3.
55. Daniel KNg, Kwok Ka-Li, Herrington D et al. Endothelial Dysfunction and Sleep Apnea Am J Respir Crit Care Med, Jul 15, 2004.
56. Schulz R, Schmidt D, Blum A et al. Decreased plasma levelsof nitric oxide derivatives in obstructive sleep apnoe a:response to CPAP therapy. Thorax 2000; 55: 1046–51.
57. Ip MS, Lam B, Chan LY et al. Circulating nitric oxide issup pressed in obstructive sleep apnea and is reversed bynasal continuous positive eairwaypressure. Am J Respir Crit Care Med 2000; 162: 2166–71.
58. Masahiko K, Roberts-Thomson P, Phillips BG et al. Impairment of Endothelium-Dependent Vasodilation of Resistance Vessels in Patients With Obstructive Sleep Apnea Circulation 2000; 102: 2607.
59. Phillips BG, Narkiewicz K, Pesek CA et al. Effects of obstructive sleep apnea on endothelin-1and blood pressure. J Hypertens1999; 17: 61–8.
60. Tamura DY, Moore EE, Partrick DA et al. Acute hypoxemia in humans enhances the neutrophil inflammatory response. Shock 2002; 17: 269–73.
61. Meier-Ewert HK, Ridker PM, Rifai N et al. Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol 2004; 43: 678–83.
62. Dyugovskaya L, Lavie P, Lavie L. Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am J Respir Crit Care Med 2002; 165: 934–9.
63. Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation 2003; 107: 363.
64. Wolk R, Abu S, Shamsuzzaman М, Virend Somers K. Obesity, Sleep Apnea and Hypertension Hypertension 2003; 42:1067–74.
65. Ip MS, Tse HF, Lam B et al. Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med 2004; 169 (3): 348–53.
Авторы
П.В.Галицин*, А.В.Аксенова, Е.М.Елфимова, Г.Р.Ишанходжаева, Т.В.Балахонова, А.Ю.Литвин, И.Е.Чазова
Институт клинической кардиологии им. А.Л.Мясникова ФГБУ РКНПК Минздрава России, Москва
*pgalicin@yandex.ru
*pgalicin@yandex.ru
Институт клинической кардиологии им. А.Л.Мясникова ФГБУ РКНПК Минздрава России, Москва
*pgalicin@yandex.ru
________________________________________________
*pgalicin@yandex.ru
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